What are the next steps for a patient who underwent an excisional biopsy on the left shin, was sutured closed, had sutures removed 7 days later, and applied steri-strips (adhesive strips) for 6 days, but the wound has started to dehisce (reopen)?

From the Guidelines

The patient with a reopened wound on the left shin after suture removal should have the wound cleaned, irrigated, and managed with daily dressing changes, and antibiotics should only be considered if there are signs of systemic infection or significant erythema and induration, as recommended by the 2018 WSES/SIS-E consensus conference 1. The management of the wound should prioritize preventing infection and promoting healing. The patient should clean the area with mild soap and water, and apply a thin layer of petroleum jelly and cover with a sterile non-stick dressing. The dressing should be changed daily to keep the wound moist but not wet. Elevating the leg when sitting or lying down can help reduce swelling and improve circulation. Some key points to consider in the management of this wound include:

• Monitoring for signs of infection, such as increasing redness, warmth, swelling, pus, or fever, which would require prompt medical attention 1.
• Considering the use of alternative closure methods, such as wound adhesives or additional steri-strips, if the wound is large or continues to worsen despite proper wound care 1.
• Recognizing that shin wounds often heal slowly due to the thin skin, minimal subcutaneous tissue, and constant movement in this area, and that proper wound care is crucial for healing. The 2018 WSES/SIS-E consensus conference recommends that incisional SSIs should always be drained, irrigated, and if needed, opened and debrided, and that empiric broad-spectrum antibiotic treatment should be initiated in patients with systemic inflammatory response criteria or signs of organ failure 1. In this case, since the wound has reopened after suture removal, it is essential to manage the wound properly to prevent infection and promote healing, and to consider antibiotic treatment only if necessary, based on the presence of systemic infection or significant erythema and induration.

From the Research

Wound Re-Opening After Suture Removal

• The patient had an excisional biopsy on the left shin, which was sutured closed and had sutures removed 7 days later, with stern strips in place for 6 days before the wound started to open again.
• The current situation suggests a potential wound infection or complication, which requires prompt attention to prevent further deterioration.

Potential Treatment Options

• Negative Pressure Wound Therapy (NPWT) with instillation and antimicrobial solutions may be considered as a treatment option, as it has been shown to reduce bacterial load and promote wound healing 2, 3, 4.
• Topical antibiotics, such as bacitracin zinc or neomycin sulfate, may also be effective in preventing infections in uncomplicated soft-tissue wounds 5.
• Antiseptic strategies, including the use of octenidine dihydrochloride and polyhexanide, may be beneficial in reducing bioburden in chronic wounds 6.

Considerations for Wound Management

• The treatment regimen should aim to reduce the bacterial load, promote wound healing, and prevent further complications.
• A comprehensive approach to wound management, including debridement, irrigation, and antibiotic treatment, may be necessary to achieve optimal outcomes 3.
• The use of NPWT with instillation and antimicrobial solutions may be particularly effective in reducing bacterial load and promoting wound healing in surgical site infections 4.