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@Josephine what you're saying seems to be the right route to go. Again I find myself confused with mixed messages. It was doing better, actually seemed to stop drainage and then a few days later it started up. The PT did a really good job cleaning it and it looked the best it ever did, till the next PT session and then it looked ok, but with the hard scab gone, the width, and depth really concerned me. The PT seemed concerned and asked another PT about it and when I asked questions the answers in return seemed vague.

In turn I did call and made an appt with the OS. I was starting to feel scared and concerned, the PT also put a call in also to see about getting this ointment. The OS choose in the end that I didn't need to be seen and put in the rx for the ointment and the PT directed me on usage and wound care. Maybe I should go back sooner to see the OS and get his thoughts, right from the start he's never been overly concerned about this spot, His approach maybe was more in line with yours, but with movement and stretching it's just not mending. I went a long time with not much in answers to why this happened and what exactly I should be expecting to happen. I need to be able to know everything is ok, reassurance.

I'll be truthful, I am scared. I know it should be healed by this time, using this new rx isn't an easy task to get a dressing to stay put, plus to only get the ointment on the wound and not the good tissue.

This ointment name is Santyl and it's very expense the cost the insurance saved me was almost $700. I will be showering shortly and I will put a dry dressing on it again at least till later today. I will also take a pic and post it soon after showering.

I just want to move forward. 10wks is a long time for a open wound. My daughter is concerned about me picking up a infection MRSA at this point also. Plus I work in a environment full of germs (I work in a Elementary school with children ages 4-8)
 
Um I'm gonna chime in here because of something you mentioned, the drainage issue. I had a THR in march 2014, and the ongoing drainage was the start of what would be a year long fight of infection. I'm not saying this to scare you, but to motivate you to take swift action to find both a wound care specialist and an infectious disease specialist to take over care of this at this point.

Good luck, hope you find some good specialists and get some relief & healing fast
 
@Josephine here's a pic of it this morning as I removed the dressing. Used a piece of surgical tape and marked off 1 inch lines this is slightly over 1 inch in length. And a about a inch across in the widest spot This ointment is used for debridement of wounds or burns to promote healing is what I've read up about it.

[Bonesmart.org] Late Bloomer<
 
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So this 'open wound' is barely an inch long? That's almost nothing. And I repeat, it is not an open wound at all, it's just a shallow pit filled with scab. It's probably no more than 10mm deep. You'd probably not be able to lay the top of your little finger in it.

You'd be much better off stopping cream and dressings and letting the scab dry off which is what it wants to do. I think these things you are doing with water wipes and cream are just keeping it moist so stop and see what happens. You'll see, it will dry up in no time and then disappear. Perhaps when you are at work, put a dry dressing on it just to protect it but take it off as soon as you get home.

As one good surgeon I worked for used to say "There's nothing better to heal a wound than God's good air".

As to why this happened - who knows. It probably began as a tissue reaction to one of the sutures but right now that doesn't really matter. I'm puzzled as to why PTs were dressing this wound and advising you on it. In the UK that's strictly a nursing task and good nurses know an awful lot more about wounds than PTs or even surgeons!
 
@Josephine I will be able to navigate a lot better with out trying to keep a dressing on it, so I will give your advice a try and see what happens.
Bathing, should I be trying to keep it dry and bath soap from running down my leg into it?
At night or when I ice should I try and avoid ice directly over that area as it prevents air circulation if I add my velcro ice wrap around my leg ( I know this has been a moist environment when I put the ice pack over the knee for the night.)
In general so I keep it as open to the air as possible???
In time will this be able to heal completely closed?? It seems like such a gap at this point to be pulled together on it's own.
 
Just take showers for now. Having the water and soap gently go over the area is fine. Pat it dry and if a scab forms again don't remove it or let the PT remove it as that is nature's way of healing. Santyl is a ointment that is a debrider which means it will just remove dead skin cells. Adding the moist dressings will slow the healing. When icing overnight try to use a barrier between the ice and the incision so that it can stay dry. And as Josephine has said let it open to air as much as possible.
 
zzevi,
Your wound will pull together as it heals, our bodies are incredible and able to heal, we just need to give them time.
 
zzevi said:
Bathing, should I be trying to keep it dry and bath soap from running down my leg into it?
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A bath is okay provided you don't soak too long but it's good to have it soaked a bit, keeps it nice and clean.
zzevi said:
At night or when I ice should I try and avoid ice directly over that area. In general so I keep it as open to the air as possible?
Click to expand...
A bit yes and a bit no. If that makes sense!
zzevi said:
In time will this be able to heal completely closed?? It seems like such a gap at this point to be pulled together on it's own.
Click to expand...
It's not going to heal side to side, it's too far gone for that. What it does is granulate up from the bottom and that's why you get a little exudate from time to time. It's like squeezing a tube of something!

So about this granulating: there are two stages of healing, first intention and second intention.

First intention is when the wound is fresh and the cut 'sticks' together, side to side. That's where the suturing comes it because it makes use of first intention healing by holding the wound together so it heals. That will last around 10-14 days or thereabouts.
Second intention is when first intention has missed its chance and the wound then has to create a not very normal tissue called granular tissue. This is laid down a little at a time in the base of the wound and increases until it eventually fills the gap. The creation of a scab is part of this second intention healing. Once that is completed, the granulation will then shrink, dry up and contract until the wound is okay. That can take about 4-6 weeks though it varies greatly. I think with your wound, that stage will probably take about 6 weeks.

Does that help at all?
 
It sounds like the hole that's left from having a tooth pulled. It fills in from the bottom up.
 
@Josephine I know in previous threads you addressed the exudate I spoke about, this odor from this incision started probably around 4 wks ago, I think I worry a lot about the odor as I've had incisions before and they never smelled. Self conscious of this smell, reminds me of something rotting , but it isn't anything to be concerned about, drainage has always been slight, staining a gauze or band aid but not seeping through. But what causes that incision to start giving off a odor so many weeks after the surgery. (seems that this incision has me puzzled and I have lots of questions, thanks for your help)
 
Is the odor present when it's dry or wet? Keeping it dry may keep the odor down.
 
If you keep it dry and open to air as much as possible the odor should not come back. The odor is caused by the collection of the exudate that was under the bandaid/guaze.
 
zzevi said:
Self conscious of this smell, reminds me of something rotting. But what causes that incision to start giving off a odor
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Well, it IS something rotting - the scab! It does smell musty and sour of it's kept moist. It might even smell like that if it's allowed to dry as immediately under the scab it will still be moist! I strongly suggest you stop worrying about it and leave it alone. It's well on its way to healing completely.
 
Thank you for your responses, as I think back to when all this started, the smell did start when I had it covered with a special covering that was to last 7 days with out changing. Really, really upset that neither the PT and surgeon seemed to be on the same page.

Through this whole process everyone's views that I have dealt with have been different and I've been the one in the end to try and figure out if what I was doing was correct or not.

I've learn so much through this Bonesmart site. A person recovering from this TKR is in no place to be trying to figure out what treatment is the right treatment.

Sorry Josephine if I seem dumb about the situation, I've just been trying to do what I've been told by professionals in their field. In the end here I've been doing a lot investigating on my own trying to figure and sort things out. I've received the most helpful information through this site.
 
No need to apologise, my dear. I feel for you - all this conflicting information zooming at you all over the place. But you have to realise that PT's are NOT trained in wound care and doctors very often think it's a nursing job! So as far as I can see, you rather fell between two stools there. I was horrified at what you were being told. Wound care has been on my list of specialist skills for many a long year and I have seen many difficult little wounds like yours before, so it's no stranger to me. I'm only sorry you've had such a difficult time with what should have been a fairly easy and uncomplicated thing.
 
Went for PT today and haven't done anything extra in the way of exercise as earlier last week I was nursing my incision. Well I was amazed that with the lack of movement, stretches, exercise bike in such this past week, I did start back to work and that has me spending about ½ my day on my feet walking and moving about, that everything went the best ever for stretching and exercising at PT. Not one thing bothered me. I am a little achy tonight, which after every PT session it's lead to a rough restless night of sleep.

Guess what I am saying is it really is paying off to take things slower and easier. Even with having my knee bandaged my ROM was the same as last time and I know the bandage was restricting some, and I wasn't pushing my self to get that reading. Feeling good about things and the progress made, now to just get the incision completely closed and I may finally be satisfied.
 
I hope u continue to heal quickly but granulation tissue comes in slowly but don't loose patience. It will heal. And as the others have said let it open to air. Keeping under a bandage will only slow the healing
 
@Dearjr , zzevi's only keeping the wound covered while at work, as a pediatrician you know the germs roaming around a school. She's giving it air while at home.
 
Well folks after yesterday's PTs session, the head therapist continued to seem concerned about my wound. Took some pic's of it and said he was going to contact the surgeon. Well to say the least I spent a lot of time talking with different folks today, they decide they thought I should go to a wound care doctor. So I thought this is something that I would get a appt for soon and get in for and let's get this show on the road.

Guess it doesn't work that way, can't get in until almost the end of Sept. I think the stress of the situation and it seems important yet you can't get an appt to be seen, I came home exhausted and in tears. Said to my husband this is not the way this was to turn out. PT called, said I should asked to be put on a waiting list so if there's a cancellation they can call and I can get in sooner. PA to the O.S. called and review things with me.

I am frustrated to no end, in the fact that since about week 6 I voiced concerns, at the removal of the staples (14 days after surgery) my wound began to bleed before I ever got out of the office, and had to have it all bandaged up to do PT. I think there were signs in the beginning that I was having a issue with the incision (still not thinking infection, I could be wrong). A little bit upset at not being listened to and having the problem taken care of, now I am back to work full time and trying to deal with this.

I'll go for this appt as some of you on here stated you thought I should go see a wound care dr but I am going this next week for a O.S. follow up and I think I will be expressing myself..........it's that redhair again. I can be patience for only so long and I've had questions that haven't been addressed.
 
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