Will separated wound edges heal together? Add more suture? (photos)

I am a health care provider who had wedge labiaplasty 1week ago. The surgeon used a 3 layer closure with 4-0 vicryl. I waited to shower 2 days. I have been restricted to mainly laying flat for 1 week. Today it appears that there is some separation of the distal wound edges as the suture absorbs. Is this normal and will it heal in? Is there any value in adding more suture?

Doctor Answers 10

Separated wound edges

Separation can occur following a labia plasty. If there is some swelling, this can force open the sutures despite a three layer closure that you mentioned. Although sometimes sutures can be placed following a separation, after several days this is much more difficult and the best treatment is to allow it to heal. It may heal much better than you expect. Usually a revision, if necessary, is a small relatively easy process although your surgeon may wish to wait six months or greater to perform.

Wedge labiaplasty came apart

As the inventor and innovator of the wedge technique in 1994, I reconstruct many women who have had labia reductions by other surgeons, both wedge and trimming techniques. Your wound will heal but you will probably need a revision. The reconstruction technique depends on the deformity. However, no attempt to revise your labia should be done until you are at least five months after your past procedure as your appearance will improve, and the swelling will be less. You need to control your anxiety and wait. The reconstruction is more difficult than a primary labiaplasty and should be done by a plastic surgeon with extensive experience in labia reconstruction. Hopefully, you only need a re-do of your wedge labiaplasty.  I published the first and most extensive paper on labia reconstruction in the prestigious journal "Plastic and Reconstructive Surgery" about two years ago. You may need various reconstructive techniques to give you a good appearance, but this won't be known until all the swelling is gone. You only get one good chance to reconstruct you, so be patient and ask a lot of questions.

Gary J. Alter, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 20 reviews

Separation of the incision line after labiaplasty

There are many options including suture revision to help cinch-in the incision line. There is a risk of further dehiscence if the incision is not secured. 

Best, 
Dr. Karamanoukian
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

When edges separate

there isn't much to do at this point except to allow it to heal.  Its similar to an ear lobe getting torn and healing will occur and if you have a split labia because of this, an office revision should lead to its resolution.  Know what your surgeon's revision policy is as you will need it down the road.  Additional sutures at this point are doomed to failure so don't waste any time and discomfort with placing any.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

V-Wedge labiaplasty wound separation

Wound separations may be re-approximated only in the first 36-48 hours after initial procedure with any hope of success. After this time the incision will not heal; the edges already have been superficially epithelialized and frequently superficially infected.

I've never tried Dr. Pelosi's innovative suggestion re: dermabond, but don't hold much hope as dermabond doesn't do well in moist, mucosal areas; I'd also be concerned re: infection.

Periodically, even well-done, well-cared for V-wedges separate, usually superficially, sometimes through & through.  All to do now is treat the aresa gingerly for the next week & hope for the best.  You will know the results by 4-6 weeks post-op.  If there is a significant separation, you will need to wait until a minimum of 2-3 months post-op to have edges cosmeticallly shaved, or a minimum of 4-6 months for a re-wedge.  Of course, consult with your surgeon.

Best wishes!

Michael P Goodman MD

Labiaplasty

Thank you for your question. Your photo does show some wound separation. You should contact your surgeon and they may add additional sutures. If they don't add sutures because they are concerned about infection, the incision will usually heal in 1 to 2 weeks.

Dermabond is better

Two edges of granulating tissue are unlikely to stick together without debridement, but debridement would do more harm than good and disrupt the entire suture line at this point in the healing process. A small amount of dermabond applied while bringing the edges together with tissue forceps would provide structural support to prevent further gaping better than suturing without debridement.

Normal post labiaplasty

Thank you fro sharing your concerns.   the depth of the separation is the most important aspect of the answer to your question.  It is difficult too determine based on the pics you have shown us.  However, I would encourage to see your surgeon sooner then later and determine the next best course of action. 
Best of luck to you:)

Do nothing, for now.

Thanks for the photo and question. I'm sorry that this has happened.

This isn't uncommon with a wedge resection labiaplasty.  It is one of the reasons why I do not perform this procedure. Unfortunately, I see this complication quite frequently and thus Revision Labiaplasty is a big portion of my practice.  There isn't anything you can do at the moment.  I would discourage you from having anything performed at this time, since you are still healing and it may end up healing "ok".  

Sounds like you've followed up with your surgeon whose giving you appropriate restrictions.  Adding a suture or revising at this time won't help.  Once you're at about 6 weeks postop you'll have a good idea as to what the end result will be.  At that time, ask your surgeon if he/she is comfortable correcting it. If not, I'd be happy to see you. You should wait till you are 3 months postop to achieve optimal results. Iowa is a 2 hour flight to Denver. This can be repaired as an in-office procedure.

Good luck.

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 23 reviews

Probable dehiscence

From the photos it appears that you should definitely see your surgeon sooner than later, and that you have a superficial (and possibly full-thickness) suture-line dehiscence that would probably benefit from additional suture placement under local anesthesia (before an infection, and/or full-thickness reepithelialization and notching develops, which I would expect if not addressed . . . )

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.