Wound Question

They say the group is always smarter than the individual.  So I thought I’d throw this one out to y’all.

I had an open wound from my second surgery.  It has finally scabbed over by leaving it out of the boot and exposed to air.  Certainly has taken awhile…over a month.  Fortunately, no infection.

My question:  now that it has scabbed over, do I treat the scab with anything (Neosporin, etc.)?

My doctor was unhelpful about this.  I’d love to know what any of you did or would suggest.  And, I know, you aren’t doctors and any advice is taken at my own risk…

Here’s a photo (sorry if it’s gross but it looks a million times better than it did at beginning of week):

Wound at 30 Days

Thanks in advance for any advice!

UPDATE:  Here is what it looks like at two months:

Wound at Two Months

It’s getting better but sloooooooooowly.

26 Responses to “Wound Question”

  1. My doc was very explicit - NO neosporin - just soap and water. I have also been using hydrogen peroxide on it once a day.

    The key is to keep it out of the boot as much as possible - for me, at least, the boot was the wound’s worst enemy…

    Ed

  2. I’ve been using a cream called bepanthen. It is used on babies for nappy rash and also i used it in tattoos for better repair. it has helped the scar look better

  3. daveleft ,

    imo - there are pros and cons of a wound scab.
    the pros - it keeps the wound closed to keep off infection
    the cons - it makes healing slow

    IF and thats a big if - we are doing wound care / management - usually it is preferred to remove the scab and treat it accordingly . but since you are not in wound care/management i think they just wat you to leave it alone till it drops off.

    thats just my opnion .

  4. Really appreciate the advice/opinions, Team ATR. Thank you.

  5. I really appreciate your blog. It is good to know someone else that is going thru a second rupture - although I am sorry that any of us had to go through this.. My second surgery was Tuesday, July 21. I am in a cast and will be for 4 to 6 weeks.
    To help with your scab Is it ok to soak in warm water with epson salts? Would that help soften the scab? I wouldn’t do anything without doctor’s ok. BTW I changed doctors because my first doc was not a specialist in this kind of injury and didn’t seem to be very helpful with information. I like the second one much better. I just hope and pray that I will one day be able to walk again. -

  6. Hey there. I’ve learned a lot from wound care these past mths. I just went to wound ctr today, but I return on Thursday and I’ll ask the dr then on your behalf. They are experts and they’ve been awesome for me. I read the one person saying use hydrogen peroxide. I’ve learned that you only use that to initially clean a wound, but never after. Because you’ll remove the good cells too. It sounds like everything is closed so that’s great for you. For an open wound, they don’t want it to wet, not too dry. SInce yours is closed I would think it’s fine to leave it alone and let it get air. If it starts to itch a lot around the area, you could use an antifungal creme around it…that’s what they put on me. Again, I’ll ask on Thursday for you. :)

  7. Thanks for any help! Going through my wound issues which, in the scheme of things, are minor compared to your issues, I have tremendous empathy for you.

    I’m just planning to continue to air out my wound. I appreciate you asking your wound people. I want to know if I should treat it with anything in order to expedite healing and/or minimize scarring. It’s not bothering me and seems a little better every day. But, as you certainly know, it’s just such a slow process.

    And hopefully, you will have the same scab questions too. Sooner than later, that is.

  8. Dave, Hey there! I’ll ask my team of little wound Dr’s tomorrow. I’ll let them know your scab opened up. And, what to do to promote healing and reduce scarring. I’ll update you tomorrow afternoon. :)

  9. Dave-Hey there. I asked both my Dr and his nurse about your wound. The scab coming off was a good thing because it needed to come off so the wound will heal. And, wound ctr folks believe in moist healing. Moisture–an essential for keeping every cell in the body alive and functioning–is central to that ideal healing environment. That means, keeping the wound covered all the time. If you change dressing frequently, the wound area cools down..and it takes about 6 hours for it to warm up again. So, infrequent dressing changes, and a moist environment is good. The key is to provide the best possible healing environment and to simply let the body proceed with the healing process without subjecting the wound to interventions that interfere with repair like strong cleaning things..no no to betadine and hydrogen perozide. Also, if the wound is really dry you can use an antibiotic cream that has moisture like Bactroban. So, keep your wound covered. I asked them about the scarring issue to, but then they forgot to answer that one. I can tell you though…and I’m a girl…I’m not too worried about a scar…and mine’s been a big hole for a long while. Hopefully that helps a little. I return to the wound ctr next Thursday so if there are new developments to your wound you want me to check on let me know. Have a good day!

  10. THANK YOU! Really appreciate the answer. Not only incredibly informative but gives me some serious peace of mind…just put on a small dab of Neopsorin (to prevent it from cracking), a fresh bandage and back into the boot! Now I know what I should be doing as opposed to guessing. Please thank the staff from me as well.

    I was asking about the scar issue only from a functional point-of-view. I want to minimize friction and flexibility problems. My scar appearance is not a big deal to me…as a guy. More a badge of honor. A hard earned one, that is.

    Although the wound center people seem great, hope your visits begin to curtail shortly. Thanks a bunch!

  11. Dr. Brahm here-Hey there! I showed my wound Dr. your picture and here are his comments:
    - the white stuff is what they refer to as “slough.” He said it would be good to remove some of that slough and also it would be good to stimulate the area
    - the back part he said looks like a scab. And, some time the scab should come off. In the picture he couldn’t tell what’s under the scab, meaning…is there a hole under there or not a hole under there.
    - it’s good it isn’t red around the area, that’s great
    - Advises no to getting it wet because woudn center protocol is that water contaminates the wound.
    So, like we talked about, it’s best to keep it covered and use the cleaning agents, and clean 1-2 times per week.
    I hope that helps. May your wound get smaller all the time! -Dr. Brahm

  12. I meant to say “black” part…not “back” part…typing too fast. :)

  13. Again…THANK YOU, Dr. Brahm! And thanks to your wound people. Appreciate the information.

    And I hope your wound is going away as well. Wanna race?

  14. You are most welcome. My wound is hanging in there. Basically the hole has filled in to be level, and I have a little skin “island” in the center. So, what happens is lots of skin islands come in..and that’s what closes the hole. Also, I forgot to tell you, the pink stuff in your wound is good, nice granulated tissue…so, you want the pink stuff. :) P.S. My kids are on their way to you. They are in a gator ride-on toy, so it should be a few hours to go from Georgia to California. They’ll see you shortly, so please leave the light on for them.

  15. Dave-Hey! Dr. Brahm checking in with you. I think your Dr. appt is today. Let me know what your doc says. I asked the wound ctr why we nded to do 2 grafts, and if we didn’t do them would it have just taken longer to heal. They responded that it’s really hard sometimes for skin to grow over tendon. So, the grafts provide a barrier over the tendon to help skin fill in. Keep me posted. :)

  16. Well hello, Doctor B! Appointment is tomorrow. But the good news, I think, is that the hole–after last week’s debridement–has rapidly filled in and is mostly granulation…the slough is now about 1/3 the size it was before. Needless to say, very pleased about that. Will see what the other doctor says tomorrow.

    And thank you for all of your support. Now we have to help hillary13 along.

  17. Doctor’s appointment #…um…I lost count. For all of you who begrudge the fact you only get a few minutes of the doctor’s time, watch out what you wish for–I get to see my doctor (nice guy) every week (standing appointment on Wednesdays)! In fact, my doctor told me he woke up yesterday and was wondering if I was coming into the office that day (no) and was praying that my wound was healing (yes). The good news is that after debridement (digging a hole into my leg) of the slough (the icky yellow stuff), it mostly filled in with granulation (beginning of skin). The slough is about 1/3 the size it was a week ago. Knock on wood but I may have turned the corner. I continue to apply the Silvadene (antibacterial ointment cream) and will see him, yes, again next week. On Wednesday.

    I am still in the boot after twelve weeks post-op. He is being even more conservative than I imagined. But no complaints here. I just want a healthy leg back. Hope the rest of Team ATR continues to heal.

  18. So glad that your hole is not as holey! :) Really, great news for you! Yippee! Yep, I know all of my ortho and his staff’s days off, vacation days, etc…we’re like family..but family that I don’t want to keep visiting all the time. At least I get free ace wraps every now and then. Woohoo…like Christmas!

  19. Dave-Hey there! Well, today more than 1/2 of my wound is closed. And, there’s a portion at the top that still needs to close. Yeah! And, even when it’s closed it takes a while for the tissue to thicken up…so, we always have to be careful until enough time has passed. Anyway, I wanted to let you know that my wound folks have used that honey substance a couple of times on my wound. It’s supposed to help granulated tissue to develop. Bee-have…get it?!?!? Keep me posted on your little hole too. :)

  20. i am on week 8 post op of repair. i too have had a “washout” procedure done & having a hard time with wound closing up. i have had a wound vac for about 7 days and its helping a lot, especially with getting good granulation to fill in however my tendon is laying on top. Also dr said only 10% or so is still in tact from first repair. im hopeful NOT to have another achilles repair & confused how that 90% came unattched. I am 33 year, pretty good health, not diebetic, and STRUGGLING to be patient! ;-) any suggestions are welcome!

  21. Hey mperdue24. First off, sorry to hear your situation. Although on one hand it seems like forever ago I went through the same thing, it also seems like yesterday. Ok the good news? Even though it does suck horribly right now, you will get through it. Trust me. I have been there.

    It took many different attempts (and multiple doctors) at discovering the right protocol to get on the road to proper healing. My final solution that worked was by an older former military doctor who served during the Korean war. Why do I mention that? Because we ended up using a nearly forgotten medicine that I still swear by. We also couldn’t stimulate granulation with a myriad of different approaches until we went old school (and a last gasp attempt before a skin graft). I got a jar of silver sulfadiazine 1% cream (brand name is Silvadene). This is/was used to treat skin infections in patients with severe burns. Our procedure was he would dig out the necrotic tissue and I would apply this cream two or three times a day. I swear it seemed like it caused the hole to fill in right away. I can’t promise that it will work any miracles for you but I wish I had been using this from the start myself.

    I suppose us veterans can tell you until we are blue in the face that you’ll get through this and be active again but it’s still hard to believe. And just so you know, I just got back from a nearly thirty mile bike ride. And you will too, sooner than you can imagine at the moment.

  22. I have read all the posts with interest as I am nearly 3 weeks post-op on my second procedure. I developed a severe MRSA infection after the first and when they went in to clean out the wound they found the original repair (at 4 weeks) had been compromised by the infection. So they re-repaired it that day. My wound is healing thankfully and the antibiotics are doing their job. My frustration is the wait. My doc is VERY conservative. I am on week 3 of 6-8 in a hard cast. It is 2 months since my original injury and it amazes me the wasting in my calf. I am worried about what will come when I can finally walk even a little. I am a former linebacker so my build does not lend itself to tiny legs!

  23. Hi, Rob. I remember scouring any and everything I could back when I was laid up. Two things that may be of comfort to you: 1. My initial surgeon was very aggressive in terms of rehab and I have to think that was the cause of my re-rupture. My replacement surgeon was the opposite. He wanted to insure that the second time around was successful. And it was. In hindsight, I wish I had gone a more conservative post-op route (I am no professional athlete so, aside from impatience, there is no rush). Secondly, yes, I imagine you will have permanent muscle loss in your calf. I lost probably about 20% in size. But the GOOD news is that it has posed absolutely no issues (sure, I guess someone might notice it if they were really looking for it). I am an avid cyclist, hiker and occasional runner. No issues. Don’t feel any weakness and, in fact, don’t even think about it anymore. I did during and a little after being healed but since it doesn’t have any effect on my life, don’t even think about it anymore. And I bet you won’t as well…someday. And that someday not as far away as you think right now. Best of luck healing and not going through this ever again!

  24. Calf atrophy can be amazing. After only 18 days in a cast, I had a 6,5 cm difference in circumference on my two calfs.

    And here’s the wierd stuff: after 7 months, My calfs were pretty much equal in size, but not in function. And my innured ankle was irritated ans swollen because the heel-raises was in conflict with some other innuries. I suspended heel-raises altogether, and focused solely on balance exercises. And one-legged cycling intervals (1 min maximum force times 5) and one-legged intervals on a rowing machine (30 seconds maximum force times 10). Guess what happened?

    My calf SHRUNK in size. But function improved brilliantly!

    I now have a circumference difference of about 1,5 cm, and my injured leg appears to be the strongest one, even if a bit smaller. I am, however, functionally limited because of those two other injuries in that ankle, but as far as the ATR goes, I’m doing excellent.

    The conclusion is: don’t worry about how your calf looks, or about size. Focus on function, and you’ll turn out all fine!

  25. Dave, I am posting for the first time on the blog…

    Quick history for me… ATR surgery 6/23/14, surgery went well, and was pretty quick healing. Boot at 2 weeks PWB, vaco boot all the way at 0 degrees by week 6 FWB. Was in a boot until first week of August, at the point I started PT & also found out that I had developed an infection in the incision area. Two weeks on anti-biotics and infection is gone… but wound had developed in the incision area. Started with wet to dry bandages for a few weeks and it seemed to only open up even more. In the meantime I continue PT and am FWB at this time… tendon is recovering great… wound just wouldn’t heal. After a few weeks of going to wet to dry bandages twice per day, the ortho refers me to plastic surgeon. He then proceeds to give me several options from a flap surgery, to skin graft, to debridement followed by a wound vac. All of which require surgery… he then allows me to think about it for several days, and tells me that while I am thinking about which direction I want to go… (btw, his suggestion is to start with the surgical debridement of the wound, followed by wound vac for 4 to 8 weeks.) He prescribes the Silvadene cream to me, and I begin that regiment (change dressing twice per day, and wearing compression stocking) for 10-days before going through with the debridement surgery and wound vac. Debridement surgery scheduled for 9/26/14

    Wake up from surgery and he informs me that there were several stitches that were impeding the healing of the wound. He felt that this was going to move along much faster now after the surgery and use of the vac. Friday 10/24 marked 4-weeks on the wound vac, just seems to be going soooo slooooowwwww… Wound size started at 3 cm long by 1 cm wide and was a little more than 1 cm deep before the surgery… you could see the tendon. At 4 weeks it is at 2.1 cm by .8 cm and completely filled in with good granulated tissue… progress yes… just slow and I am struggling with patience… Was wondering… from you or anyone that reads this that has had similar issues… does the fact that I walk on my foot slow down the heaing? (I keep my foot up while at my office quite a bit, but at the end of the day… it is a little swollen.) My plastic surgeon doesn’t think so… I have stopped PT, and doing some modified PT on my own, as I really don’t want to stretch it too much as I want the wound to heal as quickly as possible. Tendon is still great and I almost have full ROM… Just wanting to know if there is anything else out there that I can incorporate into the healing process or avoid to further promote the healing.

    BTW, thank you for sharing so much… it was very helpful to read through all of your story, especially the pictures were helpful!

  26. Bill,

    I went through a similar ordeal, although I didn’t go the route of the wound vac. I ruptured (had surgery) and re-ruptured (had surgery again). Following the second surgery, the wound became infected/reacted poorly to the sutures and would not close. I had a 3rd surgery (debridement) and still had trouble with the would for many months after that (6 months give or take). I was bearing full weight, going to PT, etc. even as the wound continued to give me issues and eventually it closed. I am now two years out from my second and third surgeries and while the wound has healed, the skin will likely never be the same. I still need to apply lotion periodically as the incision sometimes gets dry and cracks, but it never opens up. I’m told this is because the sweat/oil glands in that area are shot due to tall of the abuse that the skin has endured throughout the course of my recovery. Don’t worry - it will eventually close and hopefully having gone with the wound vac will help you avoid the long-term issues I’ve had.

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