Inflammation (confirmed that there is no infection) 7 months after surgery

Question

I recently (around 7 months ago) had surgery to remove excess skin from one of my arms. The incision was stitched with a layer of internal stitches (I was told there were complications meaning internal stitches had to be used as well as external ones.) The incision healed over with scar tissue, as expected, but has now started to repeatedly blister, and when the blister bursts it results in a crater-like appearance with a lot of thick discharge. My local doctors are puzzled about what’s wrong.

J. Timothy Katzen, MD, FACS · Answer

Hello LunaJasreg, thank you for your question regarding inflammation after surgery.

Based on the information you provided, it is impossible to tell exactly what is happening without a physical examination and pictures. Since there is no infection, the most likely source of your blisters and thick discharge would be rejection of remaining internal sutures. Many sutures can still remain seven months after an arm lift.

In terms of treatment, I would suggest hyperbaric treatment on a daily basis for 10 days. For wound care, I would recommend the application of normal saline wet-to-dry dressings twice a day. This will help to clean the wounds and promote healing.

Good luck. I hope this helps to answer your question regarding inflammation after your surgery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Camille Cash, MD · Answer

It's best to return to your surgeon for an evaluation as she/he is most familiar with the details of your surgery and how you've been progressing through recovery.  It may be suture abscesses which your surgeon can address.

James Knoetgen, III, MD · Answer

Your symptoms suggest that the surgical site may not be healing properly due to underlying issues like unresolved inflammation, foreign body reaction, or improper absorption of the internal sutures. Here's a breakdown of possible causes and steps to consider:
Possible Causes
1.	Suture Granuloma or Foreign Body Reaction:
o	Internal sutures that have not dissolved properly (or are being rejected) can cause inflammation, blistering, and discharge.
o	The body may form a granuloma around the suture material, leading to repeated irritation and drainage.
2.	Seroma or Fluid Collection:
o	A pocket of fluid may have formed under the scar, leading to pressure and blister formation.
3.	Wound Dehiscence:
o	Partial reopening of the internal layers of the incision might cause chronic irritation and discharge.
4.	Chronic Inflammation:
o	Even without infection, prolonged inflammation can cause delayed healing and skin breakdown.
5.	Underlying Scar Complications:
o	Hypertrophic or keloid scarring, or scar instability, could cause blistering and poor skin integrity.
Next Steps
1.	Seek Specialist Evaluation:
o	Visit a wound care specialist, plastic surgeon, or dermatologist. They may have more experience with complications like yours.
2.	Diagnostic Imaging:
o	An ultrasound or MRI of the area can help identify any retained sutures, fluid collections, or underlying tissue abnormalities.
3.	Biopsy:
o	A small sample of the affected tissue may be taken to rule out granulomas, unusual scarring, or rare conditions like pyoderma gangrenosum.
4.	Blood Tests:
o	Testing for systemic inflammation markers might help identify if the body is reacting to foreign material or other triggers.
5.	Management Options:
o	Removal of Sutures: If the internal stitches are causing the issue, they may need to be removed surgically.
o	Topical or Systemic Medications: Anti-inflammatory creams or oral medications may be prescribed to reduce irritation.
o	Wound Care: A wound care plan, including dressings to manage blistering and discharge, may prevent further breakdown.
o	Steroid Injections: These may help control inflammation or scarring in specific cases.
Your persistence in seeking answers is important. Make sure to track any changes, such as increased redness, worsening discharge, or systemic symptoms (e.g., fever), and report them immediately to your healthcare provider.

Connie Hiers, MD, FACS · Answer

You did not post photos, so I cannot be specific. However, I would suggest having the opened areas cultured to see what kind of bacteria is present. Also, hyperbaric oxygen treatments could be very helpful to minimize infection and inflammation. You may need to be referred to a wound care specialist.

Inflammation (confirmed that there is no infection) 7 months after surgery

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Inflammation (confirmed that there is no infection) 7 months after surgery

Answers (4)

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