Case of Post-Surgical Wound Dehiscence with Suspected Cellulitis

Case at a Glance

A 34-year-old male presented with a dehisced surgical wound one week after a cyst excision, complicated by local inflammation and regional limb pain, raising strong suspicion for a developing soft tissue infection.

Patient's Story

The patient is a 34-year-old male who underwent a surgical excision of a subdermal cyst on his arm one week prior to presentation. He reported that he was recovering uneventfully until the night before, when he began experiencing a notable ache in his arm and shoulder. Upon inspection of the surgical site, he discovered the sutures had failed and the wound had opened. He described the wound as being round, approximately the size of a dime, and covered with a crust. The surrounding skin appeared red and inflamed.

Initial Assessment

The patient presented with a chief complaint of a non-healing surgical wound. He was concerned about a potential infection due to the local signs (erythema, dehiscence) and the associated pain radiating into his arm and shoulder. He is 5'10" and weighs 212 lbs, with a self-reported sedentary lifestyle but no other significant co-morbidities. Notably, his attempts to seek immediate medical care were hindered by a holiday weekend, with his surgeon's office being closed and unsuccessful visits to an urgent care and emergency department due to administrative and insurance complications. He was seeking guidance on interim wound care.

The Diagnostic Journey

Based on the patient's report, the primary clinical concern was post-surgical wound dehiscence complicated by cellulitis. The localized erythema and tenderness are classic signs of inflammation or infection. The aching pain in the entire limb was a concerning feature, suggesting a spreading inflammatory or infectious process beyond the immediate wound site. Without a physical examination, it was impossible to assess for purulent discharge, fluctuance (indicating an abscess), or lymphangitis (red streaking), which would necessitate more aggressive intervention. The differential diagnosis included simple wound dehiscence with an expected inflammatory response, but the radiating pain made an infectious etiology more likely.

Final Diagnosis

Presumptive Diagnosis: Post-surgical wound dehiscence with secondary cellulitis of the arm.

Treatment Plan

Given the inability to perform a physical examination, the immediate advice focused on conservative interim management and safety netting.

1. Wound Care: The patient was advised to gently clean the area once or twice daily with mild soap and water, pat it dry, and apply a thin layer of over-the-counter triple antibiotic ointment.
2. Dressing: The wound should be covered with a clean, dry, non-adherent dressing to protect it from contamination.
3. Monitoring: The patient was given strict instructions to monitor for worsening signs of infection, including fever, chills, an increase in the size or intensity of the red area, red streaks extending from the wound, or a significant increase in pain.
4. Follow-up: He was urged to contact his surgeon's office for an urgent appointment as soon as it reopened. He was also strongly advised to return to an Emergency Department immediately, regardless of insurance status, if any of the aforementioned 'red flag' symptoms developed, as this could indicate a rapidly progressing infection requiring intravenous antibiotics.

Outcome and Follow-up

The patient was scheduled for an urgent follow-up with the surgeon. The expected course of treatment upon evaluation would include wound debridement and culture, followed by a course of oral antibiotics effective against common skin pathogens (e.g., Staphylococcus and Streptococcus). The wound would likely be left to heal by secondary intention with a regimen of regular dressing changes. Close monitoring for resolution of cellulitis and progressive wound healing would be essential.