Does This Gaping Hole Need Stitches? (photo)

Question

I had an arm lift with a three way stitch, and it opened under my arm pit. I've seen my doctor twice, this hole has been open for well over 2 weeks and is draining a green liquid with a slight bad odor. He says let it heal on its own; want to get your thoughts and see if you would choose to restitch.

Richard J. Bruneteau, MD · Answer

It's not unusual for patients to have wound healing problems following arm lift surgery. The problem typically occurs where the vertical incision meets the transverse incision. This location is at risk for wound separation for a variety of reasons. These include poor blood supply to the skin flaps and high levels of bacteria that occur in the axilla. Both of these factors can contribute significantly to wound breakdown in this area.Once breakdown has occurred, wounds tend to heal by secondary intention. Tissue tends to form a layer of granulation and wounds contract. The skin grows over the top of the granulation tissue. In the initial phases of healing, there may be an intense inflammatory response that can make the wound look red and angry. Depending upon the size of the wound, this process may take 4 to 6 weeks to reach completion.For these reasons, these wounds should be monitored closely. If infection appears, antibiotics should be started immediately. In the interim, local wound care should be continued with dressing changes. When this approach is taken, wounds tend to heal nicely. Rarely, scar revision may be necessary as a secondary procedure. If you have questions or concerns about how your wound is healing, it's important that you discuss them with your plastic surgeon. Your surgeon should be able to address your concerns and alleviate your anxiety.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether this gaping hole needs stitches. You have undergone an arm lift/reduction or brachioplasty. Wound openings are probably the most common complication after an arm lift/brachioplasty. Suppose wound openings are going to occur during a brachioplasty or arm lift. They typically occur in the armpits. Wounds like this occur in the armpit because of the presence of sweat glands, hair follicles, and lymphatic vessels and the fact that there is an area of high mobility. All these factors contribute to wound breakdown. Your plastic surgeon is quite right that you should leave the wound open. The wound needs to heal from the inside out. If one were to close this with sutures, the wound would inevitably open again, perhaps even more significantly. The reason for this is that the wound is covered with bacteria. If the bacteria are trapped in the wound closed with stitches, the infection would become more extensive, and you could become very sick. Therefore, conservative treatment is the best. I suggest you apply bacitracin, mupirocin, or silver sulfadiazine to the incision. These are topical antibiotics that can accelerate healing. Another topical cream that can help accelerate closure is a product called Venelex. These all help wounds to heal. Fortunately, these wounds can get wet in the shower, and I would encourage these areas to mechanically debris wounds such as these. Thank you for your excellent question.

Kenneth Hughes, MD · Answer

This area does open in arm lifts on a somewhat routine basis. This is usually a small area when it does occur. At any rate, suturing this area together is not advised. Local wound care is best. If there are signs of infection, which will be determined by your surgeon, more intervention may be necessary. Kenneth Hughes, MD Los Angeles, CA

Tom J. Pousti, MD · Answer

Congratulations on having undergone the arm lifting procedure. I think that your plastic surgeon has given you good advice;  generally speaking local wound care will work better in your situation than attempts at wound closure.

	 Continue to exercise patience and continue to follow-up with your plastic surgeon.

	Best wishes.

Darryl J. Blinski, MD · Answer

I agree with the plan your chosen surgeon has taken. Allow secondary closure by wound contraction and re-epithialization.

Jourdan Gottlieb, MD · Answer

As a general rule it is better to let an area like this heal on its own without resuturing. Closing the wound at this stage has a high chance of failure, and will just set you back a couple of weeks. This is not uncommon occurrence after arm lifting. Although the adjacent skin edges look not to be inflamed, you might check with your surgeon about getting a culture and using antibiotics. 

	All the best.

Does This Gaping Hole Need Stitches? (photo)

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