For those of you who had wound complication / complex wound from surgery

[PsychoJane]

Hello!
I am curious to see what you have been told regarding the healing of your wound. I had surgery at the beginning of may and well, the wound did not quite heal the way it should have but apparently it is quite usual to have this happening when you suffer from Crohn. Anyway, my incision site (about 4,5inch) never closed so it's healing from inside out since (It's gonna be a long walk to healing that entirely). Anyway, here are my questions since I've had so many different input from health professionals.

Here is what I have been told:

-Some say: "Go for a VAC, negative pressure therapy, I've seen miracle to accelerate wound healing". [Even though I'd like to try, surgeon does not seem convinced it could even help and as long as he does not prescribe it, it's pretty much out of question. He believe the VAC is probably inappropriate as it will hardly be fitting the wound because of the stoma flange and all and from his experience he says he has not seen real benefits with that type of wound and the VAC]

-I've also been told to shower and expose my wound to the water to stimulate the healing process

-I've been told, not to do so, to avoid changing the wound temperature and such

- I've been told to change my dressing once a day to keep it as clean as possible.

-I've been told to change my dressing twice a day, to keep it even cleaner.

-I've been told to keep my dressing on for a few days and change it every 2-3 days (with silver dressing once the wound would not be producing as much fluid) because changing the dressing would cause a temperature change in the wound and slow the healing process.

So yeah, because all these informations comes from... "trustworthy" health professional, I am curious to read what you have been told to do, what you have done, and what have worked for you in term of healing complex wound.

Every input will be much appreciate as I don't really know what direction I shall be taking with my wound care. I think it's only up to me at this point and hence, your experience might help make a choice!

TY

 

[Loshy79]

Eeek! Lots of conflicting 'advice' you've been given there.

I too have an unwilling to heal wound.
Had surgery just over six weeks ago, and around 10 days afterwards, thick, yellowy discharge was oozing from between my stitches. Rushed back to hospital and they had to unpick a few stitches (about 1 1/2 inches) to let the gunk out. Was also given Anti B's incase of infection.

Then had the fun of a home visit nurse coming each day to change the dressing and insert packing, Silvercel, up behind the remaining stitches. This went on for about 5 days then because I wasnt bed ridden I then had to go to a local health center to get it done.

When the remaining stitches were taken out only the very top, and very bottom had healed, so then had a lovely big hole on my tummy, around 4 1/2inches long!

Silvercel was laid over the wound with a waterproof dressing over it, again changed by a nurse every day for about 2 more weeks.

As it was healing a little, I could get it changed every other day, and am now changing it every two days, doing it myself and just getting it checked once a week at the health center. Oh and stopped using the Silvercel and it just has on it this mesh thing with Iodine (?) plus the dressing

Was told on my last check that it may be over granulating / over healing so might need steroid cream....but to me it looks no different from 2 or 3 weeks ago, may it shrunk a teeny bit, but since its been over 5 weeks, thought it would of been healed by now.

It sure is a long process this healing from the inside out thing!

xxx

 

[KWalker]

I think I've already told you most of the stuff I know but I was always told to keep the area as clean as possible. Baths, exposing it to water when showering, etc. Whether I should be or not, I even wash mine with body wash now help clean it out and its been really helping me with smell and even seems to be decreasing the output. The vac is said to be very effective but also very uncomfortable. My nurse was quite up front with me about that. Luckily for me because of the area it wouldn't work anyways.

Silvercel is the stuff I told you completely messed up my healing and caused me the second surgery. If you're doing the packing yourself and its not too much you could even do it as much as you feel necessary. I was told that with every loose BM, it should be changed because odds are it touched. Eventually you'll find yourself changing it less and less until you can't even get a piece to stay in there long enough so it should heal by itself from there.

 

[PsychoJane]

Wow! Can I just say Wow and I think re-Wow!

So... my darn wound, that had been leaking so much and reopening and what not... Well there was a culture that had been performed at the beginning of june. The results were sent to my nurse and to the surgeon. I've been shown these results and there was some creatures living in my wound but you know, even though I know a lot, I don't know where the line can be drawn when it comes to the normality of the presence of this organisms or that one. So yeah... there was all sorts of organisms, which I was told were pretty normal considering it was a chronic wound, but anyway, these results were only expressed in term of (+, ++, +++,++++) and what that meant was pretty much a mystery and no one could apparently tell me. Bare in mind that I haven't seen the surgeon, only the results were sent to him and I told myself that without news, it was probably because it was no big deal.

Well,it happened once that wound liquid smeared down in my lady's part by a matter of gravity and after that, I got troubles. Ended up with bacterial infections down there and ended up with a strep throat... Because of that last one, I got hooked on a new course of antibiotics and guess what!! Well the wound is almost closed now!!!

 

[Jennifer]

That's great that its almost closed now PsychoJane. I find it odd that the whole thing dripped so low. The only time mine did that was when it first burst open a week after my surgery. Other than that it should have be covered well and packed well. Mine was the same size as yours.

I had to shower and pack the wound twice a day. I removed the packing and scrubbed the wound clean with soap in the shower and then my mom cleaned the would with saline and then packed it tight with saline soaked gauze and then put a lot of bandaging on top. There was no dripping or anything. Took one month to fully heal.

The muscle layer healed and so did the skin layer but the fat layer in between had not causing the infection. They cut the skin back open and cleaned it out and that's what I was told to do until it fully healed. I've never heard it done any other way.

 

[PsychoJane]

Yeah, well Crabby,
What I am guessing is that the wound was actually infected and not only just colonized as people seemed to believe. From what I read, infected wound (it was even harder to tell since I had silver dressing and these cause the exudate to get coloured funny) can produce lots of fluid. It was producing a lot, but no one seemed overly stressed about it. They would pack it, with silver hydro-alginate fiber, then put hydrophilic foam dressing, then 2 layer of gazes, then a mesorb absorbant pad and well... it would fill all that stuff within 24 hours, normally around 12-16hours so by the time I was getting the dressing changed again (I had to walk to go there) well it happened once or twice that it kinda broke the whole thing and dripped down... Not fun actually lol.

Anyway, I'm overly excited that it is now healing properly thanks to the antibiotics. I'm kinda mad no one seemed to have taken the time to seriously look at my culture results which seemed to indicate a streptococcus pyogenes infection 5 weeks ago and that it is just until I got it everywhere that I finally got some antibiotic prescribed. I'm glad the wound remained "ok" and that the infection did not get more invasive/systemic. My wound was still 1,5 cm (was 2,3 at the worst) deep before antibio and within the last 5 days, I've made more progress than I had in the past month and I've manage entering the epithelialization stage. There is a part that is just the natural course of healing but as the nurse said, I was probably healing 75% capacity all the time because of the darn bacteria no one cared to remove...

Sorry for all that babbling, I needed to share to whom might be interested lol

 

[Jennifer]

Hey no problem. Its possible it might have continued to go unnoticed if the packing was changed twice a day and you might have gotten sicker. I don't recall anyone doing a culture on my ooze (mine was a sort of bright milky orange and smelled REALLY bad) that came out but I wouldn't be surprised if they did. Although I think I was given antibiotics immediately anyway once I got back to the hospital that did my surgery. Had to stay there for another week while they changed and dressed my wound for me and taught my mom how to do it.

None of it is any fun and I hate how people still have this stuff happen after surgery. I really wish they took better care of the wound rather than poke at it every morning then send you home to have you come right back the next day or so.

 

[PsychoJane]

Crazy eh! The morning they released me I had started a fever. They did not worry about it, told me that the poor Crohnies that we are get that sometimes, fever with no reason when we temporarily stop our anti-tnf/mtx (It did "whatever" in my head when they told me this). I just sooooo hate when they just assume at random that everything and nothing is caused by our crohn. Can anyone just take us seriously when we speak and say things are different than what we are used to....

 

[Jennifer]

Wow, I couldn't imagine my old hospital releasing me if I had a fever. They were taking my temp twice a day. Didn't have a fever until the night I left, just 6 hours later really.

I hate it when doctors blame everything on Crohn's. One of my biggest fears is dying from "Crohn's."

 

[Jaano711]

Yep
I know the non healing wounds.. Had panproctocolectomy 10 weeks ago and I am still waiting for both ( midline and perineal) incision wounds to heal. Midline has closed and opened twice. And the perineal one well, I feel that will never heal funny thing is my butt now leaks and bleeds constantly, even more than when my perinatal disease was was at its worst. Every time one section heals another opens and starts leaking blood and ooze. It really is crazy since I now don't have any of the hardware left, it is now purely cosmetic!

 

[Susan2]

I've already written about this on the forum, so I apologise to anyone who has read it before.

I had a large amount of diseased tissue in the perianal area because I had left it rather too long to have my proctocolectomy. After the surgery I was left with a hole the size of a large man's fist. The surgeon sewed it up but the stitches tore open because there was so much damaged tissue down there. There was blood everywhere because it had pooled up behind the sutures.

Because the hole was so big, there was some discussion of the pros and cons of taking some flesh from my upper leg to make a graft, but they decided to leave the wound open and let the flesh grow from the inside. The district nurses came every day for almost seven months. I took an Endep tablet for the pain, had a shower, then the nurses arrived and washed the wound out with saline and packed it with Kaltostat (an alginate dressing). Either the Kaltostat was extremely effective or I was very lucky because I had no infection of any sort during the period of healing.