Another Wound Thread
I am a little over two weeks out from bilateral mast with DIEP. This week, my abdominal incision has gone from iffy to horrible. The insicion has come apart and is gaping widely and absolutely gross looking. My PS is out of town and hasn't seen the wound but he is trying to decide whether or not to send me to a wound clinic. I had to call the office today and ask for stronger pain medicine. Has anyone else had experience with a wound clinic or home health for wound care?
Comments
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My incision opened also - at 2 weeks post op. I was just leaving Houston to go back home to Colorado. PS saw it and thought it was just a stitch that opened.
Long story short -- it got pretty big and open and it took 6 weeks to heal up. Had it treated by local general surgeon. I saw him every week. He did debrise [spelling?]each time. I had to pack it and clean it twice a day to allow it to heal from inside out. Really slowed down my recovery, but it did heal. It is really important that it heal properly. When I did see PS for 10 week visit, he told me that it had healed well and he was expecting it to look worse! That was comforting. Unfortunately, that is just part of living in a rural area and having to get medical care in a distant city.
Sorry to hear that you are going through this; not what you need now -- or ever!
Wishing you the best!
Debi -
I have home health care in regardless, and I'll tell you, I love my nurse. I've had 4 visits now, and while I know I don't really need them, it's comforting, ya know?
as a nurse I can tell you..
KEEP YOUR WOUND CLEAN, Do NOT put peroxide on it for ANY reason, if it's red, hot to touch, oozing yellow or green or YOU start running a temp, get to the emergency room ASAP.
have you tried steri strips or butterflies to close it?
best wishes. I'm sorry about your pain. I'm too embarassed to call my dr.! -
Amy---I'm so sorry to hear you are having more problems. Did the blisters on your heels heal up yet? When my hysterectomy incision wasn't healing well, my doctor prescribed panafil ointment which I had to use for a few weeks and it seemed to do the trick after a while. If the opening is very large and not responding to other treatments, they may suggest wound vac therapy. It is a new thing used a lot in the hospitals with very good results, and I have seen some patients go home with it. It heals from the inside out, kind of "vacumns" out the wound with a sucking sensation. It's a little weird, but it works for tough wounds. (which I hope yours isn't!!! Praying for quick healing for the incision and your heels as well.
Anne -
Hi Amy: I think for peace of mind, I would go to the wound clinic. I am still battling a wound in my breast area from an infection after mastectomy. This happened in March. We have always taken care of it at home, seeing the PS twice a week or three times a week at first.
Be very careful, and watch for any signs of redness and fever. Good luck. It sure seems that many people wind up with these wounds. . .
Colleen -
I went back to the wound care clinic today for my second appt. and the doctor has ordered a wound vac for me. I thought I was improving, rats! My abdominal incision has dehisced, about three or four inches in length and two inches wide. I am getting stir crazy being inside all the time! I still have a couple more weeks of staying off my heels.(pressure blisters somehow occured during my surgery) Are dressing changes with the wound vac painful? Just wondering...
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I hope I don't make anyone mad by posting this twice. I created a new thread THEN found this thread which is more relevant
I had stage 1 a breast cancer in the right breast. It was only 4mm. I decided to have a double mastectomy rather than a lumpectomy for personal reasons. 6 weeks after surgery I am having severe complications on the right side. This is what happened. April 14 mastectomy. About a week or two after the right side opened up at least 4-5 inches wide and about 1/2 in depth. There was one hole near the center and I don't know how deep it was. I panicked and went to plastic surgeon who said we see this all the time. Don't worry let it air out and it will heal from the inside out. I felt stupid panicking. week or two later woke up with blood all over my nightgown and sheets. Panicked again and saw plastic surgeon who said it was no big deal and he had seen this before and it would heal from the inside out. At this point he wanted me to pack it with moist gauze and cover it. Felt like a dumbass again. A week or two later I was standing in the bathroom when suddenly at least 1/4 to 1/2 cup of clear yellowish drainage came out all over me and pooled on the floor. Panicked again. Saw plastic surgeon and he said that was good and just continue packing it twice a day. I felt like a dumbass again. A week or two later I smelled this horrible smell and thought I needed to take the trash out but when I went to change the dressing I discovered it was my wound that stunk horribly. Panic again. Saw plastic surgeon who said I don't smell anything now. I REALLY felt like a dumbass. Why would I make up something like that? Anyway, he looked at the wound and at first said he would have to go back in and remove the expander because it was exposed. I freaked out. Then he massaged around the perimeter of the wound and suddenly a large amount of drainage spit out over him, me and the floor.He cleaned it up and changed his mind. He didn't think the expander needed to be be removed. Once again he said just pack it with saline soaked gauze and cover it. I never really saw what the wound looked like then.
When I got home I saw the wound had opened up all the way and I could see muscle tissue. Again keep packing it twice a day. It has now been six weeks since the surgery and I have a giant gaping deep wound and all I keep getting is pack it twice a day and it will heal from the inside out.
I am beginning to question my plastic surgeons judgement> My husband and I got into a fight over this. "Are you calling the Dr a liar? and do you think you know more than the doctor?"
Several years ago I had a lipoma removed and had to go to a wound care specialist for a couple of months. The treatment was brutal and painful but the wound did finally heal to a point where the doctor could suture it up.At one point he used a wound pump on it. I found out that the rule of thumb is that if a wound does not heal on its own after a month the patient should see a wound specialist. If I just continue packing it twice a day I believe it could take at least 9 months to a year to heal on its own. THEN scar revision THEN heal again THEN begin filling expanders. It just doesn't make sense to me that it keeps getting worse but Im told to just let it heal from the inside out. In the meantime, I have resorted to using a female mini pad to absorb the drainage because the large open wound weeps all over my clothes.
Does this sound normal to you? Please be honest with me. Should I get a second opinion and go to a wound care specialist and piss of my plastic surgeon or accept that it might take 9 months to a year to heal on its own? I really need your advice. I want to move on with my life. Cant lift more than 5 lbs. Cant swim or fish or do many other day to day activities. Advise me on what I should do.
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Wow, what a horrible nightmare! I was getting queasy just reading it. I would DEFINITELY get a second opinion or see wound care specialist. That just doesn't sound right to me. It could get infected. I've had an infection. Trust me, you don't want that on top of what you are already dealing with. I'm sure there are others that can give you better advice, but that's my two cents. Good luck to you! Let us know what happens.
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sOrry but you MUST see a different surgeon. You can not mess around with open wounds now that you have expanders. Infection will colonize it and you will wind up in the hospital on IV antibiotics. This just happened to me from a few tiny stitch wounds. Sorry to scare you but this is very real. You need wound care and possibly antibiotics right now. Best of luck!
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I agree, littleblueflowers!! I think we have posted on the same infection posts before. Good advice, hope it is folowed
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Jill
I had something totally different near my port. My PS sent me to the wound center immediately. They treated it for 6-8 weeks. I think you should just ask them to send you over to the wound center and ask them to take a look.
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JUST to give you an idea of different plastic surgeons modes of treatment- my PS saw my breast with the tiny stitch sinuses, and sewed it up. I still got a staff infection from having tiny open wounds for a month. He just saw redness, no pain or fever, and sent me immediately to the hospital for 4 days of IV antibiotics. During that time, he also did emergency surgery, washed the implant pocket, and swapped the implant. The implant, tissue, and fluid were cultured. He set me up with an infectious disease doc and a wound care specialist. This was all before infection was even confirmed. He is the one who told me that foriegn objects kb our bodies attract bacteria so we have to be extra careful. Also, if you had nodes out or radiation you can't fight infection as well. This was all him, and I feel that this is how a normal plastic surgeon who cares about his patients SHOULD act. I still have hope for a good outcome thanks to his aggressive treatment of complications.
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Just to put in my 2 cents, if you don't have enough Vitamin C to build Collagen during the healing process, your wound will heal weaker and be much more likely to dehise.
As Vitamin C is a water soluble nutrient, it is not possible to overdose on it, if you have normal kidney and bowel function. When you get to tissue saturation with Vitamin C orally, you can expect to get loose stools. When you are sick, or under stress, your need for Vitamin C is exponentially higher than when you are well. That is why you will be able to have a considerably higher amount of Vitamin C by mouth before you get diarrhea now than you would under ordinary circumstances. For instance, you could have 2,000mg of Vitamin C normally and get loose stools, and 3,000 to 6,000mg, or even higher before getting loose stools, (which would indicate tissue saturation) when sick or physiologically stressed.
Other nutrients that are also important for wound healing are Vitamin A, D3 and Zinc. I hope you are getting Vitamin D3 5,000IU per day.
http://www.surgerysupplements.com/the-role-of-vitamin-c-in-wound-healing/
Vitamin C: a wound healing perspective.
Abstract
Vitamin C, also known as ascorbic acid (AA), is involved in all phases of wound healing. In the inflammatory phase it is required for neutrophil apoptosis and clearance. During the proliferative phase, AA contributes towards synthesis, maturation, secretion and degradation of collagen. Deficiencies affect the maturation phase by altering collagen production and scar formation. The body strives to maintain homeostasis of AA, thereby ensuring availability for collagen synthesis. After wounding, plasma and tissue levels of AA diminish and, as a consequence, supplements may be useful for healing, although levels beyond saturation are excreted Clinicians need to be aware of both the nutritional status of patients with either acute or chronic wounds and the possibility of any AA deficiency which may hinder healing.
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Hello, first time poster. I had a double mastectomy 1/29/19, nipple sparing. Shortly after surgery the cancer side (left) turned dark purple then like a burned marshmallow. I had to have a second surgery to remove the necrosis and the nipple. I have had expanders in and doing quite well. For fills, he has been doing 60 cc's and we had changed to to every other week, 1. because of work and their lack understanding and 2. to let the skin stretch and heal. The left side has funky scars and the skin is very thin. Last Thursday, we only did 25 cc's because he said he could see it "blanche" and we want to take our time. Fill days for me are usually extremely painful because it is under the muscle and again, we are stretching that skin.
Throughout this time, inside stitches "poke" out and either start as a small pink bump and then poke through. He usually is able to "trim" them because they are a very heavy stitch and he said they will take a long time to dissolve. Saturday or Sunday I noticed one stitch had come through with a small clear fluid. I am constantly putting lotion on and nothing tight so I assumed normal. Now there is a round hole, small, but increasing, so I used the antibiotic cream I had from hospital in February, and I cover with a light dressing. There is a yellow/pink discharge now and I am beyond freaking out. I am at 535 cc's, hoping to get to around 600 cc's which would be about a size "C" and looks decent on my frame since I was a small B.
I see my PS surgeon today and I am worried about the outcome. Has this happened to anyone???
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