When undergoing surgical oncology procedures to remove cancer from the lower leg, patients face an intricate recovery process. While the primary goal of surgery is to eliminate cancerous tissue, the post-operative journey often presents its own challenges. One of the most common complications faced by patients is wound dehiscence—a condition in which a surgical incision fails to close properly and reopens, leading to delayed healing or infection. This problem is especially prevalent in patients who undergo radiation therapy following surgery.
In this blog, we’ll explore the condition of post-surgical wound dehiscence, why radiation therapy plays such a pivotal role in causing incisions to remain open, and how Dr. Philip Wrotslavsky at the Advanced Foot and Ankle Center of San Diego Wound Care Division has been successfully treating these complex wounds for over 18 years.
Wound dehiscence refers to the partial or complete reopening of a surgical incision that was previously stitched or closed. While any surgical wound has the potential to dehisce, certain conditions increase the likelihood. This complication is particularly problematic when it occurs in areas of the body that are difficult to immobilize, like the lower leg. Incisions that do not heal properly not only delay recovery but can also lead to secondary complications like infection, tissue necrosis, and, in severe cases, the need for further surgery.
1. Tension on the Incision Site
Surgical wounds in the lower leg are subject to stress from daily activities such as walking and standing. This constant movement can place tension on the incision, preventing it from closing properly.
2. Infection
Post-operative infections can disrupt the body’s healing process, weakening the incision site and leading to wound reopening.
3. Impaired Blood Flow
Reduced circulation, common in the lower extremities, deprives the wound of oxygen and nutrients essential for healing.
4. Radiation Therapy
One of the most significant factors contributing to wound dehiscence in oncology patients is radiation therapy, which often follows surgery to remove cancerous tissue. Radiation weakens the skin, blood vessels, and underlying tissues, making it more difficult for the body to heal surgical wounds.
Radiation therapy, while an essential component of cancer treatment, presents a major challenge for wound healing. Radiation works by damaging the DNA of cancer cells, preventing them from multiplying. Unfortunately, it also affects healthy tissues, particularly in areas of the body where radiation is targeted.
– Reduced Skin Elasticity: Radiation can cause the skin to lose its elasticity, making it more prone to tearing or breaking open during the healing process.
– Damage to Blood Vessels: Radiation therapy often damages the small blood vessels that supply oxygen and nutrients to the skin and muscles, hindering the body’s ability to heal.
– Tissue Fibrosis: Over time, radiation can cause scarring (fibrosis) of the skin and underlying tissues, which makes healing slower and more difficult.
– Increased Infection Risk: Radiation weakens the immune response in the affected area, increasing the likelihood of infection in an already vulnerable surgical site.
The combination of these factors creates a perfect storm for wound dehiscence and prolonged healing times. For patients dealing with this complication, finding a specialist in wound care becomes critical to prevent further deterioration of the wound site and to avoid serious complications, including the possibility of limb amputation.
At the Advanced Foot and Ankle Center of San Diego, the Wound Care Division led by Dr. Philip Wrotslavsky has been at the forefront of treating difficult-to-close surgical wounds for over 18 years. With a focus on advanced wound care technologies and personalized treatment plans, Dr. Wrotslavsky has successfully treated complex post-surgical wounds, including those complicated by radiation therapy.
Dr. Wrotslavsky’s approach combines non-surgical techniques with surgical interventions when necessary, ensuring the best possible outcome for each patient. His expertise in both wound management and limb preservation has led to many patients avoiding amputation and regaining mobility and quality of life.
1. Negative Pressure Wound Therapy (NPWT)
NPWT uses a vacuum system to remove fluid from the wound, reducing swelling, and promoting faster healing by stimulating blood flow to the area. This technique is particularly effective for deep or irregularly shaped wounds.
2. Topical and Antibiotic Therapy
In many cases, chronic wounds require the use of topical antibiotics or systemic antibiotics to fight off infection and promote healing. A key part of ensuring the success of antibiotic therapy is culturing the wound to identify the specific bacteria responsible for the infection. This allows for targeted, appropriate treatment rather than broad-spectrum antibiotics, which may not be as effective or could contribute to resistance. By using the right combination of topical and oral antibiotics, Dr. Wrotslavsky ensures that infections are controlled, and the wound environment is optimized for healing.
3. Bioengineered Skin Substitutes
In cases where a wound is not healing on its own, bioengineered skin grafts can be applied to cover the wound and encourage natural tissue growth. These products are designed to mimic human skin, providing a scaffold for cells to regenerate and fill in the wound.
4. Surgical Debridement and Reconstructive Procedures
When non-surgical methods are insufficient, Dr. Wrotslavsky may perform surgical debridement to remove dead or infected tissue. In more severe cases, he may also perform reconstructive surgery to close the wound and restore the integrity of the affected area.
One of the hallmarks of the Advanced Foot and Ankle Center is the commitment to offering second opinions. Patients with non-healing wounds are often unaware of the advanced treatment options available to them. Dr. Wrotslavsky’s vast experience allows him to provide new insights and alternatives that may not have been previously considered, empowering patients with more comprehensive treatment options.
By seeking a second opinion, patients can discover innovative therapies that may significantly improve their healing outcomes and avoid further complications. Dr. Wrotslavsky takes a personalized approach to each case, ensuring that every treatment plan is tailored to the specific needs of the patient, their surgical history, and the nature of their wound.
Living with a non-healing surgical wound following cancer removal and radiation therapy is a difficult and frustrating experience. The combination of surgical oncology and radiation presents unique challenges for the body’s healing process, often leading to complications like wound dehiscence. However, with the right medical expertise and advanced wound care techniques, healing is possible.
At the Advanced Foot and Ankle Center of San Diego, Dr. Philip Wrotslavsky has spent over 18 years helping patients overcome these obstacles through cutting-edge wound care and limb preservation strategies. His work has saved countless legs from amputation, and his commitment to providing second opinions ensures that every patient has access to the best possible treatment options.
If you or a loved one are facing a non-healing surgical wound, don’t wait—schedule a consultation with Dr. Wrotslavsky today to learn about the innovative treatment options available and take the first step toward healing.
