My wounds has gotten bigger & not healing. Is there any reason not to have the wounds cleaned up & re-sutured?(photo)

Question

My reduction was 5-8-14. Healed rapidly except for the top of a suture line. I'm on Actemra for RA & am concerned that my infusion will have to be held if I have an open wound. This opened on 6-1-14 & has gotten bigger & shown no sign of healing. I see my surgeon in two days. Is there any reason NOT to have this cleaned up & re-sutured? It would certainly be my preference to have it done. I've had the same issue post biopsy & after weeks of an open wound it was repaired and healed in days. Wound dehiscence in immune compromised patient

Steven Svehlak, MD · Answer

The medication you are taking for RA does weaken your immune system and decreases inflammation.  This will increase your risk of infection and slow the healing process.  Occasionally, an open wound may develop at the sutured incision lines after a surgery from either a spitting suture or even a small stitch infection.  In all cases, and especially in yours (because of your weakened immune system), it is important that the infection is drained.  This is by far the best treatment.  Your infection has and is draining.  The most important thing for you to do is to keep the wound area clean.  Even though the wound appears clean, it still has bacteria in it.  Closing the edges with sutures can trap the bacteria within the tissue.  This will cause another infection.  It is usually best to allow these to slowly heal from the inside out over time.  This can take several weeks to a few months.  In your case, your healing will be slower.  Be patient with the process.   In some instances, it can be cleaned and resutured.  But your risk of reinfection is much higher.  Please discuss your concerns with your surgeon.  Thanks for the questin.

Curtis Wong, MD · Answer

If you cannot get your infusion with an open wound, then consideration has to be given to secondary closure.  This requires the entire wound to be resected to create fresh edges and then closure can be done.  Simply re-suturing the wound will fail as it is loaded with bacteria.  If your infusion can wait, consider secondary healing of your wound which is what you are currently doing.  All of the debris must be gone before it will start closing so a debridement could be beneficial if you choose to watch it.

Alan M. Engler, MD, FACS (retired) · Answer

Although resuturing the wounds may sound like a good idea, in a situation like this is isn't  You have an open draining wound and simply reinserting sutures will actually trap inside things that need to come out - like blood, serum, exudate and other fluids.  It is better to let the inflammatory process settle down on its own, after which the wound should close up on its own with appropriate local wound care.Your situation is different because of the RA and your meds.  You need, therefore, to coordinate your care with your PS and your internist.  You may, in fact, need to taper your meds until the wounds have healed but that decision needs to be made by all three of you together.I hope that this helps and good luck,Dr. Alan EnglerMember of RealSelf100

My wounds has gotten bigger & not healing. Is there any reason not to have the wounds cleaned up & re-sutured?(photo)

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My wounds has gotten bigger & not healing. Is there any reason not to have the wounds cleaned up & re-sutured?(photo)

Answers (3)

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