wound care
Comments
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Hi
I had a bilateral mastectomy beginning of April. I now have three wounds on my incision site and one seroma which was leaking through the wound. My ps said to shower twice a day and place gauze into the wounds. So far , no infection, but these wounds are big. ?Has anyone used a wound care specialist, and/or a wound vac? I have not had reconstruction.
thanks for advice,
Cary -
I had several large 'wounds' along my incision line. The surgeon said to keep an antibiotic on them. I used Polysporin. No infection and it kept them nice and soft. I tried some generic antibiotc creams, but the Polysporin was the smoothest to apply on the sensitive areas. After 11 weeks, all the 'holes' have filled in. My joke was that there was no danger of the incision NOT healing from the inside out!
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I had a flap in April and have a wound on the side of my breast. It's really gross looking and oozes out a yellow bloody mess. My PS doesn't seem overly concerned with it. She has me cleaning it once a day, applying Silvadine cream and keeping it covered with a guaze dressing. I'm hoping it heals soon.
I think these type of wounds are fairly common with the surgeries we're going through.
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Yup, I'm definitely healing from the inside out, since my abscess was opened up!
My husband, bless his soul, was a Navy corpsman in VietNam, so at least I don't have to pack it myself. I wish my surgeon seemed to care a little more, but I suppose he sees a lot of this.
This is very yucky - as my teenager reminds me daily.
By the way, does anyone else's ITCH?
Sue
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Itching can mean healing going on. I was told it was a good sign. I had some minor healing issues this past surgery but nothing like you ladies. A few years ago I did have an infection that they had to open on my abdomen and let it heal inside to out. They had me doing wet to dry dressings every day. It took a good month for it to heal (went down to the facia). They are yucky though. Prayers and best wishers for everyone!
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Cary, Are you doing wet to dry packing or just dry gauze? I had forgotten about the showering twice a day but I do remember doing the wet to dry packing 3 times a day for almost 4 months. Fortunately, it does all heal and any scarring can be taken care of and become a thing of the past.
Hang in there! This, too, shall pass.
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Thank you all for your comments and well wishes. It's nice to know I'm not the only one. Interesting, my surgeon is kind of blase about the wounds, while my wound care specialist wants to be more aggressive. No one suggested antibiotic cream. I am putting in dry gauze. What do you use to wet the gauze? also, what is silvadene cream? I was also told to keep an eye(?)/nose to the smell that comes off the gauze. Different smells can mean different kinds of infections.
hanks again,
Cary -
Cary - My ps had me just doing dry dressings for the first couple of weeks when this opened. She gave me the silvadene cream when I saw her last Monday. Silvadene is a prescription cream used to fight bacteria in wounds (used a lot on burn patients). So far I'm not seeing any great improvement, in fact I think it has opened up more since last Monday.
I'm seeing my BS on Monday so I'm going to have her look at it. It looks horrible to me and cleaning/dressing it pretty much grosses me out, but to them it may be a very normal occurance. I don't see the PS until the 16th so I'm glad I had this follow up with the BS in between. Hopefully she'll tell me I'm healing OK.
Did you go to a wound specialist on your own or did your surgeon send you there?
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Hi Cary - I feel like an expert on open wounds.....my abdominal incision opened up about March 10th, 7 days after my Diep surgery. It was extremely disturbing to look at - I still feel like Frankenstein monster sometimes!
I've been packing it twice a day - in the morning after I shower and in the evening before bed. My plastic surgeon has me using a Collagenase ointment called Santyl - more info about this drug is here: http://www.rxlist.com/cgi/generic/collagenase.htmI'm jealous to read how other women's wounds have healed faster than mine - but then again, my incision opened due to a staph infection and it was pretty deep.
Cary it sounds like your surgeon is like both of mine - my PS and breast surgeon kept saying, "Oh you're healing so well!" whereas I felt like it's taking too long......I probably should have gone to a wound specialist weeks ago - but I'm almost healed now, so it's water-under-the-bridge.
There are other women on this site who have used a wound-vac Cary - so you came to the right place. Good luck with your healing!
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Hi
I found a wound care specialist on my own. Asked my bs and she said the they didn't have one for out patients! I was traveling two hours each way weekly to NYC and decided to find a specialist close to home. He recommended Aquacel Ag, but I haven't started it yet. I hear a wound vac may not really be any more effective? I think the surgeons see this matter differently than us.
Cary -
I was given a saline solution to wet the gauze. It gets wet then you squeeze out most of the water before packing. I also bought a saline wound wash at the drug store that worked really well for flushing out the wound. It is a spray that could get up in there (my hole was in the bottom of the breast and went up). I used no medications or creams there.
I remember feeling like it was the end of the world but the doctors were pretty calm and matter-of-fact about it all. I thought that they obviously weren't understanding the problem.
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Kathy - Just wondering if once you started treating the wound did it get worse before it started getting better. My incision had a small spot that was oozing and the ps just had me keeping it clean and covered. When I saw her last Monday she cleaned that out and also removed quite a bit of scabbing that was adjacent to it. So I left there with a much bigger wound than I went in with. I feel like it's gotten somewhat bigger since then even though I'm cleaning it and applying the silvadene cream everyday. Just wondering if it's normal for it to look a little worse before it starts getting better.
How long does it take these things to heal?
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Well, in my case it got worse before it got better. I had the fat necrosis that liquified. I went in with a section that was squishy and leaking something and left with a big hole and gauze stuffed up in there. My doctor said that it was is the 'vomitous' stage. That was correct in two ways. Anyway, I had to wait for the liquification to stop before the healing could begin. There is a huge difference in the smell when that happens. The healing from the inside out takes time but it does happen. Try to just take care of the bandaging as directed and forget about it the rest of the time. Get on with your life and keep things normal. Don't let it take you and your personality over.
Mine took about 3 1/2 months to heal. Mine started about 6 weeks post-op (surgery was Jan. 3) and would no longer hold the wet gauze by the middle of May. That was a good thing. It meant that there was only scar tissue there and nothing left to heal. It's gonna take as long as it's gonna take. Hang in there - it will be over and your PS will do wonderful things to correct any scarring.
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Thanks Kathy. My BS saw it today and immediately changed the care to 3 dressing changes a day and wearing a bra 24/7 to keep the weight of my breast from pulling it open (it's on the top/side). She wasn't overly concerned about it either, but I think they're just so used to looking at these things. The oozing has eased up since last Monday and it doesn't smell at all. It does bleed when I change the dressing but the PS said that was a good thing because it means there's a good blood supply to the flap. My biggest worry is losing the flap but they both seem to think it's going to be OK.
Thanks for the advice on not obsessing over it. I've definitely been doing that and do need to try to get my mind off it.
We just never know how this journey is going to turn. . .a couple of weeks ago I was worrying over how I was going to camoflauge my lopsided boobs in a swimsuit and now I'm just hoping to get this wound healed before the end of the summer so I can enjoy the lake a little.
Getting through this crap is so much easier with the women on this board who can say, "been there, done that, hang in there, it gets better". Thanks.
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I don't know how many of you fine ladies are still checking this particular topic, but I need your expertise. Unfortunately, I have had a surgeon whose favorite saying is "It just takes time." I had my surgery Nov. 17, 2008. One week later at my post-op visit, she pulled off the tape and said "hot spot because of your thin skin"; her instructions were to use neosporin and keep covered. One week later, redness encircled outer edges. I called and went in. Again, no big deal--toher; no infection but just keep clean, dry, and uncovered, but did drain seroma which had formed underneath. Over next few weeks, hard black crusty scab covered nickel-size indentation with red rim continuing. I called her office to see if I needed to dab something on it to hasten the scab falling off. Went in 12/23 and she assured me no infection but she removed scab. Now, shallow hole looks terrible (yellowish mucus?) and draining of pinkish fluid is occurring periodically (no odor). Today (12/26), called office which was closed; then called emergency number. I was assured by some woman (no credentials given) this drainage is good and no need for antibiotics. The real problem with all of this is 1) I wish my surgeon had been more forthcoming with what to expect and 2) my chemo is scheduled to begin Jan. 30. Big questions for anyone: Did your wound recovery postpone your chemo start-date? How long between your surgery (the healing of the wound) and chemo???????????? I'm very worried..........
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Hi
I had my tram flap surgery Oct 6, 08 and am still dealing with two open wounds. I go once a week for the PS to check it and debrie it. He cuts away all dead skin and packs it. I pack it twice a day with a wet saline gauze. It is gross and I dont' see how it is ever going to heal. The hole is pretty deep the other one seems to be getting smaller. I panicked when mine turned black. I went in the next day and had to have surgery to remove the necrosis (dead skin) in the O.R.
I had my chemo prior and radiation last year, this is my 2nd round with cancer. It came back 10 months after I completed radiation. so I don't know how your chemo will be affected. Because chemo kills your immune system, I would think they will monitor your wound to make sure it does not get infected. Try not to worry, your oncologist will postpone chemo if he/she thinks your body is not ready yet.
Good luck.
MB
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babyc -- I haven't been on a while and just saw your PM. Sorry I haven't responded sooner. I think your PS is being non-chalant about the wound because they see these things all the time and know they will eventually heal. I know I used to get aggravated with mine because I was sick of taking care of it and thought she should do more, but she was right and it did heal. My wound was approximately 2 inches long, 1 inch wide and about 1/2 inch deep at it's worst point. I cleaned and packed it twice a day for 6 1/2 months before it finally closed. The woman who told you the drainage is good is right, you definitely want that stuff to come out. I hope it has gotten better for you by now. I have no idea how it will impact your chemo because I was fortunate enough to not need chemo.
MB - Sorry to hear you're dealing with a recurrance and open wounds. Hang in there, they do heal but it takes a while. Of course some are faster than others and I hope yours heals fast. They have to heal from the inside out which is why they have to be packed and left open. It was definitely one of the grosser things I've had to deal with in life. After mine healed I am left with a large dent where it was but my PS assures me she can fix it. I will be having that surgery late March.
Hope you're both doing better. Take care.
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Thanks for your response and concern.... I've not had to do any packing or such. With a bilateral mastectomy (no reconstruction), I guess I expected the incisions to heal quickly and easily. This was indeed the case for my left side. This small spot on my right side has successfully postponed my chemo for two weeks (I was originally scheduled to begin Dec. 30, not Jan. 30 as I mistakenly posted). It will probably do so again for at least one more week (six to 12 weeks window for optimum benefit from chemo according to some study). If there is some up-side to all of this, it would have to be that I have used this time to address some possible dental issues. I see my oncologist tomorrow and expect to hear one to two more weeks. Even though I know this is not an earth-shattering development, I do want to talk to her about a wound specialist; surely, there is something to "dab" on this.... I want to begin chemo no later that 10 weeks.....(like "our wants" have any place in all of this!!!!!!!!!) Anyway, best wishes to you all for the New Year.
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Hi
I developed two wounds on one of my breast incisions after my bilateral mastectomy with reconstruction. The wounds turned out to be a necrotic flap (dead black skin) with yellow drainage but not infected. The PS prescribed Santyl oinment( which is a collagenase ointment) twice a day, my wound care nurse added CarraKlenz which is a dermal wound care cleaner which can be used with the Santyl oinment. I cleaned the wound with CarraKlenz and then applied the Santyl Oinment and covered them with gauze and my bra. The wounds did push my chemo back and when I started chemo the wounds kind of stopped healing. Now I am done with my chemo the wound have closed and new skin is growing in. Now I am using Medema Oinment on the scar. If you have a wound make sure you are eatting more lean protein and Vitamin C. A healthy diet is very important to wound healing.
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Hi
I developed two wounds on one of my breast incisions after my bilateral mastectomy with reconstruction. The wounds turned out to be a necrotic flap (dead black skin) with yellow drainage but not infected. The PS prescribed Santyl oinment( which is a collagenase ointment) twice a day, my wound care nurse added CarraKlenz which is a dermal wound care cleaner which can be used with the Santyl oinment. I cleaned the wound with CarraKlenz and then applied the Santyl Oinment and covered them with gauze and my bra. The wounds did push my chemo back and when I started chemo the wounds kind of stopped healing. Now I am done with my chemo the wound have closed and new skin is growing in. Now I am using Medema Oinment on the scar. If you have a wound make sure you are eatting more lean protein and Vitamin C. A healthy diet is very important to wound healing.
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Good News! My onc. says Monday is the day to begin chemo. She looked at my spot today and said it's time. I felt it could have gone either way. Anyway, I'm ready. Agnes 17, were you using the cleaner, ointment, and gauze covering throughout your chemo?
Everybody, thanks for your input and support!
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Hi Babyc - last summer I had chemo while also packing an opened abdominal incision about 8 inches across, 1 inch tall and 1/2 inch deep - my oncologist said the chemo couldn't wait. I had a free-tram reconstruction and developed MRSA in my abdomen which caused the wound to open. I had to pack it twice a day for four months - like Agnes, I used Santyl ointment twice a day, but only Dial anti-bacterial soap in the shower. It was very gross dealing with this.......but even during chemo treatments, the wound slowly closed up. I'm now left with an ugly red scar and will need more surgery this summer (when I'm finished with Herceptin) to repair the large abdominal hernia/bulge I'm left with. The four months of chemo was with Navelbine (not as strong as other chemo's) so perhaps that made the healing easier for me.
I wish you luck with your chemo and healing - let us know how you feel!
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Thank you SwimAngel for the info. My "spot" is looking better and better. It sounds like you really went through it and have more to go; there is just nothing simple about any of this.....
I'll be on taxotere and cytoxan- 4 rounds. I am quite relieved to get this next phase started. I've got my bag packed and ready to report at 8:30; it really looks like I'm moving in. I made a batch of fudge for onc.'s staff. My mama always said to "make 'em glad to see you!" We'll see how that works out.
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I am using a wound vac after having three areas debrided of dead skin after my DMX and DIEP reconstruction. I hate the thing, but when my dressings were changed on Thursday (six days after the surgery to remove the skin and dead tissue areas) the wounds look clean, healthy and healing, and close to ready for the skin grafting surgery scheduled for Monday.
I do hate the wound vac--just because it is an annoyance. My PS is obsessive about no infection, and so far I have had just one small spot that got infected--he completely cleaned it out and it is now being wound vac'ed until my surgery for grafting tomorrow.
I would say the types of wounds you are dealing with are a whole lot to handle at home.....my doc would be working them to make sure the flaps were spared and my health was not compromised
do you have to have authorization from insurance to see a wound specialist? If not, go and find one, please? It seems some doctors let wounds go too far and the last thing anyone needs is a generalized infection from wounds the doctor didn't take seriously. A friend recently had a c-section, the incision site ended up with a staph and MERSA infection--two ER trips for help, and just a few days later hospitalized and successfully treated. You know your body, find a provider who respects your concerns, they do not sound extreme to me..... -
StarlitMomMom - This Thread was started in May, '08 and last posted on (until you) in Jan '09. Several of those who posted back in 08/09 have not been back to the site in years, a couple have been back recently.
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