TKR Right TKR is done

[sistersinhim]

I'm crossing everything, too, hoping the new pump will work like a charm!

 

[GingerP]

I did get the replacement vac this afternoon and can't believe how quiet it is compared to what I had. I hope that the vac was part of my problem in healing too - but time will tell. See the dr tomorrow so will have to see how the incision looks then. I'm a little more hopeful.

 

[Celle]

I hope the new vac works for you.

 

[sistersinhim]

Good, you finally go a new vac. I bet you're going to see a big improvement!

 

[GingerP]

Today was a Dr visit and when the nurse was taking off the dressing she casually mentioned that maybe I would like a second opinion. I thought it odd now that would come up and since I have been trying to hang in there with them all these months because they are supposed to know what to do with healing me, really didn't think another thing of it.

The Dr comes in and says, I hear you are thinking of a second opinion. Uh, well, what would that be and where would I go. He told me that he was thinking that perhaps a plastic surgeon would look at it and perhaps they may be able to offer an opinion to do surgery on it and do some kind of sewing on the tissue inside. It's all so foreign to me in thought right now.

The depth from top to bottom is shrinking ever so slightly and is down to 1.5 cm . But, the undermining areas are still bad. One area is 4.2 cm. And another 3.5 cm. All that has to heal before the top closes up more. I have resolved that I don't want to have it opened again. They did that a month ago and the top of the incision wants to close up again, so something more has to be done.

They told me when I checked out that the plastic surgery office will call after they get all my records and referral and set up an appt to look at my case. I was told it could be at least a week before I get a call.

When I called my local wound nurse to fill her in on it, she told me that it could even be a month before I could get an appt, so.......I may become healed further than they want on top, but don't know about the undermining area. They are filling it in with what Dr called prisma. It's a collagen that dissolves if it works and so far, mine has been dissolving. It would be great for the collagen to kick in, but as I write this, I'm not sure what to think.

The new vac is so quiet. I barely hear it and check often to see if it's even on. What a difference. Wouldn't it be great if the new vac kicks things into gear and I do get the healing. Any more, I don't know what to think is happening. I first had the opening cut on March 23. So, as you can tell - 4 months later here I still am. Really ready for the healing to be over.

 

[SusieShoes]

It sounds like your wound care doctor has used every trick in his bag. He doesn't know what else to do but hope a second opinion will bring you better results. While the plastic surgeon is an option, certainly, have you considered seeking out another wound specialist? Perhaps at the University of Wisconsin in Madison? Has your doctor suggested hyperbaric wound therapy?

I ask because your wound is taking so long to heal and maybe what's needed is a fresh set of eyes or a new approach. Maybe the plastic surgeon can point you to a way to treat this.

 

[KarriB]

It certainly can't hurt to seek a second opinion. Another doctor may see something that others haven't.

 

[GingerP]

@KarriB & @SusieShoes I thank you for encouragement. Lord knows I could use a big dose about now. I would have thought before now they may have suggested a second set of eyes, but how am I to know what they typically use for wound care? I guess we shall see how long this process will take. I will be going to the U.W. Hospital in Madison for this. My other options are Iowa City or Mayo in Rochester, MN. Both of them are 3 hrs from here so took the 1 hr + option for now. Appreciate your thoughts and comments.

 

[sistersinhim]

Ginger, you are in my prayers!

 

[Jamie]

Ginger, I think the idea of a second wound and infection specialist is a good one. I'm not sure a plastic surgeon will be comfortable dealing with this otherwise as there likely is still some infection present. Please work to get appointments as soon as you can and continue to let us know how things go. These things can take a lot of time, but your wound does appear to be rather stubborn and in need of a new approach. I think your decision to try the University is the right way to go for now.

 

[sistersinhim]

Please know that you have a whole lot of people pulling for you!

 

[KarriB]

If this was me, I'd make multiple appointments with docs in the areas I'm considering, especially if there's a longer wait. Then if you find one you're happy with the first doc just cancel the others, if you aren't happy you have other appointments with other docs. This is what I did with my TKR, made appointments with the docs I was considering and stopped when I found Dr. Right.

 

[Josephine]

He told me that he was thinking that perhaps a plastic surgeon would look at it

This an entirely correct second opinion for him to go to. I've seen many of these chronic slow healing wounds, some can be quite big and deep. And a plastic surgeon is the one who has all sorts of remedial alternatives up his sleeve, up to and including, skin grafting.

As for the Prisma treatment, that's one of them and here's a demonstration of it. Don't you just love the ease with which the CGI hands slide the compression stocking on and off the leg!!



But looking at that wound, I wouldn't be surprised if in the long term, this other surgeon doesn't opt for a good debridement to clear out all that static granular tissues and detritus and do a rotation flap skin graft. I have a photo of something similar. If you want to see it, I'll give it to you in a PM as it's pretty graphic but they do work!

 

[GingerP]

@Josephine . Do pm me the info on the skin flap graft. The wound dr said something about that, when he was talking about the referral to the plastic surgeon.
@KarriB I'm being referred by the wound dr and so I'm not in charge of getting the new dr since they will be sending all my records oN to them. For now, I'm not in the driver's seat on this. It won't be an infectious dr - it's to a plastic surgeon. He feels that an orthopedic dr would not be advantgeous.
@Jamie I haven't had infection in my opening outside of cellulitis on the outside of leg near my incision. And i think there was a time that it was precautionary for infection. The last culture taken was clear 2 weeks ago . I've been off antibiotics for a long time now. I think the wound dr is searching for a surgeon who is familiar to work on tissue that can't seem to join together. Maybe this will be the end to it.

 

[Jamie]

Thanks for the explanation, Ginger. It does sound like you're on the right path then. The clear cultures are a really good sign. I will be looking forward to hearing what your plastic surgeon has to say.

 

[KarriB]

I'm glad cultures were taken recently and were clean. That's a load off your mind. Do you have an appointment yet? I'd be very antsy to get moving and I'm sure you are as well.

 

[GingerP]

@KarriB I have to wait until all my mediCal records are sent to the plastic surgeon and they review my case and then THEY will call me. I was told it could be more than a week before I get the call so hopefully something gets set up this coming week.
It's just like I have two different plains and with it being so close to the knee, every step I take, one goes one way and the other the opposite way -like rubbing your hands together. It's like friction between them so no wonder they don't heal together.
Friday, the wound nurse felt that the prisma wasn't working and left it out when replacing the dressing. As a matter of fact, she thought the undermining had gotten deeper, so that is going in the wrong direction.
@SusieShoes the wound clinic where I go refers people to the hyperbaric chambers they have next door all the time. My mom was referred there by him, so I would think if he thought I could benefit he would do that. Anymore, I really don't know what their thinking is. Sometimes I think they are grasping at straws. Before they cut me open a month ago. I wish they would have given me some scenarios as to their next approach but I wasn't and I guess throughout all of this I haven't been told much except that it was going to take time and have patience. Now it's coming to a standstill of sorts and sometimes I think they are throwing things out to see if it 'might' work. Knee surgery was Dec 8. Second surgery to "fix" hole Feb 22. Opened incision March 23 and still dealing with aN opening with undermining. Not a good progression.
The best thing is I have a great knee replacement! !

 

[GingerP]

Today was wound dressing change anD I went locally. The wound nurse thought that my depth of incision has come up ever so slightly and the side that doesn't have undermining is also closer in. Last Friday she took the prisma out because it didn't seem like it was doing anything to benefit and she thinks too that the undermining has come in a little too. I don't go to the dr until Friday so we shall see what happens by then.....but the top opening is also closing in.....
No word from the referral to the plastic surgeon yet either. Just hanging in there for now. Picture as of today.....

 

[SusieShoes]

The visit on Friday will tell you for certain if you have significant wound healing. Even tiny degrees of healing are hopeful. I'll be praying for a good result!

 

[sistersinhim]

I pray for a good outcome and treatment plan.