Incision holes, infections or necrosis

Question

I see patients who have developed holes in the incisions, infections or necrosis and wonder why these cant be cleaned and closed rather than left gaping like I often see? Also I see a lot of issues at the T of the incision on breast lifts due to the intersection, can't extra stitching or some type of proactive prevention be used?

Andres Taleisnik, MD · Answer

This is an excellent question, and one that I discuss often with my own patients when they develop an opening in part of the wound after surgery. Once a wound has opened, the bacteria counts increase in that wound. Attempting to close it can trap bacteria inside, raising infection risk. The body actually does an amazing job of closing and healing even LARGE wounds, so patience is almost always the best course. This may be inconvenient or somewhat uncomfortable for the patient, but is usually for the best. The resultant scars can be quite excellent, but they can also be revised once healing has occurred if needed. This type of problem can occur more frequently at the T of a breast lift or reduction for a few reasons. First, the surgery itself divides much of the normal blood flow to skin and other tissues. The corners of skin at the T are farthest from the blood supply, so they may not receive enough blood flow for optimal healing. Second, there can be tension at the T, contributing to some breakdown of the wound. With time, these wounds pull themselves together, as I discussed above.

Steven Wallach, MD · Answer

If a wound breaks down, there can be many reasons why it did so.  But once it does, it is often safest to allow it to heal secondarily and revise the scar in the future if necessary. Attempting to close some of these may lead to more problems.

Kenty Sian, MD · Answer

If there is separation of the incision due to an infection, we generally leave these open since these are considered to be dirty wounds. The patient needs to be started on antibiotics ASAP to treat the infection. As the infection subsides, the open wound should gradually heal and close. One way of minimizing healing problems with the inverted T junction in breast lift or breast reduction surgery is to avoid it altogether by using the vertical mammoplasty technique. With the vertical mammoplasty, you will end up with a lollipop shaped scar instead on an anchor shaped scar, thus, avoiding the inverted T junction which is prone to wound healing problems.

Peter A. Lennox, MD · Answer

Thank you for an excellent question.  With large incisions (body contouring, breast reduction etc.) you can have areas of wound breakdown.  The T junction you describe is one area.  In general, if a wound breaks down, it is safer to let this area heal on its own ( called secondary healing) and then revise the scar later.  If you simply re suture it there is a higher rate of infection and repeat breakdown.Wound healing complications are not very common, and are usually easily handled with appropriate wound care and then scar revision if necessary.

Paul H. Rhee, MD, FACS - Account Suspended · Answer

Your question relates to wound closure techniques.  Generally, the type of wound closure selected is based upon the clinical scenario.The main types of closure are:1.  Surgical closure (best for clean, fresh wounds)2.  Secondary healing (usually for contaminated/infected wounds)3.  Closure after a period of time secondary healing (used for wounds that were initially contaminated but are cleaner after a period of wound care)How a wound is managed varies from surgeon to surgeon, but there are common principles that are used and the treatment method is usually based on years of experience in terms of what works and what is safe.  Knowledge of wound healing is a vital part of every surgeon's data base, as it not only helps in the treatment of problems, but helps one avoid issues in the first place.

Ronald V. DeMars, MD (Retired) · Answer

That's a good question. When you close a skin opening that has been present for several hours or happens as a result of minor skin cell death, it will usually get infected so we get better and safer results by allowing what we call closure by secondary intent, or delayed healing.

Incision holes, infections or necrosis

Answers (6)

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