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

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

Hello, and thank you for your question regarding a reaction to Silvadene (SSD) and whether Silvadene is a second-line therapy for dehiscence wounds above the gluteal cleft (butt crack) after a lower body lift. Thank you for your history and your pictures. I'm sorry to hear about your poor wound healing. SSD is an excellent topical antibiotic. In some situations, SSD may be a first-line treatment for certain wounds. SSD has positive wound healing effects. Most plastic surgeons have used SSD as a great topical antibiotic for many years. Most plastic surgeons continue to continue to use SSD on surgical wounds. Most plastic surgeons do not believe SSD delays wound healing. SSD is good. You may also want to consider hyperbaric oxygen. Hyperbaric oxygen therapy can aid in healing wounds like this. However, please stick with your plastic surgeon. Go with their advice. They are your treating physician. Do not value Internet opinions over your plastic surgeon's advice on a wound like this. I hope this helps, too. Clarify your fear regarding using SSDs. I don't think the Wound expansion is due to the SSD cream but rather tension in the wound. Good luck. I hope this helps answer your question regarding a reaction to Silverdene. Sincerely, Dr. Katzen (Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

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.