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Surgery incision opened wide

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Posted 6/19/2011 11:15 PM (GMT 0)
Hi, I've posted this kind of on j pouch but I need help!  My incision above my pubic bone has opened up 2-3 inches wide and 1/2 inch deep.  I can see the dissolvable stitches and don't know how long they will hold on!  Everytime I change my gauze it seems this hole has gotten wider.  I'm wondering, will it stop spreading??  I have puss and today saw blood and am so fearful that it's going to either pour blood or tear wide open...  I'm freaking out!  The nurse said to pack it with ribbon dipped in saline and then cover it with gauze.  For those that had to deal with this: did you clean out the wound with hydrogen peroxide or anything before packing it?  how many times a day did you change the gauze?  did you ever let it air dry or is that a bad thing?  did your wound stop growing after awhile?  do you still have a scar?  any advice to help me deal with this, I cry every time I look at it...  I'm crying now just thinking about it.  I know, Im a wuss!  cry
Posted 6/20/2011 1:55 AM (GMT 0)
Go to the E.R. You should not have to be dealing with this. If those dissovable stitched rip you might get in real trouble. If you have nobody around, call 911 and get an ambulance ride to the hospital. What they make patients deal with on their own is beyond me. Best wishes. Rosemary
Posted 6/20/2011 2:03 AM (GMT 0)
Mine didn't open nearly that wide, but someone around here's did. I did have to pack mine with a special packing ribbon that had antibacterial stuff on it, but I didn't do any soaking. To me that sounds like it would defeat the purpose of drawing out the fluids that caused it to reopen in the first place. Was the nurse you spoke to you WOC nurse? They specialize in open wounds as well as ostomies so if it wasn't a WOCN then go see yours and get some of the packing materials. Do NOT put hydrogen peroxide on it though. not necessary, once you start packing it, it will start to close, slowly but surely.

As far as changing the packing, it really depends on how saturated the packing is. Mine open area was about 3/4 inch deep and 3/4 long and a bit less than 1/2inch wide. Mine closed in a week after starting to pack it. You may want to pack it when you wake up and before bed to start since it seems rather large, but 1 or 2 times a day should suffice. I never air dried it since it would just leak fluid down me anyway. I did have a wider scar there, (mine was just above the pelvic bone too) but when i had my second surgery, my new surgeon removed all my excess scar tissue like a plastic surgeon would so now its the same size as the rest of my incision scar.

Watch the color of the stuff seeping out. If it starts to look like just blood, go see your doctor or WOCN fast! if its pale pink, orange, and just a twinge of blood every now and then your fine. You said it looked like puss, so I would call your ppl and tell them your concerns, especially if you start to run a fever. They may want to take a look at it.

Try not to worry too much though you won't split wide open! Your a week out so the initial healing has taken place and you must have just been a bit on the unhealthy side which is generally why wounds reopen. But it is icky to think about and even ickier to deal with. Deep breaths and Call the nurse/doctor tomorrow with your concerns. This will get better! *hugs*

*or if your too scared to wait for tomorrow, like esoR said, go to the ER*
Posted 6/20/2011 12:29 PM (GMT 0)
Boy can I relate to this. Don't worry though... it does heal!

My incision started to do weird things two weeks post-op. I got the staples taken out on schedule at ten days and everything looked great. Then a few days later lots of clear drainage started coming out of this one spot along my incision. I thought it was really weird, but just sopped it up with gauze. Well the next morning, not only did that get worse, but my incision started to open about an inch. I called my surgeon and he had me pack it just like you are describing. However, over the weekend it got worse and the opening got longer and really deep. Plus the drainage increased a lot... and I mean a lot. My gauze would fill up with fluid within 15 minutes of putting it in. I went to see my surgeon in person the following week day. He poked around it a bit and said, "looks like you are going back to surgery" Apparently, the opening went all the way into my abdominal cavity. So, I was sent over to the hospital next door and was in surgery again that evening. He re-stitched the muscle wall and all the other layers, and everything once again looked great. I was only in the hospital for a day. My surgeon felt it was due to poor healing from Prednisone.

Two weeks later, I got the staples removed from that one, and again, everything looked fine until it began to open up again! This time it only opened a tiny bit and only in the superficial layers. My surgeon checked it out again, and we began packing that section with strip gauze. Everything was healing wonderfullyl until around the first of the year when the wound began to tunnel under the skin and then a big abscess formed. My surgeon was frustrated by this time because he knew that Prednisone should be out of my body and not causing trouble by this point. Also, my anal wound had healed beautifully, and if Prednisone had been the culprit, that one probably would have been a poor healer as well. He decided it was best to go back to surgery again to open the wound up and see what was going on. In the operation, he discovered that the poor healing and recent abscess was all due to a rare reaction to the dissolvable suture type he had used in my abdominal wall. He had not used the same type of sutures anywhere else for my surgery. In his 15 years of doing surgery, he and his team had never seen a reaction to this suture material, which is one of the least reactive and most benign. He removed the offending stitches, replaced them with another material, and left the wound completely open to heal. It was 13 cm long and about 3 cm wide and about 2 cm deep. It was the most freaky thing I have ever seen on my body. I could see my abdominal muscles in the bottom, and the line of stitches in my abdominal wall. I really had to mentally detach from it to even look at it.

I was hooked up to a wound vac, and though it was slow going and painful, the wound healed beautifully in 6 weeks. I had no more troubles with my incision and am back to health. Yes, I have a scar, but it is not that bad considering the shark bit appearance of my wound. The body's ability to heal is pretty amazing. As it healed, it first filled in with granulated tissue and then sort of zipped itself up over the weeks, getting narrower and narrower. My scar looks like a 13 cm pink line going from my pubic bone to my belly button. The scar is about a cm wide in the widest section. I really could care less. I am not one to worry about cosmetic stuff though. I am just happy to have my life back and feeling amazing.

Are you in contact with your surgeon? Fortunately, mine was very accessible and hands-on and worked with me constantly until I was back to perfect health. I saw him every two weeks regarding the wound and was in frequent communication about what to do next. He worked with me on my wound care more than my ET nurse (except when I had the wound vac and saw a home health nurse every other day). Even when I had a home health nurse helping me with it, he still saw me every two weeks to check the progress and called me on the phone often to check in. I hope you have this type of support, as it very much helps with not only the physical aspects of wound healing, but the psychological aspects as well. It is not something to have to figure out on your own.

I would definitely go back in if you see any pus or have increased pain or a fever. This is a sign of infection. Do NOT use peroxide. It kills tissue and only makes things take longer. Wound healing is a very, very long process. Follow your doctor's and nurse's advice to a T. I know as you are packing with gauze that it is pretty gross looking with some drainage, but this is what it is supposed to look like. Betsaronie is right on about the colors to watch for. Mine bled a lot, but minor amounts that just tinged the gauze (or wound vac drainage when I had that). Also, I would highly recommend a wound vac if you are given that option. It is a pain and very expensive, but heals things up very nicely.

Good luck and don't be scared. Lots of people have issues with wound healing. I would imagine it is one of the most common complications of surgery. Just work closely with your medical team and you will heal up.
Posted 6/20/2011 2:41 PM (GMT 0)
My surgeon is out of the country until the 30th which is my post op appointment. I made an appointment with the fill in surgeon last week when the wound just started opening and the surgeon's nurse just saw me and gave me the gauze strips and saline. That nurse said to use peroxide since I have yellow puss still coming out. She also said that the wound opening is common and nothing to be too concerned with and to let it heal from the inside out. I guess since the nurse made it out to be no big deal is the reason I'm afraid to go to the ER. I did read online that peroxide can kill the new cell growth and is bad but I'm afraid to not clean out the infection too.?? I'm not sure how well these internal stitches will hold as this continues to stretch/ and what will happen if they stop holding. I'm being seen by a home health nurse today (not sure if its a WOC nurse?) I hope they have knowledge about this stuff! Blueheron- sorry you went through all of that! I really wish I had more support from my docs, it really would help me mentally and physically!
Posted 6/20/2011 5:07 PM (GMT 0)
Where is Rambo when you need him?
Posted 6/20/2011 6:22 PM (GMT 0)
My surgical wound did exactly the same thing. I was shocked and cried too. You should have either your surgeon or wound nurse take a look to be sure everything is fine but it isn't unusual to have that happen.
My open wound was treated with silver nitrate packing, kaltostat, a little protective gauze, and a bandage. It took 2 and a half months to completely heal.
I washed the wound with saline and changed the dressing daily for about a month, then switched to every other day. Don't be surprised by a little bleeding as it heals. The wound was inspected twice a week for the first month by a wound nurse, then once a week. The second month the wound was treated weekly with liquid silver nitrate instead of the packing. The wound sort of zips itself up over time.
The scar is much smaller than I thought it would be, It is the size of a normal incision.
Many hugs to you!
Szm

Post Edited (Subzeromambo) : 6/20/2011 12:26:36 PM (GMT-6)

Posted 6/20/2011 7:06 PM (GMT 0)
Well, my home health nurse said I'm still ok. She measured it 2" X 2.25" X 2" deep! Apparently I have a hole in the bottom that goes down another inch (gag). She said NO peroxide! I just have to wick the hole with saline gauze twice a day and keep it covered. She also said when changing my bag that my stoma doesn't mushroom at the bottom and she is concerned about separation! (So, I have to worry about this now too? )
How did you shower with an open wound? Do you cover it or let it wash out?
Posted 6/20/2011 8:18 PM (GMT 0)
Glad to hear that things are going okay. Still keep an eye on it as I have learned from experience that wounds are complicated and can sometimes do unexpected things since they take so unbelievably long to heal!

I was thinking more about your case and had a few more thoughts. Having had my incision open up three times to varying degrees, the big red flag for the one that happened two weeks after my initial surgery and was the most serious because it went though my abdominal muscle wall was the amount of drainage. I had over 1/4 cup of wound drainage come out of it over a weekend. Drainage is normal, but not that much! I am jinxed in that my serious problems always happen right before the weekend. My wound started to open on a Thursday, and I talked to my surgeon the next day. I actually felt really stupid after finding out how serious it was that I did not go in that Friday to see him, but it really didn't seem that bad at first. I think I may have downplayed it a bit as I was more concerned with talking to him about another issue... my stoma was separating from the skin. It wasn't until Saturday and Sunday that the incision opening started getting longer and deeper and my mom (who is a nurse and was staying with me for a couple of weeks to help out) started to get concerned. I felt like I was unzipping. This is when I really started to cry and actually got a bit hysterical a few times. I kept saying to my mom, "my guts are going to spill out, aren't they!" Fortunately, my mom and hubby were very good at reassuring me and I made it through the weekend. I actually went to my wound care nurse on Monday as I already had an appointment with her about the separating stoma, and I knew my surgeon did his major surgeries on Monday and I wouldn't be able to get in. She took a look at my incision, packed it for me with saline and gauze and gave me some tips, but basically said that I needed my surgeon to see it. So the next day is when I got in to see him. I will never forget when he said, "we need to get you back in for surgery." I said, "When? In the next few days?" And he said, "No, right away. I will meet you over at the hospital at 5 p.m." I was completely shocked and stunned. It is so hard to know what is serious and what isn't, so now my motto is, when in doubt, go to the professionals! Sounds like your nurse thought your wound looked fine though, so that is such good news! She would have told you if it was serious enough for a surgeon to see.

So, as I mentioned above, I was also having issues at this time with a separated stoma. Basically, the stoma separates from the surrounding skin and leaves a gap. I believe it is fairly common... I think the formal term is mucocutaneous separation. It can be caused by poor tissue healing due to Prednisone. Mine looked gnarly, but my wound nurse packed it with some sort of cotton-like algae dressing and said it would heal fine. I never got to test this out, as when I went in to have my incision re-closed, my surgeon also restitched the stoma.

I would ask your nurse the bathing question, as it might depend. My surgeon had me leave my wound uncovered in the shower... but I would think it would really depend on your wound. Don't feel like you are bugging your medical team with too many question. It took me a while to realize how "hands-on my surgeon was, even though he stressed in my consult that I could call him anytime. I just assumed he would be like every other doctor I had where they sort of rush you in and out and have you deal with their nurses for most stuff. Because I sort of expected that, I shied away from asking him about stuff initially and felt like I was bothering him with all my questions. I soon realized that it seemed to bug him when I didn't ask questions or stay in contact. He liked to help his patients and know what was going on. So test out your surgeon and see how involved he/she likes to be in his/her post-surgery patient care. And if your surgeon leaves a lot of post-op stuff up to the nurses, then ask them as many questions as you need to. The whole team may be more supportive than you realize.
Posted 6/20/2011 8:52 PM (GMT 0)
Same thing happened to me and it took a long time to heal. I remember my dr. telling me it's ok to get it wet while showering...just don't submerge yourself in water. And don't put anything on it. It just has to take it's healing course and it will take a while if it opened up that much. Keep the gauze on it and change it daily and you will be fine.

Posted 6/20/2011 10:59 PM (GMT 0)
Oh man, I'm really sorry. This happened to me. They took my staples out before I had healed, and open I came. It IS really upsetting, so don't feel silly for crying.

The best thing you can do for it is to eat a TON of protein. Buy protein powders - I like Beneprotein, you can get them from amazon, and put them in your milk if you drink it, or sprinkle it in soup. You won't notice it in there. This will get the wound healing up so fast you won't believe it.

Just keep packing it the way they told you to. I don't wash mine out with hydrogen peroxide, but what I do is I take the packing out, get in the shower and soap it up, and then repack after the shower. I also wash all the equipment (scissors, etc.) with hydrogen peroxide. If you notice red inflamed skin around the circumference of the wound, a smell from the wound, or a lot of thick goopy yellowish drainage, go to a hospital and get it swabbed. They'll culture it to check for infection.

Post Edited (elddiReMsihT) : 6/20/2011 5:18:59 PM (GMT-6)

Posted 6/20/2011 11:05 PM (GMT 0)
The WOC nurse is your ostomy nurse. It stands for Wound Ostomy and Continence. You should have seen one after your surgery to show you how to put on your appliance and such. the home health nurse can keep an eye on it, but you may still want to see a wound specialist at least once for comfort.
Posted 6/21/2011 2:26 AM (GMT 0)
I'm not the only one!!! I too have the same issue not as big though. I change it 1 x a day n clean it with saline n dry it n put antibiotic cream. Pack it with gauze. Still a lil pus. But starting to dry up at the ends. Still hurts for sure though!! I'll pray for u. God bless.
Posted 6/21/2011 7:10 PM (GMT 0)
I am so glad the nurse said your wound is healthy!
My incision depth and width were about the same but I had a vertical incision from 1.5" above my navel down to my pubic bone. My large intestine had perforated and broken into pieces so they had to find all the pieces and clean the remaining organs.
I covered the wound and bandages with plastic and sealed the plastic with waterproof tape before taking a shower. I used a bathing chair in the shower for about three weeks. It really helped.
When the wound became smaller, I just put a waterproof bandage over the kaltostat.
Today I got the ok to take baths and go swimming. I am delighted!
I am not sure what "stoma doesn't mushroom at the bottom" means. My stoma looks like a small climbing rose. It protrudes about 1/2". There are lots of pictures of stomas on the internet. It might make you feel better to see the variety of stoma colors and shapes so that you know what to expect as your stoma changes.
I hope you are feeling much better and enjoying the first official day of summer. It is absolutely beautiful here. Time for a little sunbathing.
All the best, Szm
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