Why Isn’t My Wound Healing?

Dealing with failed operations

Often patients ask me why their “cystectomy” won’t heal. Or, why it heals but then reopens.

Surgeons often blame this on:

• poor patient’s hygiene
• poor quality of wound care
• poor general health (“You just don’t heal well!”)
• the development of a new “cyst”
• or “It was so extensive, we just couldn’t get all the cysts and tracts with the last operation“.
• there is too much hair
• too much activity made the wound come apart
• reaction or “rejection” of the sutures
• infection
• excessive granulation tissue
• sitting too soon after surgery
• a possible fistula to the rectum
• a possible bone infection (osteomyelitis)

These reasons are almost never the reason for the failure. However, believing that they are the reason for failure can send you off on the wrong direction trying to remedy the situation. Examples of the wrong direction are in the next paragraph.

And, surgeons may recommend:

• repeat excision
• methylene blue dye injection to define new tracts and then re-excision
• skin grafting
• silver nitrate application
• a wound VAC
• frequent packing and visits to a wound clinic
• a MRI, ultrasound, CT scan, fistulagram or other radiologic study
• more antibiotics
• laser hair removal
• waiting, waiting, waiting (“It looks a little better, just keep up with the wound care and come back in a month”.)

However, the actual reason for non-healing is usually the same in almost all cases:

• the cleft was not flattened, or not completely flattened throughout its entire length
• the incision is in, or crosses, the midline

Of course, if a patient had a huge excision that was left open (or fell apart after closure) it will take a while to heal, and the size does matter. But, there should be good, steady progress. If it is taking many months, the wound actually gets larger, or the wound seems to heal – but then reopens, or a new sinus tract opening appears, the cause has to do with the two reasons above.

When a patient gets to the point where it seems that it is just not healing, the original surgeon may suggest another excision! In general, this is the wrong approach, and just brings you back to square one. The best approach is one that will flatten the cleft and move the incision off the midline. My personal preference is the cleft-lift, which has been engineered to do exactly that. There are other flap procedures that may or may not work, depending on the expertise and experience of the surgeon performing the flap, but the cleft-lift is cosmetically the most appealing.

At our clinic we specialize in correcting the anatomy so that these wounds heal quickly. Our success rate with the cleft-lift in patients who have had previous operations is 95%. In the few patients who have problems, a revision of the cleft-lift is almost always successful as well – so overall, we get over 99% repaired and on with their lives. If you have been dealing with an open wound for more than two months without progress, contact us. We’re glad to help!