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    Heal a wound over tunneling?

    Asking for a friend. Is it ever okay to let a wound heal that has undermining and tunneling? His is not getting packed, just covered over with foam dressing. He was just taken off a picc line for osteomyelitis. The last measurement for the tunneling was 4 cm and undermining all the way around the wound. The doctor says if it still has an infection it will not heal and if it is not infected then it will heal. So the plan is to try to let it heal completely over and see what happens. I am very uncomfortable with this and told this to my friend. What is the consensus here?

    #2
    If there is tunneling or undermining of a wound it may heal over it but it will not be permanent.
    Its like having shifting sand under a board It be stable for a while but not for long

    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


      #3
      Originally posted by SCI-Nurse View Post
      If there is tunneling or undermining of a wound it may heal over it but it will not be permanent.
      Its like having shifting sand under a board It be stable for a while but not for long

      pbr
      Thank you. I am concerned about infection control as well. Is that right? I will talk to him.

      Comment


        #4
        Ain't gonna work. We tried that for years. Finally the surgeon set a date for surgery to close it up. Wasn't going to be a big deal but would be laid up in a Clinitron for 6 to 8 weeks. Just prior to surgery, the tunneling got infected and within hours was heading for the femoral artery. Came really close to cashing it in. He had to do a major cleanout of the infection and then a two week lay up in a clinitron bed with massive amounts of antibiotics. Then a 5 hour surgery to close the wound and an 8 week 24/7 laydown in a clinitron bed in assisted living. It never really closed up so he went in and did major surgery again with another 6 week stay in assisted living and a Clinitron bed.

        I got home; the wound wasn't quite closed up so I did the lay down routine. Kept going to the doc for different treatments to get it to close. One day I went down hill fast. By the time I got to the ER in an ambulance my blood pressure dropped to 40. They tried and tried to get it up to 90 so I could be sent up to ICU. The ER doc said he was going to try one more technique and if that didn't work, he was going to let me go as I had a DNR in my records. They got it up to 90 by inserting a line down the carotid artery. Turns out I had an abscess under the newly almost closed wound. Probably had it since day one. If they had done an MRI they would have found the abscess earlier. He thought I couldn't have an abscess because of the heavy doses of Antibiotics I was given so never had an MRI done. Another 2 week stay with drainage tubes and in the Clinitron bed. Had Mri's almost everyday to check on the progress. Once we knew it was gone, the wound closed up quickly. I had a seating eval and ended up with a Java cushion. It'll be two years since the ordeal ended and no problems since.

        Get that tunneling under control, do the surgery and laydown and be done with it. I wasted years trying to do it the way you're trying. Once an infection sets in, it'll either kill you or in the least, make it much tougher with a whole lot more scarring etc.

        The doc said sepsis infection seems to have a mind of it's own. They head towards the nearest artery and once it enters the blood stream it can be deadly in a matter of hours.

        Comment


          #5
          As mentioned above by Patrick not only would you be concerned about infection of the tissue but also of the bone once the bone is infected it is extremely difficult to eradicate. The bone has to be cut out if infected treated with IV antibiotics and of course as mentioned reconstruction with plastic surgery. That damaged bone will always be at risk for reinfection again.

          I hope your friend gets the medical attention he or she deserves

          pbr
          Last edited by SCI-Nurse; 22 Dec 2018, 12:09 PM.
          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
            Tell your friend to go for flap surgery. Better outcome, faster healing and less chance for the recurrence. One thing came to my mind. No wonder medical care in the USA is so expensive. I spent 4 weeks on bedrest on a ROHO overlay (no fancy Clinitrons or LAL mattresses), turned every 3 hours on my sides and stomach, and it healed properly (ischial pressure sore). After 4 weeks I could start sitting program, starting from 30 minutes twice per day, ending on 6-7 hours per day one month later. Now I sit 9-11 hours per day with no problems. I do weight shifts every 15-20 minutes though and sleep in prone position. All people from the wound unit I was in follow the same schedule and there are barely any reoperations. If someone follows this schedule, uses proper cushion, performs regular weight shifts, it will be fine. Almost all pressure sores are the result of one's negligence.

            I also had osteomyelitis, surgeons don't fuck around and just cut out the bone, there is little chance antibiotics will fully eradicate this. Btw, is there any research about outcomes of flap surgeries in Europe and US? I haven't found any and I'm asking because some advice from SCI Nurses (especially KLD) sound often ridiculous. I bet (I may exclude UK) few surgeons in Europe have ever heard of Clinitron beds or even LAL mattresses.

            Comment


              #7
              Originally posted by Patrick Madsen View Post
              Ain't gonna work. We tried that for years. Finally the surgeon set a date for surgery to close it up. Wasn't going to be a big deal but would be laid up in a Clinitron for 6 to 8 weeks. Just prior to surgery, the tunneling got infected and within hours was heading for the femoral artery. Came really close to cashing it in. He had to do a major cleanout of the infection and then a two week lay up in a clinitron bed with massive amounts of antibiotics. Then a 5 hour surgery to close the wound and an 8 week 24/7 laydown in a clinitron bed in assisted living. It never really closed up so he went in and did major surgery again with another 6 week stay in assisted living and a Clinitron bed.

              I got home; the wound wasn't quite closed up so I did the lay down routine. Kept going to the doc for different treatments to get it to close. One day I went down hill fast. By the time I got to the ER in an ambulance my blood pressure dropped to 40. They tried and tried to get it up to 90 so I could be sent up to ICU. The ER doc said he was going to try one more technique and if that didn't work, he was going to let me go as I had a DNR in my records. They got it up to 90 by inserting a line down the carotid artery. Turns out I had an abscess under the newly almost closed wound. Probably had it since day one. If they had done an MRI they would have found the abscess earlier. He thought I couldn't have an abscess because of the heavy doses of Antibiotics I was given so never had an MRI done. Another 2 week stay with drainage tubes and in the Clinitron bed. Had Mri's almost everyday to check on the progress. Once we knew it was gone, the wound closed up quickly. I had a seating eval and ended up with a Java cushion. It'll be two years since the ordeal ended and no problems since.

              Get that tunneling under control, do the surgery and laydown and be done with it. I wasted years trying to do it the way you're trying. Once an infection sets in, it'll either kill you or in the least, make it much tougher with a whole lot more scarring etc.

              The doc said sepsis infection seems to have a mind of it's own. They head towards the nearest artery and once it enters the blood stream it can be deadly in a matter of hours.

              Patrick, wow thanks for all this information. This case is very much similar to yours. It started out as a superficial abrasion the size of a nickel that would not heal. After going to a wound clinic and trying several different types of dressings, it finally healed three months later, except for one very small area. He was discharged from the wound clinic. About a week later a tiny pinhole started to discharge a fluid from that area that looked like water. The next day it changed to a pus like substance, lots of it. He went back to the wound clinic with a fever. He was admitted and was septic. He went in for surgery the next day to open up the abscess. The wound after surgery was about 5 cm all the way around with undermining and tunneling to the bone. A biopsy showed positive for infection. He went home for 8 weeks with a picc line for antibiotic infusions every 8 hours that he adminstered himself. He had a wound vac placed while in surgery.

              After the picc line was removed, so was the wound vac. The wound still had 4 cm tunneling and undermining all around the wound. The doctor decided to let the wound heal over the undermining and tunneling. At this point the wound healed over except for one small area about the size of a pencil tip and still draining. This is what is really concerning me right now. I don't think this is a good idea. How is anyone to know if the osteomylitis is gone? His sed rate is still high.
              Last edited by Sugarcube; 22 Dec 2018, 7:14 AM.

              Comment


                #8
                Originally posted by K_Soze View Post
                Tell your friend to go for flap surgery. Better outcome, faster healing and less chance for the recurrence. One thing came to my mind. No wonder medical care in the USA is so expensive. I spent 4 weeks on bedrest on a ROHO overlay (no fancy Clinitrons or LAL mattresses), turned every 3 hours on my sides and stomach, and it healed properly (ischial pressure sore). After 4 weeks I could start sitting program, starting from 30 minutes twice per day, ending on 6-7 hours per day one month later. Now I sit 9-11 hours per day with no problems. I do weight shifts every 15-20 minutes though and sleep in prone position. All people from the wound unit I was in follow the same schedule and there are barely any reoperations. If someone follows this schedule, uses proper cushion, performs regular weight shifts, it will be fine. Almost all pressure sores are the result of one's negligence.

                I also had osteomyelitis, surgeons don't fuck around and just cut out the bone, there is little chance antibiotics will fully eradicate this. Btw, is there any research about outcomes of flap surgeries in Europe and US? I haven't found any and I'm asking because some advice from SCI Nurses (especially KLD) sound often ridiculous. I bet (I may exclude UK) few surgeons in Europe have ever heard of Clinitron beds or even LAL mattresses.
                All of this is probably the route to go. Going to let him know. Not sure how to get the ball rolling, but looking into it. Thanks for this post.

                Comment


                  #9
                  He's trying. These posts confirm my thoughts. Thank you.

                  Comment


                    #10
                    Four weeks then the protocol?
                    How the hell can surgeons do that to you?
                    Mot flaps fail anyway.
                    Ugh



                    Originally posted by K_Soze View Post
                    Tell your friend to go for flap surgery. Better outcome, faster healing and less chance for the recurrence. One thing came to my mind. No wonder medical care in the USA is so expensive. I spent 4 weeks on bedrest on a ROHO overlay (no fancy Clinitrons or LAL mattresses), turned every 3 hours on my sides and stomach, and it healed properly (ischial pressure sore). After 4 weeks I could start sitting program, starting from 30 minutes twice per day, ending on 6-7 hours per day one month later. Now I sit 9-11 hours per day with no problems. I do weight shifts every 15-20 minutes though and sleep in prone position. All people from the wound unit I was in follow the same schedule and there are barely any reoperations. If someone follows this schedule, uses proper cushion, performs regular weight shifts, it will be fine. Almost all pressure sores are the result of one's negligence.

                    I also had osteomyelitis, surgeons don't fuck around and just cut out the bone, there is little chance antibiotics will fully eradicate this. Btw, is there any research about outcomes of flap surgeries in Europe and US? I haven't found any and I'm asking because some advice from SCI Nurses (especially KLD) sound often ridiculous. I bet (I may exclude UK) few surgeons in Europe have ever heard of Clinitron beds or even LAL mattresses.

                    Comment


                      #11
                      I'm almost 9 months post flap, finally I can live normal life. Trying to heal IV stage pressure sores with dressings or wound vac is a waste of time, money, energy and worthless suffering. Once the bone gets infected, there is no way to heal it unless you get the flap done. Period. And it's not true most flaps fail. Any evidence on that? What does 'failed flap' mean? One that requires immediate reoperation? Pressure sore recurrence? If the sore recurs in the same spot after a few months, then it's not the surgeon's fault but patient's stupidity and negligence.

                      Comment


                        #12
                        So here's an update. The doctor reopened the wound. He was sent home with gauze dressing to cover it and instructed not to remove it for 4 days. Needless to say, the gauze became so saturated with blood that the dressing became too wet to stay in place and came off the following day. The wound looked terrible to me. The cavity, that the doctor thought would heal on its own, is completely visible. This is so frustrating.

                        This feels like he has taken 100 steps backwards. The only good thing is that all of the drainage is no longer staying within the wound. It looks like all of the progress that has been made with the wound vac was for nothing. I'm worried that there may still be Osteomylitits going on. What to do next?

                        Comment


                          #13
                          ER, different doctor, lawyer.

                          Comment


                            #14
                            I'm so sorry he's going thru this SC. It seems the docs spend more time concerned about what insurance will pay than doing the necessary steps to get it over with.

                            What really helped me was the Ride Java Cushion. The hole in the center offloaded all the pressure that was on the wound. Forget ROHO, IMO, they are the worst thing a person can use, esp. women. The rubber holds in heat and moisture more trouble. If he's using one. you may want to tie off the nodules under his wound so there is no pressure on the wound.

                            Yep, ER, different doc.

                            Comment


                              #15
                              Baldfatdad, He doesn't want to sue. He just wants to get better. It is hard to find doctors who have had a lot experience with sci. Looking into what other doctors have to say might be a good idea though. Thanks for your input.

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