Dealing with tight skin

My ICD went in on 16 Deptember (13 days ago) and all has been well, except for a pocket haematoma which was reduced by compression before I was discharged.  

The wound is healing swiftly - I removed the dressing a week after the op, as per instructions. The pain lasted a couple of days, manageable with paracetamol (tylenol) and wearing a supporting bra with extra padding (a rolled up flannel) to reduce the downwards drag on the wound, day and night. The bruising is still spectacular but nowhere near as bad as it was, and not painful at all (except when a cat walks over it).

My previous pacemaker was not very visible -- a combination of its size and its placement (quite deep). The new ICD however, is extremely prominent, even as the swelling is reducing.

I'm not bothered about the appearance -- my face/body has never been my fortune and I'm happy just to have insurance against another SCA.

However, the skin is very taut (uncomfortably so) across it, and starting to flake,  and I can clearly see the edges of the device (where the skin is white in spite of the bruising). I have very fragile skin, to the extent that if I get severe leg oedema (from heart failure) the skin breaks down and weeps.

Is there anything sensible I can do to reduce the tautness (and possible skin damage)? Avoiding the wound obviously until it's completely healed! If this was my legs, I'd be applying Dermol ("an antimicrobial and emollient (softening and moisturising) treatment") but I'm not sure if softening the skin will do more harm than good in this situation.

 


4 Comments

Should be OK

by crustyg - 2021-09-29 08:34:45

I think you're wise to be cautious about *excessive* skin tension over the ICD.  In general, as long as the blood supply (to and from) the overlying skin isn't compromised then I predict that this scaling will settle down.  The biggest risk is to the surgical wound - if the edges of that are under too much tension then it will break down => real trouble.  With luck your surgeon has used some nice sub-cuticular sutures which will hold it all together while the dermis heals completely.

Don't let the skin under tension stay damp/moist as this will tend to reduce skin strength - it's the basis of the old poultice method of allowing a wound to drain through the skin, but I think you're wise to apply a little moisturiser from time to time.

Any increase in redness or tenderness over the device, or any sign that the surgical wound is parting and I would take pictures and get back to my implanting EP-doc ASAP.

Best wishes.

A few thoughts

by Gemita - 2021-09-29 14:00:18

Atiras, 

Yes haematomas can take a long time to disperse and can travel far.  I had one after an angiogram and ended up spending 3 nights in hospital where they eventually diagnosed a pseudo aneurysm.  I was taken off anticoagulants to allow healing to take place.  It spread all the way down my leg to well below the knee, but it looked far worse than it felt.

I certainly wouldn’t let the skin around your device dry out too much and risk it weeping/flaking/opening.  I hope that rolled up flannel isn’t rubbing against your device.  Make sure the cloth is a natural fibre and isn’t irritating your skin.  As the swelling further reduces over your ICD, your skin should become less taut and feel more comfortable.

What do you use to cleanse your skin?  We avoid harsh soaps and only use quality cleansing gels in the shower.  “Pat” your skin dry, after rinsing well, never rub it, and remember to apply moisturisers soon after patting dry to trap moisture in (of course avoiding your wound until well healed and well drained) and it sounds as though your haematoma is still draining in any event.  Some meds can cause dry skin.  Keep as well hydrated as your heart condition allows to prevent your skin drying out in centrally heated homes.  Bio oil, Vaseline, Vitamin E cream or E45 cream we were told could all help to soften our skin/treat our wound scars. Supplements Vit C and Zinc (+ check Vitamin D levels?) are good for skin healing too so make sure you get plenty in your diet, or take a supplement with your doctor’s permission.

I would keep your affectionate cat off your chest.  I know they love to knead, but please not around your new device.  Are you sure that it is not happening when you are asleep?  Oh they are adorable creatures of habit, aren't they.

Stay safe and I hope everything goes well for you.

Tight skin

by AgentX86 - 2021-09-29 23:00:11

It can take some time (many weeks) for all of the swelling to go down.  In that time the skin is stretched tight.  After the wound is fully closed you can use skin softeners.   My OT recommended vitamin-E oil to reduce scaring.

 

Thanks

by atiras - 2021-09-30 07:17:47

All, thanks for the advice.

Neither the flannel nor the cat is getting anywhere near the wound.  Boycat does love to knead but he's a creature of habit, and only does it if I'm resting on my left hand side -- which I'm not doing for obvious reasons right now. By the time I can lie on that side, I'm hoping he's forgotten his habit.

The wound bled slighly last night (I remember the same thing happening after my pacemaker went in) so I've applied a silver dressing for safety's sake, and am taking my temperature daily. I've been cleaning the area just with water, and patting dry as recommended.  Any moisurising is gong to have to wait until the dressing is off and the wound looks intact again.

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I had a pacemaker when I was 11. I never once thought I wasn't a 'normal kid' nor was I ever treated differently because of it. I could do everything all my friends were doing; I just happened to have a battery attached to my heart to help it work.