Reaction to silvadene? Second-line therapy for wound dehiscence above gluteal cleft (butt crack) after lower body lift? (Photo)

Question

5 weeks post-op. Week 2, small opening above gluteal cleft ~1/4". Day 20, PS started daily silvadene cream, but due to exudate I have to change dressing BID. Wound has expanded a lot since I began the SSD. Many papers question using SSD on wounds (may delay healing), and I know they are controversial, but still... Will see PS again tomorrow and ask about debridement and other options, but am seeking internet opinions as well. It's not an ideal forum, I know, but any help is appreciated.

Richard H. Tholen, MD, FACS · Answer

Thanks for your question and photographs. The gluteal cleft is a common area for wound difficulties, and potential bacterial contamination, as well as persistent underlying seroma (common at two weeks post-op) can make this more than a superficial wound healing concern.I mention this as something to consider because you are having to change dressings twice a day due to "exudate." This is either a contaminated wound (exudate = pus) or one that has a minute communication with an underlying seroma cavity (exudate = seroma). Your photos show some redness but this does not seem to be a grossly infected wound, so I am surmising this might be deeper drainage coming to the surface and preventing wound edge healing,Why this is important is because Silvadene will do nothing to close a seroma cavity. That takes a drain remaining in place (if you still have one or two draining the posterior wound depths), aspiration one or more times, or reinsertion of a drain. This will stop drainage via your incision, and a clean (non-draining) wound will go on to heal, Silvadene or not.As long as the wound edges are still in at least rough approximation and are not infected, debridement is neither necessary nor advisable--debridement is for dead tissue and fibrin debris, not healthy tissue that is incompletely healed.Silvadene is not causing your wound to expand but an undrained seroma trying to escape can do this. Your surgeon will know how to best handle this, so don't second-guess with too much online information that is based on photos and speculation, however well-intentioned, including my own thoughts. They are based, however, on over 27 years of experience and several hundred lower body lifts over the past 18 years. I hope this is of help. Best wishes! Dr. Tholen

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. I'm  sorry about your problem which unfortunately is Farley common following a lower body lift. Since 80% of my practice is devoted to post massive weight loss body contouring I am unfortunately all too familiar with your complication. Silvadene is absolutely appropriate for your wound. However you can go to either regular antibiotic ointment or a saline wet to dry dressing. I prefer the latter. In your case the wound is clean and granulation very nicely and will heal no matter what you do. Even dry gauze at this stage would work.I do however  see a potential problem with the incision adjacent to the midline which appears to be just about to open itself in a few different areas. Keep some antibiotic ointment on these areas and hopefully they will stay closed.Peter Fisher M.D.

Reaction to silvadene? Second-line therapy for wound dehiscence above gluteal cleft (butt crack) after lower body lift? (Photo)

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Reaction to silvadene? Second-line therapy for wound dehiscence above gluteal cleft (butt crack) after lower body lift? (Photo)

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