Managing Poor Wound Healing After Clavicle Fracture Surgery

Poor wound healing after clavicle fracture surgery?

Hello Doctor: I have fractured my left clavicle twice due to car accidents.
The first fracture was at the distal end (November 3, 2014), for which I underwent surgery that involved self-paying for internal fixation with a steel pin and artificial ligament; the steel pin does not need to be removed.
The second fracture was a mid-shaft fracture (March 17, 2015), and the surgery involved fixation with a plate and screws.
However, three months post-surgery, the plate and screws penetrated the skin, necessitating a debridement surgery on July 13, 2015 (bacterial cultures were taken, and no infection was found).
Two months later, the screws again penetrated the skin, so the plate and screws were removed early on August 31, 2015, after five months of fixation.
Currently, X-rays show that the clavicle has healed, and I do not experience pain in the clavicle.
However, during my follow-up on October 6, 2015, the doctor assessed that I could start rehabilitation on my own, so I am unsure if I will feel any pain after rehabilitation.
I have a relatively small body frame, so my clavicle is more prominent.
Since the surgery on August 31, the wound healing has not been ideal; the skin around the mid-clavicle area is purplish and fragile, and it has not healed.
It seems that the artificial ligament from the first distal clavicle fracture fixation surgery is also protruding about one centimeter from that area.
The exposed artificial ligament appears slightly raised.
Since the suture removal on September 22, I have been using artificial skin to see if it can heal on its own, but the exposed area has not yet healed (the surrounding purplish fragile skin looks somewhat better than after the suture removal, but the exposed white artificial ligament is still uncovered).
I would like to ask if continuing to apply artificial skin can help the wound heal in this situation, and approximately how long that might take.
The attending physician mentioned that surgery could be considered to trim the artificial ligament and suture the wound, but they advised me to first apply artificial skin to see if the wound can heal on its own.
I wonder if the doctor is concerned that the wound may not hold together if sutured, which is why they want me to let it heal on its own first.
Additionally, I am worried that if the wound heals this way, the protruding clavicle will not look good.
If surgery is necessary, should I wait until the surrounding fragile skin heals and is no longer purplish before proceeding with the suturing? I would like to ask for your opinion on what approach might be best.
Can you provide me with some advice? Are there any other treatment options? I feel really frustrated with the clavicle fracture; now that the plate has been removed, the wound is still not healing, and I feel quite lost.
I hope you can give me some valuable advice.
Thank you for your patient response.

tiā, 20~29 year old female. Ask Date: 2015/10/07

Dr. Hong Ximing reply Orthopedics

Multiple fractures of the clavicle have resulted in poor skin healing after surgery.
The subcutaneous tissue in that area is relatively thin, but circulation is good.
However, due to the inability to assess the actual condition of the wound, a definitive judgment cannot be made.
It is recommended to consult with the surgical physician or directly seek advice from a plastic surgeon.
Wishing you a speedy recovery.

Reply Date: 2015/10/07

More Info

Managing poor wound healing after clavicle fracture surgery can be a challenging process, especially when complications arise from previous injuries and surgeries. Your situation, involving multiple fractures and surgeries, highlights the complexities of bone healing and skin recovery.
Firstly, it is essential to understand that the healing process for both bone and soft tissue can vary significantly among individuals. Factors such as age, overall health, nutritional status, and the presence of underlying conditions (like diabetes) can all influence healing. In your case, the fact that you have had two surgeries on the same area and are experiencing issues with skin healing is not uncommon.

The use of artificial skin (or dermal substitutes) is a common practice in managing wounds that are slow to heal. Artificial skin can provide a protective barrier, promote moisture retention, and facilitate the healing process. However, it is crucial to monitor the wound closely. If the area around the artificial skin appears to be improving, that is a positive sign. The fact that the surrounding skin has shown some improvement indicates that the healing process may be underway, albeit slowly.

Regarding your concerns about the exposed artificial ligament and the potential for it to remain visible or "bump out," this is a valid concern. If the skin does not heal adequately over the artificial ligament, it may lead to cosmetic issues or discomfort. Your surgeon's recommendation to continue using artificial skin for a while longer before considering further surgical intervention is likely a cautious approach. They may want to see if the wound can heal on its own without additional surgical trauma, which could further complicate the healing process.

If you are considering surgical options, it is generally advisable to wait until the surrounding skin has healed sufficiently and is no longer discolored or fragile. This is because performing surgery on compromised skin can lead to poor outcomes, including infection or further skin breakdown.
In terms of additional treatments, here are some suggestions that may help facilitate healing:
1. Nutrition: Ensure you are consuming a balanced diet rich in vitamins and minerals, particularly protein, vitamin C, and zinc, which are essential for wound healing.

2. Moisture Management: Keeping the wound moist (but not overly wet) can promote healing. Continue using artificial skin as directed by your physician, and ensure it is changed regularly to prevent infection.

3. Avoiding Stress on the Wound: Minimize movement or pressure on the area to allow the skin to heal without additional strain.

4. Follow-Up Care: Regular follow-ups with your healthcare provider are crucial. They can assess the healing process and determine if and when surgical intervention is necessary.

5. Physical Therapy: Once your doctor clears you for rehabilitation, engaging in physical therapy can help restore function and strength to the shoulder area, which may also aid in overall recovery.

6. Pain Management: If you experience discomfort, discuss pain management options with your physician. Managing pain effectively can improve your ability to engage in rehabilitation exercises.

In conclusion, while it can be frustrating to deal with slow healing after surgery, it is essential to remain patient and follow your healthcare provider's recommendations. If you have concerns about the healing process or the appearance of the wound, do not hesitate to communicate these with your surgeon. They can provide tailored advice and determine the best course of action based on your specific situation. Remember, healing takes time, and with the right care, you can achieve a positive outcome.

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