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Bone-Like Chips and Nodules Formed in Tissue Near Almost Healed Wound

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    Bone-Like Chips and Nodules Formed in Tissue Near Almost Healed Wound

    After spending the last 4-5 months lying on a air filled Dolphin bed and having a woundVAC attached to my right tronchator pressure sore, it almost closed. It started at about 1.5x2cm wide and 1.5 deep and shrunk to .4cm. Granulation was taking a long time.


    Every week, the doctors at the Wound Clinic debride it. About 6 weeks ago they started finding little chips of hardened bone-like material. One doctor asked if I had a history of calciphylaxis.


    Everything looked great 3 weeks ago - sent the WoundVAC and bed back and was discharged from Home Health nursing.


    Then about 10 days ago, overnight, the wound flared up looking very red and angry and twice its size. Went to the Wound Clinic finding it had grown from .4 to 2.5 in depth. The doctor extracted a white stone between the size of the top of a Qtip cotton head and a small tooth. Attached was a string of clear mucous. Both the doctor and nurse said they had never seen anything like it. He cultured it but I still haven't hear the results.


    Four days later, home health nurse installed the WoundVAC and said that wound was tunneling and was now 3.5 cm. I've been sick all weekend with fevers ranging from 100-102.7, chills and wringing in sweat. Must be infected because I am so weak and tired.


    The wound doctor scheduled the surgeon to see me on Monday to cut it out and close it. My question is - if the wound flare-up is caused by irritation from all the bone-like chips surrounding it, shouldn't that be addressed before surgery is considered? Logically, it would appear that closing the wound up won't stop the irritation from the hard "chips" in the tissue.


    My lab for thyroid sensitivity was low. (The thyroid regulates calcium in your body). The doctor ordered a parathyroid PTH lab test (parathyroid hormone serum).


    Is anybody familiar with this? I haven't found many results in my Google searches. They mostly associate this with end stage renal disease.

    #2
    The culture results would be important because infected wounds shouldn't be closed.

    Is there any reason why they don't think the "chips" are from early stage Heterotopic Ossification in the soft tissue and muscle around your hip trochanter?

    Calciphylaxis is a really rare condition. The blood vessel calcification associated with it is microscopic, not Q-tip size. Don't scare yourself on Google

    Wishing you a speedy recovery from the surgery.


    Last edited by 2drwhofans; 6 Sep 2015, 6:03 PM.

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      #3
      I would bet that you are experiencing heterotopic ossification, not calciphylaxis. HO as it is known is far more common in individuals with spinal cord injury. It needs to mature before it is surgically removed, which takes time. It can cause. Wound to open up. The other option could be from osteomyelitis, but much less likely if it is embedded in the wound.

      i would ask your physician to look into these causes before assuming the worst.

      ckf
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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        #4
        I have never heard of this! I wonder if this is why my foot wounds have never healed.
        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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          #5
          Any time there is a protruding bone or bone growth below the surface of a healing wound that re-opens does need an opinion from a surgeon. The surgeon can weigh in whether the bone or bone growth can be shaved so as to not be protruding, but also do a bone biopsy to see if there is infection in that area. Infection or pressure can prevent a wound from healing on its own. All the wound vac does is bring in the blood supply which is a great contributor to healing a wound.

          pbr
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


            #6
            I am curious if you have experience with NPWTi, pbr? I've read that it works well in treating infected wounds even osteomyelitis infections. Another for osteomyelitis was phage therapy or biocontrol. Some feel that it may be a better treatment of treating infections over antibiotics, especially with bone infections. I don't think that it is a popular method but has shown good results treating infections.

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              #7
              Heterotopic Ossification Triggered by Pressure Wound

              Originally posted by SCI-Nurse View Post
              I would bet that you are experiencing heterotopic ossification, not calciphylaxis. HO as it is known is far more common in individuals with spinal cord injury. It needs to mature before it is surgically removed, which takes time. It can cause. Wound to open up. The other option could be from osteomyelitis, but much less likely if it is embedded in the wound.

              i would ask your physician to look into these causes before assuming the worst.

              ckf

              Thank you for all your posts. I read some of the other threads here and links to HO. Yes, it definitely sounds like that is what it is. I'm following up with my doctor.

              New question: If HO is growing at an infected wound site, the right trochanter, what would a surgeon do? I read that a flap surgery can also trigger HO.

              Comment


                #8
                To Brent K Yes NPWTi - seen it as treatment for patients - I've seen it nearly close wounds that were then treated topically with dressings until healed.
                I have also seen that it works to a point and then stops.

                The think about wounds is that not one is alike. The "ideal" wound is in a healthy individual that closes. But there are so many factors that complicate the healing process that you really have to be "big picture" and look at the many factors. Nutrition, Blood Flow, inflammation, Infection, Pressure from outside and inside (bones), history of other illnesses, mobility, immobility, etc.

                To Broken Doll - Yes HO can be "ignited" after being dormant. It is best to consult with a surgeon to get her/his opinion on this and the HO before proceeding.

                pbr
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  Can HO cause dysreflexia? My blood pressure is not that high but I am sweating like crazy, needing to change my shirts and pajamas a few times a day. Not to mention, because we are experiencing three digit temperatures so air-conditioning is everywhere and with the sheen of moisture on my skin I'm freezing. Very uncomfortable.

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                    #10
                    By the way, what is the medical term for excessive clamminess and sweating?

                    Comment


                      #11
                      Originally posted by Broken Doll View Post
                      By the way, what is the medical term for excessive clamminess and sweating?
                      Diaphoresis

                      Re: "Can HO cause dysreflexia?"

                      Yes

                      Did you have the surgery or have a chance speak with the surgeon? Concerned because the weekend is almost here.

                      Comment


                        #12
                        Originally posted by 2drwhofans View Post
                        Diaphoresis

                        Re: "Can HO cause dysreflexia?"

                        Yes

                        Did you have the surgery or have a chance speak with the surgeon? Concerned because the weekend is almost here.

                        Thank you for "diaphoresis".

                        I have a MRI tomorrow on my right hip where my wound reopened to see if bone is infected and hopefully to see extent of HO. I asked if they could look at left hip too since it's such a big hassle for me to get undressed and dressed for the MRI, but the Dr. said there was no clinical indication to do so. I'd like to know for preventative reasons to take action to avoid a pressure sore on the other side.

                        on Friday , I meet with my physiatrist to get his spinal cord injury specialist opinion.

                        next week, I meet with the wound clinic plastic surgeon. After reading that HO is not all that common and requires a special knowledge, I'm a bit apprehensive about his opinion.

                        1) Any advice on questions to ask him to make sure he is qualified to handle HO appropriately?

                        2) Or any recommendations for a surgeon experienced with HO in Southern California?

                        Comment


                          #13
                          Originally posted by Broken Doll View Post
                          Thank you for "diaphoresis".

                          I have a MRI tomorrow on my right hip where my wound reopened to see if bone is infected and hopefully to see extent of HO. I asked if they could look at left hip too since it's such a big hassle for me to get undressed and dressed for the MRI, but the Dr. said there was no clinical indication to do so. I'd like to know for preventative reasons to take action to avoid a pressure sore on the other side.

                          on Friday , I meet with my physiatrist to get his spinal cord injury specialist opinion.

                          next week, I meet with the wound clinic plastic surgeon. After reading that HO is not all that common and requires a special knowledge, I'm a bit apprehensive about his opinion.

                          1) Any advice on questions to ask him to make sure he is qualified to handle HO appropriately?

                          2) Or any recommendations for a surgeon experienced with HO in Southern California?
                          A lot of the decision making will depend on your MRI results but, base on your initial 9/6/15 post: "Went to the Wound Clinic finding it had grown from .4 to 2.5 in depth. The doctor extracted a white stone between the size of the top of a Qtip cotton head and a small tooth. Attached was a string of clear mucous. Both the doctor and nurse said they had never seen anything like it." , the wound care Plastic Surgeon may not be your person for H.O. treatment advice.

                          Your SCI Physiatrist will likely be the best source for recommendations and referrals.

                          There was a CareCure post not too long ago about a new type of catheter being developed by a SCI Marine. I wanted to read more about him and remember that his experience with H.O. surgery was available online.

                          Have a look : http://www.derekherrera.com/heterotopic-ossification/

                          He lists a few really good questions to ask any surgeon before undergoing an operation.
                          Last edited by 2drwhofans; 23 Sep 2015, 3:59 PM.

                          Comment


                            #14
                            Thank you 2dwhofans. Great questions from Mr. Herrera.

                            Comment


                              #15
                              Broken doll any updates or answers about what's going on with your wound? I't sounds like the same thing I've been dealing with the last few months. I've had a wound vac on since August 11th and my wound is healing VERY SLOWLY. It's been a nightmare dealing with the wound care doctors & nurses, infectious disease doctors & plastic surgeons. Non of them seem to be on the same page because they don't seem to communicate with each other. I live in the Houston area, a huge medical center of hospitals but still can't find any doctors with answers. TOTALLY RIDICULOUS & UNACCEPTABLE. I'm at my wits end & ready to throw in the towel. ��

                              I hope you've found some answers & are on the mend! ��
                              Renee

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