TAH Hysterectomy (TAH) 4 weeks ago and incision is still somewhat open

I had my TAH on Dec 1 and have had issues with my incision closing on the outside. I am trying to take it easy but since 2 weeks post op I have been on my own with my children from 1pm til they go to bed so I had no choice but to fend for myself and for them. I have not been doing heavy lifting or vacuuming per my dr instructions but since then my incision has stayed open in 2 different places despite me religiously cleaning and using steri-strips to close it up. My doctor has said that if it leaks or the steri strips come loose and its still open to keep putting new strips on but I am 4 WEEKS out. Shouldn't the incision be closed by now? I have been on antibiotics to prevent infection and all that good mess so I don't know what is going on. Anyone else dealt with this??? Please help me.

CSellers86

I had my hysterectomy DaVinci, but have had several abdominal surgeries over the years. If the top layer of an incision does not close on its own, most docs will tell you that it has to "heal from the inside out". Basically, they can't stitch that top layer together because that just creates a breeding ground for bacteria (it's an open pocket under the skin where it is dark, moist, etc). When a wound is left to heal from the inside out, the inside layers of muscle heal together, then the deepest layers of skin come together and heal, and the process continues layer by layer, until eventually that open spot will fill in on its own and the spot will close. It may heal slightly wider than the rest of the incision, because it had to fill in that gap (usually it is not very noticeable over time). It can take a while for this process to happen.

How long is each open spot? How deep (extremely shallow or is there some depth to it)? Is the tissue pink and healthy looking (does it look much different than the tissue around it)? When was the last time your doc took a look? I would say that he is having you keep it steri-stripped in order to prevent it from being pulled open any further. Still, some incisions have trouble closing on their own and need a little help. I have had incisions that were slow to heal that were treated with silver nitrate. Basically, it is a chemical that is rubbed on the open part of the wound. It turns the tissue black/gray and actually chemically peels off or burns off the outside layer of tissue (please believe me when I tell you it is not nearly as horrible as it sounds, it just looks bad). If that top layer of tissue stops healing, removing it allows the healing process to continue with the layer below.

You should continue to follow your doctor's instructions, but if the wound continues to stay open, I would ask that he take another look.

	Quote:
Originally Posted by jfrog123 CSellers86 I had my hysterectomy DaVinci, but have had several abdominal surgeries over the years. If the top layer of an incision does not close on its own, most docs will tell you that it has to "heal from the inside out". Basically, they can't stitch that top layer together because that just creates a breeding ground for bacteria (it's an open pocket under the skin where it is dark, moist, etc). When a wound is left to heal from the inside out, the inside layers of muscle heal together, then the deepest layers of skin come together and heal, and the process continues layer by layer, until eventually that open spot will fill in on its own and the spot will close. It may heal slightly wider than the rest of the incision, because it had to fill in that gap (usually it is not very noticeable over time). It can take a while for this process to happen. How long is each open spot? How deep (extremely shallow or is there some depth to it)? Is the tissue pink and healthy looking (does it look much different than the tissue around it)? When was the last time your doc took a look? I would say that he is having you keep it steri-stripped in order to prevent it from being pulled open any further. Still, some incisions have trouble closing on their own and need a little help. I have had incisions that were slow to heal that were treated with silver nitrate. Basically, it is a chemical that is rubbed on the open part of the wound. It turns the tissue black/gray and actually chemically peels off or burns off the outside layer of tissue (please believe me when I tell you it is not nearly as horrible as it sounds, it just looks bad). If that top layer of tissue stops healing, removing it allows the healing process to continue with the layer below. You should continue to follow your doctor's instructions, but if the wound continues to stay open, I would ask that he take another look.

Thank you for the reply!! One open spot is about a centimeter wide and only a couple millimeters deep the second spot is about an inch wide, about twice as deep as the first and bleeds a little on occasion. I think I'm allergic to Silver Nitrate or something in it. I had to have a colpo/biopsy and when the Dr put that on my cervix my skin blistered and peeled off from the inside out. YIKES!!!! The last time he looked at my incision was about 2 weeks ago, made the comment about me being his paranoid patient, and my actual post op appt isn't until Jan 9.

	Quote:
Originally Posted by CSellers86 Thank you for the reply!! One open spot is about a centimeter wide and only a couple millimeters deep the second spot is about an inch wide, about twice as deep as the first and bleeds a little on occasion. I think I'm allergic to Silver Nitrate or something in it. I had to have a colpo/biopsy and when the Dr put that on my cervix my skin blistered and peeled off from the inside out. YIKES!!!! The last time he looked at my incision was about 2 weeks ago, made the comment about me being his paranoid patient, and my actual post op appt isn't until Jan 9.

The silver nitrate does icky things. When used on my incisions, it actually turned the skin a whitish gray color, then the skin came loose and came off in stringy bits! But after that, the tissue below was nice and pink and healthy. If a wound gets to a point where it stops healing there are other treatments they can do besides the silver nitrate too.

I am glad that you have another appointment with your doctor. He can take a look and make sure it is healing properly. Since you are on antibiotics you should be fine, just keep it clean and keep watching it for any sudden changes or signs of infection. The occasional bleeding is actually probably a good thing (since it isn't a lot). It is an indication that the tissue is alive and working to heal. Sometimes wounds can be stubborn. It might be that no additional treatment is needed, but it may take a few more weeks to totally close up. We all heal at different rates. Be sure to come back and keep us posted on how you are doing.

	Quote:
Originally Posted by jfrog123 The silver nitrate does icky things. When used on my incisions, it actually turned the skin a whitish gray color, then the skin came loose and came off in stringy bits! But after that, the tissue below was nice and pink and healthy. If a wound gets to a point where it stops healing there are other treatments they can do besides the silver nitrate too. I am glad that you have another appointment with your doctor. He can take a look and make sure it is healing properly. Since you are on antibiotics you should be fine, just keep it clean and keep watching it for any sudden changes or signs of infection. The occasional bleeding is actually probably a good thing (since it isn't a lot). It is an indication that the tissue is alive and working to heal. Sometimes wounds can be stubborn. It might be that no additional treatment is needed, but it may take a few more weeks to totally close up. We all heal at different rates. Be sure to come back and keep us posted on how you are doing.

I will. Thank you so very much.

I had a part at the top where they opened me up that would not close. I could not put steri strips,on as it caused huge and painful blisters. It did scab over around 4 weeks and when it came off, I had a nice red mark. So now it is a ugly round scar.. Ugh.

	Quote:
Originally Posted by Cinl11 I had a part at the top where they opened me up that would not close. I could not put steri strips,on as it caused huge and painful blisters. It did scab over around 4 weeks and when it came off, I had a nice red mark. So now it is a ugly round scar.. Ugh.

Did yours bleed while it was still opened that little bit??

It didn't bleed, but had yellow discharge and clear fluid . The doctor said it was the top layer and so it wasn't infected.

I just finished a 7-day course of antibiotics along with antibiotic cream for an infected incision. The bellybutton one opened up around the 2-week mark and it slowly became very nasty looking, despite keeping it very clean and dry.

Open is okay, but if it starts to look nasty please get it checked.