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Surgical wound dehiscence

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On nov 26 I had surgery to remove adhesion's. when the surgical glue came off, approx 10 days later in the shower, one of the laporascopic incisions was not closed. went back for my post op and doc cleaned it out and said to come back next week. went back, still wasn't closed and was oozing clear to light green stuff. it was infected and he said the tissue was necrotic. put me on antibiotics and asked me to come back the next day to stitch it and remove the necrotic tissue. I did. he put steri strips on the wound. the strips continued to come off due to the oozing saturating them. went back to have the stitches out and he said it didn't work so he cleaned it out again and removed the necrotic stuff. said to come back in a week but to keep the strips on. I went back the following week, at this point I'm upset and worried. he said it isn't healing and he needs to take me back to surgery for a scar revision or wound dehiscence. went back to surgery four days after that. he made a much larger incision and stapled it closed. he took the staples out 5 days later and the wound was closed. Happy day for me as he released me to go back to work the following Monday. woke up Thursday morning (day after staples were removed) and part of the wound had opened. went back that morning crying and upset. he said I needed to stop worrying and stop crying and etc...that it will close and to just keep the strips on. I told him that I do and have but the blood soaks through them and that they fall off in the shower because they are soaked. he gave me more strips to change them. My question is, it is now Sunday and the wound shows no signs of closing. my doc was pretty frustrated with me because I had been crying and upset. he said I was acting like a baby and stressing my family out and "them" , but I feel justified in being worried and crying because its not closed and i don't want to go through all this again. its been painful, especially when he cleaned it out the second time and used nothing to numb me. He told me it will close. i don't know what to do or how long I should wait to see improvement. he did not put any restrictions on me in terms of not moving around or what have you and I am going back to work tomorrow. I work as a behavioral therapist and I spent a lot of time on the floor with kids moving around and lifting and etc.. I am worried. it isn't closed all the way and it is still oozing blood. As I step away from the computer to take a look at the new strips I put on, I see the blood soaking thru, it isn't a ton, but enough that it soaks thru. I dab it with tissue often to try to keep it dry. Is this all normal? How long should I be expected to wait for it to completely close? I have had all my blood work done and checked for diabetes and it was negative. This has been going on since the surgical glue has come off 10 days after my first surgery. I am depressed and frustrated and I am not sure if I need to get a second opinion so I am asking you guys your thoughts and adding photos of the hole after my doctor cleaned it out the second time, the staples from my second surgery and the photo of the wound partially opened after the staples came out.

Category: Family Physician-GP

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days ago


Thank you for choosing DoctorSpring

I have gone through the images and your medical history. I understand that this can be really frustrating for you . But let me assure you there is nothing much to worry. The surgical wound appears healthy and in the process of healing from the pictures. It is NOT uncommon for wounds from surgery to under go a delayed healing. Your Surgeon might have dealt with hundreds of cases like this by now. (and that explains his easy go reaction !)

The wound has to heal naturally . There is no other way. The best we can do is give approximation. So basically there is nothing much you or your Surgeon can do at this stage. Just make sure you are not stretching or moving it too much . Some soaking is ok. This will gradually decrease.

One thing to be ruled out if the healing is delayed is the infection in the wound site. From the image the surgical site looks clean. (so infection less likely ). Still do keep this in your mind and discuss this possibility with your Surgeon.

Hope this helps
Feel free to ask followups.
Thank you

Patient replied :

Thank you for your response. in your best guess, what would be the time frame in which I should give this to close? Since this past Thursday,to today, it has not decreased in its leaking of blood, again, not tons just enough to keep the strips wet and leak onto my clothing. and is it possible to have a wound dehiscence a second time? I will indeed wait though. it indeed does not appear to be infected like the last time so I am glad about that. I know what to look for in terms of an infection. Perhaps just an estimate of time to wait for proper closure until I should seek my surgeon out again. Thank you very much

Expert:  Dr. Deepu Sebin Sebastian replied 3 Days ago

To be honest the time frame for wound closure is over. So what we are considering is an extended time frame. That would be something around 1 week. You need not get a complete wound healing in one week, but within 1 week you should be able to see a good progress - that means less gaping of the wound, or better approximation, healing tissue , less or no fluid leakage etc. So in 1 week a at-least a general direction into healing is good.

Event though there are no obvious signs of infections it is better be consider that option if wound remains unhealed even after a week.

Hope this helps
Feel free to ask followups
Thank you

Dr. Deepu Sebin Sebastian
Category: Select Speciality
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
Dr. Deepu Sebin Sebastian and 4 other Medical Specialists are ready to help you

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