Surgical wounds that won’t heal (wound breakdown)

What wound breakdown means

Dehiscence means the closed edges of an incision separate, partly or completely, because healing has failed. When it starts at the surface, the edges begin to part and the site bleeds or drains more than before.⁠^[1]

An incision can also become infected. More than half of these infections stay in the skin and the fat beneath it; others reach muscle or lie deeper still, including around plates and screws.⁠^[7] That is why we first ask how deep an opened incision goes.

Why some incisions don’t heal

Incisions break down for the same reasons any wound heals slowly: poor blood flow, infection, diabetes, poor nutrition, smoking and obesity.⁠^[1] After surgery for a diabetic foot infection, breakdown is common: in data pooled from two trials, 137 of 180 closed wounds (76.1%) had not fully healed over, or were still draining, when the stitches came out.⁠^[2]

• Diabetes with nerve damage. In a study of 1,465 foot and ankle operations, nerve damage, a Charcot foot, a smoking history and a longer operation were each linked to infection, and nerve damage mattered more than the diabetes diagnosis itself.⁠^[4] In a later study of 2,060 operations, an A1c of 8% or higher was also linked to infection, but diabetes without complications was not significantly linked.⁠^[8]
• Smoking. Across 140 studies of 479,150 surgical patients, smoking was linked to slower healing, wound separation, infection and, most strongly, tissue death at the wound (about 3.6 times the odds).⁠^[5]
• Age and a long tourniquet time. After planned foot and ankle surgery, age 60 or older, tobacco use and a tourniquet (a cuff that stops blood flow during the operation) left on for 90 minutes or more each independently predicted wound problems.⁠^[3]
• Circulation. Narrowed leg arteries are common with diabetes: about half of people with diabetes and a foot ulcer also have peripheral artery disease.⁠^[9]

Our sister practice explains how smoking and diabetes affect healing after foot surgery (external site).

Signs your incision needs attention

Call us the same day if you notice:

• edges pulling apart, or a wound that has come open
• new or increasing drainage, especially pus, or new bleeding
• redness, swelling, warmth or tenderness that is getting worse
• skin at the edges turning dark or black
• fever, or pain at the incision that is growing instead of easing⁠^[1,7]

Call 911 or go to the emergency department instead if redness is spreading and you have a fever, your foot turns cold, pale or blue, black tissue is spreading, the drainage smells foul, or you feel very unwell.

If your feet are numb, check the incision daily instead of waiting for pain. With diabetes or poor circulation, new foot pain at rest or at night is also a same-day call; see diabetic foot infections and a red, hot, swollen foot. If another surgeon did your operation, let that office know too.

How we evaluate an opened incision

We measure the wound, check its depth, look for infection and dead tissue, and ask about blood sugar, smoking, nutrition and medicines. X-rays at the practice show the bone and any plates or screws; CT or MRI, when needed, is arranged at an outside imaging center. Noninvasive circulation testing is done at our practice, with detailed artery imaging arranged through a vascular specialist. See how a foot wound is evaluated.

When infection may reach plates or screws used to repair a broken bone, experts call deep tissue samples mandatory. Antibiotics start after the samples are taken, or right away if you are seriously ill with sepsis, and are then adjusted to the culture results.⁠^[6]

The foundation: wound care in the office

Wound care, offered at all three of our offices, is the base any surgery builds on.

• Clearing the wound. We trim away dead tissue in the office so healthy tissue can grow. See wound debridement.
• Regular visits, usually every week or two, with the wound measured each time and the plan adjusted. See wound care visits.
• Treating infection with antibiotics chosen from culture results.
• Taking pressure off an incision on the sole or heel with an offloading device we fit for you.

For the wounds that need it, we use negative-pressure wound therapy (a “wound VAC”): a dressing connected to a suction pump that draws fluid away from the wound into a canister.⁠^[10] The international diabetic foot guideline gives it conditional support for wounds left after diabetic foot surgery, when good standard care alone has not healed the wound.⁠^[11]

When another operation is the right step

Some wounds won’t heal with dressings alone: a deep infection, a pocket of pus, dead tissue under the skin, or infection in bone or hardware. For these, a return to the operating room clears the way; in the study of 295 planned operations, all four deep infections needed an operation to wash out and clean the wound.⁠^[3]

Dr. Efe Ozturk, a Foot and Ankle Surgeon who is board certified in wound care (FAPWH), performs these operations himself: draining infection, removing dead and infected tissue and, when infection has reached the bone, removing infected bone. For each of these, the physician watching your wound is the one who operates on it. See bone infection (osteomyelitis).

When infection reaches plates or screws holding a broken bone, the hardware can sometimes stay; otherwise it is removed if the bone has healed, or exchanged if it has not.⁠^[6]

Some wounds need two operations: one to clear the infection, a later one to close the clean wound. A clean wound may be stitched closed or left to fill in, sometimes with suction therapy, and when a wound needs it, Dr. Ozturk closes the gap with a skin graft or local flap. In a randomized trial of 162 people with diabetes after partial foot amputation, suction therapy healed more wounds than moist dressings within 16 weeks (56% vs 39%), and faster, with similar rates of side effects.⁠^[12]

Dr. Ozturk also uses skin substitutes, including amniotic or placental tissue, for wounds that need more help. The international guideline gives conditional support to placental-derived products for diabetic foot ulcers that good standard care alone has not healed, and to hyperbaric oxygen for such ulcers when blood flow is reduced.⁠^[11] If hyperbaric oxygen therapy fits your wound, we refer you to a center.

Limits, risks and recovery

Another operation carries its own risks, including new infection, which is more likely with complications of diabetes.⁠^[4] The evidence that suction therapy helps diabetic foot wounds heal, including wounds after surgery, is rated low certainty.⁠^[10] A UK trial published in 2026 randomly assigned 686 people with open surgical wounds, 80% of them on the foot and most after vascular surgery, to suction or usual care; healing was no faster with suction (a median of 187 days, versus 195 days with usual care).⁠^[13] Across added wound therapies, the guideline calls the certainty of the evidence improving but still poor.⁠^[11] After infection around fracture hardware, experts advise at least 12 months of follow-up once treatment ends.⁠^[6]

As the UK trial shows, an opened incision often takes months to heal,⁠^[13] so we measure progress at each visit. See also our sister practice’s guide to recovery after foot and ankle surgery (external site).

Lowering the risk next time

The CDC’s guideline estimates that about half of surgical site infections are preventable with steps such as bathing with soap at least the night before surgery, keeping blood sugar below 200 mg/dL during the operation, and not putting antibiotic creams on the incision.⁠^[14] In four randomized trials, help to quit smoking around the time of surgery lowered the odds of a surgical site infection by more than half, though it did not clearly reduce other healing problems.⁠^[5]

Quitting smoking, controlling blood sugar and treating circulation problems first are part of preparing for limb salvage surgery.

When to seek care

See us within a day or two for any foot or ankle incision that isn’t healing, especially if you have diabetes. Call 908-215-5953.