Tore Stitches After Upper Eyelid Surgery

Question

I had upper eyelid surgery and tore out a number of stitches 7 days later. My doctor looked at it and said that it would be more traumatic to restitch it so we would leave it as is and it should heal over time. My next appt was scheduled in 7 days. I am into day 4 and a small amount of blood continues to seep from it daily. Does this sound normal?

David C. Pearson, MD · Answer

I've had the occasional patient do this very thing. Your surgeon is correct, however. Closing the wound once it's been opened in a non-sterile, partly-healed way would invite infection and would not likely improve the aesthetic outcome.

	Usually, the best thing to do is to let the wound heal on its own (what we call "secondary intention") and revise the scar later if need be. Surprisingly, this revision is often unnecessary.

	Best of luck,

	--DCP

Parham Ganchi, PhD, MD · Answer

It's odd that your incision opened after 7 days.  Usually, eyelid skin is pretty much healed by 7 days.  However, now that the incision has opened, usually, the best option is to let the wound heal by itself.  You can help the healing process by always keeping the wound moisturized and protecting it from sun exposure.  Worst case scenario, if your scar doesn't look good when you are healed, your surgeon can always revise the scar.  This is an unlikely scenario.  Good luck!

	Dr. Parham Ganchi - NJ Plastic Surgeon - www.ganchi.com

Peter A. Aldea, MD · Answer

The experience with how to best manage wounds goes back to pre-historical times. Before knowing anything about germs, the Roman described stitching a wound closed as PRIMARY closure (ad primum) and allowing a wound to close by itself - Secondary closure (as secondum). Over the hundreds of years that followed, surgeons slowly learned WHICH wounds could be stitched closed and which were best left to heal by themselves. The scar of a stitched wound is ALWAYS narrower than that of a wound that closed by itself.

	The realization of germs as sources of disease and the science of Microbiology came out in the 1880's. Within 30 years, World War I broke out - the greatest loss of lives in any war before or since. Much of that war was fought in Europe in fields which were fertilized with animal waste (and bacteria and spores for centuries). The principles of wound closure were firmly adhered to but now surgeons learned that there was a Golden Period, a time window, during which even a clean wound could be stitched closed BEFORE it contained too many germs. Once that 8 hour period has passed the rate of infections seen after closing a wound was very high. Such wounds healed safer if left to heal by themselves.

	BUT - we ALSO know that wounds of the face are different than wound of the extremities. The face has a much better blood supply and as such may be able to tolerate closure of wounds that are older than 8 hours.

	Allowing YOUR wound to heal by itself is a very conservative decision and no surgeon can fault it. However, with a facial wound (better blood supply, clean surgical wound, higher visibility), I would have ALSO given you the option of washing the wound and closing it with a higher rate of infection BUT a better scar.

	Dr. P. Aldea

Marc Cohen, MD (retired) · Answer

Eyelid skin heals very well.  I agree that if some stitches break after 7 days you are better off letting the incision heal on its own without additional stitches.  In my experience it is very likely that the incision will heal beautifully.  I would continue to put an eye ointment on the incision, to keep it lubricated, until things have healed.

	Hope this is helpful.

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