Why won't my leg heal? Pending 2nd revision leg due to seroma, excessive swelling, leg leaking, & infections. Any ideas? (Photo)

Female, age 52, 200 lb w/l, great health, non-smoker. Hernia repair w/TT, leg & arm lift. Compression worn knees to elbows 24/7 for 8 wks. 3-4 wks postop formed seroma. 5th wk fluid constantly leaking from incision. Wk 10 bad infection. Revision week 11. Wound capsulated. Repaired/closed w/drain. Next 3 wks drained avg 115-140cc's day. Now, wk 4,infected, constant leaking @ 3 holes that opened in incision & port entry. Swelling, seroma, pain, infected & on meds. Surgery pending. Any ideas on why?

Doctor Answers 3

Great health?

I disagree, being 200 lb means you are not a healthy patient and therefore not a good candidate of such risky, combined, time comsuming and prone to tromboembolism surgery.

With that said, that wound need URGENT surgery and treatment. The wound must be opened and LEFT open, to allow sound management with local antibiotics and antiseptics in order to eradicate the infection and take cultures to adjust the antibiotics adminitrated, endovenously and during many days. You run a risk of necrotizing fascitis development.

Spain Plastic Surgeon
4.9 out of 5 stars 44 reviews

Complications Following Thigh Lift Surgery

Your history and pictures suggest an extremely complicated post-operative course following medial thigh lift surgery. During this time, you've developed a chronic seroma complicated by wound breakdown, drainage and infection. This has been treated with multiple surgical procedures and systemic antibiotics. Unfortunately, your wound has progressed to the point that it now represents a serious and potentially life threatening condition that requires aggressive treatment.

Although it's hard to make a specific recommendation without a physical examination, your history and pictures suggest several areas of concern. These include chronic persistent infection, significant serous wound drainage, chronic seroma cavity encapsulation and the possible presence of necrotic tissue. In addition, your pictures suggest an undrained fluid collection. This could represent recurrent seroma, hematoma or possibly an abscess.

At this time, wound exploration is warranted with aggressive debridement to remove any necrotic or encapsulated tissue. Since chronic drainage and infection are significant components of this wound healing problem, it's not appropriate to close this wound. Under these circumstances, the wound should be allowed to heal by secondary intention. This can be facilitated by a VAC suction device which, hopefully, addresses your serous drainage.

Although a multitude of treatment options are available to treat this type of problem, I believe that this approach is the safest and will ultimately give the best result. In some cases, a secondary scar revision may be necessary once the wound is completely healed. This should be a relatively minor procedure that can be performed when your current problems have resolved.

It's important to thoroughly discuss your options with your current surgeon before proceeding with surgery. If you're not satisfied with his response, it's appropriate to obtain a second opinion.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Leg infection post op #woundhealing #hyperbaricoxygentherapy

Dear KathySha

Thank you for your questions and photos!  I am sorry that you are having difficulty.  There are several factors that can lead to wound healing and infection issues.  1) antibiotic 2) collection of fluid or dead tissue 3) nutrition 4) decreased circulation to the tissues

A radiologic examination to define the area, a check on the cultures to make sure the antibiotic is correct, addition of hyperbaric oxygen therapy to the post op care, keeping your leg elevated, checking your blood sugars and nutrition.

 With Warm Regards
Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 115 reviews

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.