Wound healing problem. Do these openings need to be stitched back together? (Photo)

Question

My armpit incision looks like this. My surgeon is abroad, and returning to him is not an option. Do these openings need to be stitched back together? Or should I let them heal as they are? I would like scarring to be as minimal as possible. Thanks!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your request regarding wound healing problems.  Do your wound openings need to be stitched back together?  Thank you for sharing your history and pictures of your brachioplasty, arm lift, or arm reduction.  You must follow up with your plastic surgeon for your arm lift.  Even international plastic surgeons are accessible via landline, phone, cell phone, Zoom, FaceTime, or WhatsApp.  Regarding your arm wounds, every plastic surgeon has their own form of wound care treatment.  Most plastic surgeons would not suture these arm lift wounds closed.  Suturing these brachioplasty wounds can prevent closure by trapping bacteria, which could lead to a worse infection.  If you look closely at the pictures, there are retained sutures in each wound.  These are exposed sutures that should be removed.  However, check with your plastic surgeon.  After the sutures have been removed, creams such as bacitracin, mupirocin, and Venelex can be applied to promote rapid healing.  Fortunately, most plastic surgeons agree that there are no signs of infection in these wounds.  However, prophylactic antibiotics would be a wise idea.  I hope that I’ve answered your question regarding wound healing problems after a brachioplasty (arm lift), what to do about your arm lift openings, and specifically, if these wounds need to be stitched back together.  I hope that I have answered your questions regarding the arm reduction.  If you have any more questions regarding the arm lift, arm reduction, brachioplasty, or arm crease fat grafting, please get in touch with an arm lift expert.  Since a brachioplasty or arm lift surgery is a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts.  Do your research.  Make sure your chosen plastic surgeon has performed at least 100 arm lifts.  Ensure they have the before-and-after pictures to prove it.  Carefully examine their before-and-after pictures and check their reviews on RealSelf.   Sincerely, Dr.  Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive 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, 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.)

Arif Eroglu, MD · Answer

Hello
Arm lift surgeries are among the procedures where suture separation is more commonly observed. Suture separations can occur due to infection, suture reactions, or hygiene issues. In your case, there is a suture separation problem, but there does not appear to be an infection.
For now, the most appropriate treatment is cleaning the area with Betadine twice a day. If no infection develops, it will heal secondarily within 10-15 days. However, if an infection occurs, antibiotic treatment will also be necessary.

Ryan Rebowe, MD · Answer

In general, any wound healing issues following surgery should be allowed to heal on their own. After they are healed, they may require a scar revision. However, excising and reclosing them at this point would risk reopening, infection, and other issues.

Daniel Barrett, MD · Answer

Dear littlered510,
I understand your concern. generally speaking, this type of wounds heal with time, there is no need for stitches. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

If returning to your original surgeon is not possible, it is imperative that you see another one as soon as possible for an assessment.

Tyler Frew, MD · Answer

Hi there,
You should let them heal with wound care and dressings changes and not suture them back together. the tissues are inflamed and during this stage the skin wont hold sutures very well and could result in a larger wound or infection.
I would recommend you cleanse the wound twice a day with soapy water, then cover the area in antibiotic cream, and cover with gauze and or bandaid. It will likely take a few weeks to heal completely.
Afterwards once healed you could seek consultation about scar revision if need be.,
All the best

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and pictures. Wounds like these are not generally sutured closed as that might promote deep infection.  Discuss with your surgeon's office about wound care instructions.  These scars may heal well, if not the scar can be revised in several months, good luck.

Connie Hiers, MD, FACS · Answer

They are too old to be closed safely, so they will just need to heal.  Do let your surgeon know about your issues. If need, find a surgeon in your area to check you.

Camille Cash, MD · Answer

No the open areas should not be resutured.  It appears you possibly have one or more suture abscesses.  These are typically handled by your surgeon in the office with minor follow up home care.  You will need to make arrangements with another surgeon in your area for post op care if  you are unable to return to your surgeon.  This will be an additional expense.

Mats Hagstrom, MD (license on probation) · Answer

I do not recommend people travel long distances for elective surgical procedures, especially not out of the country.
People seem to not appreciate the importance of having in person consultations before selecting a provider, the importance of having access to your provider, how many people have significant issues after surgery, the number of people will have complications or need for revision surgery.
Your surgeon is responsible for your outcome and you are responsible for choosing that surgeon.
You cannot just close Open wounds with sutures.
I don’t know what to tell you.
You are now stuck with the consequences of your decision-making.
You can wait it out and see what happens or you can get a hold of a plastic surgeon in your community and ask if they’re willing to help you.
Best,
Mats Hagstrom, MD

Wound healing problem. Do these openings need to be stitched back together? (Photo)

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