TKR Right TKR is done

[GingerP]

The wound clinic staff was very thorough with me and they had received all the details about my original knee surgery as well as my repair surgery so I was very happy with that. They took a small tool and inserted it into the opening and discovered it goes the full length of my incision on the top of my knee from the hole to the knee bend. I was told 8 cm. They also told me that the depth or width of it was 4 cm. I wasnt clear on it. A culture was taken. Photos were taken.

I asked about how this might get resolved and a wound vac was discussed. The doctor says that he couldn't do anything for me and referred me back to my surgeon. I do have an appointment with him tomorrow that I had before I worked in seeing the wound dr. The wound dr says he can put a wound vac in if the surgeon wants to open it up. I guess it takes 2 days for insurance on the vac approval, I really dont want the surgeon to open it up tomorrow over the weekend. The wound dr is out of the office tomorrow so no chance of the Dr's talking tomorrow either.

I'm just wondering if the surgeon finds out it to be a pretty large area along the incision open if he wants me to go back under surgery and close it up or go the wound vac route.
So they sent me home to see what the surgeon says.if I can, I need to keep a tight ace bandage over the dressing as well.

I'm a little upset that the surgeon didn't do more than to tell me to milk out the fluid and keep it dry and covered. Something as large as that is just not going to 'dry' up.
Sorry, but my sad saga continues. On to yet another day.
The reason the wound dr said he was referring me back to the surgeon was that some are very protecting of their work and because the hole is a result of a total knee replacement. I totally understand it.

I guess we shall now see what my surgeon has to say and what, where and when all of it is about to be taken care of.

 

[zzevi]

I think the sooner you deal with it, the sooner you will have good results, I know you may not want to have to deal with this prior to the weekend. @ACDCJen it seemed like her's really opened up and deepened and widen fast.
So if you can get someone to deal with it, don't put it off, get started, remember the longer ( in my mind )that something is open the more chance of an infection to set in. I really think personally I would have had less issues had everyone moved a little faster for me and took it more seriously then they did.

 

[GingerP]

@zzevi Thanks for your input. I guess I wasn't sure if I wanted my Incision opened up and then no one would get a wound vac on it until next week - maybe Wednesday. That would be a long time with packing gauze in it and that's my concern to risk infection. Im Having a terrible time keeping the bandage oN my leg. Every step I make the ace bandage drops down my leg......darn gravity! When I tighten it then it bunches together like a tourniquet. Always something.
I guess that is my reason not wanting the dr to open up the incision and nothing happen for a couple of days so it may be better the way it is until I get more immediate results next week.

 

[newlybionic]

Once they open so the old tissue is removed then the wound vac can then do its job. The last thing you want is for the tissue on the outside of your knee to close and still have an open area underneath it. The wound vac then 'sucks' the wound to help close it faster. The couple of days with some packing in it won't cause a problem as long as it is kept dry. Let a visiting nurse do a wound dressing care if needed. Wound vacs are very amazing in there ability to heal.

 

[Celle]

I'm sorry your visit to the wound clinic wasn't very encouraging, @GingerP . But at least they did investigate the full extent of the problem (which was surprisingly large) and they took swabs for culture. Both those actions were good.

It does sound to me as if the only way to clear this up is going to be for your surgeon to open up the incision again. I think that your surgeon and the wound clinic need to work together, so that you can have the wound opened up and then the wound vac placed on it the same day, or very soon afterwards. Do suggest that to your surgeon when you see him.

 

[GingerP]

@Celle thank you for your thoughts. I would feel more comfortable if the 2 Dr's speak first to work out a plan together. I have confidence in the wound dr since he actually did some measuring to investigate how big of a problem we have. I'm wondering how they open up the incision again - as outpatient in the clinic, surgical theatre, I'm nervous how bad I'm going to be in pain with a big open cut. I reviewed another you tube video on wound vacs tonight and think that may be my best approach. Guess I was pretty surprised how large of a 'space' it was under my little hole. Appreciate your comments.

 

[Arttie]

"Every step I make the ace bandage drops down my leg......darn gravity!"

I had to keep a bandage on my knee 2 weeks ago after my arthroscope on my knee. We use flannel sheets and I knew that they would have an adverse effect on the bandage staying in place. I used my compression tights to hold the bandage in place while sleeping and had very little movement in the bandage. Perhaps that might work for you. Just a thought. https://images.nike.com/is/image/DotCom/PDP_HERO/703082_010_A_PREM/pro-mens-3-4-training-tights.jpg One leg of a pair of panty hose???

 

[Josephine]

Another thing you can use to secure the bandage is this stuff, Coban. It is stretchy but soft and self-adhesive but it also sticks to the skin but lightly. You can get it from Amazon.com but you might also be able to get it from a local pharmacist. Just be careful not to stretch it too much when you apply it!

 

[SusieShoes]

I hope you get some idea soon about what will happen and when. Waiting really is the hardest part.

 

[ACDCJen]

@GingerP

Sorry I'm late to the party! I've had a wound vac since my incision and drainage surgery on January 12. It's a smallish VAC VIA by KCI. I was doing fine with the incision until the staples were removed about 10 days after my RTKR, very ineptly I might add. I developed an opening at the top of the incision that just got bigger and deeper. It also tunnelled underneath as deep as 7cm before I had the I&D surgery.

I started Keflex on January 10, and it was changed to Cipro once they identified my infection as Proteus Mirabilis. At about 3 weeks post surgery, I was switched to Levaquin because the first 2 made me very sick. The Levaquin was awful too, and I took my last dose a few days ago, thankfully! I'm just waiting for the effects of the Levaquin to abate so I can function again.

The wound vac I had has to be changed about every 3 days. I was going to my OS weekly at first, and now it's every 10 days. My home health nurse does the other changes. My wound has greatly improved in the last 2 weeks, in particular. The wound will probably be too small for the vac at my next OS appt next week!!! Yay!!! I'll then go back to packing it with Aquacel Silver until it is gone!! I also have a wound specialist to follow my case and give treatment recommendations to my OS.

I have a bunch of pictures on my thread (The girl with the 2 fake knees.) For the last 6 weeks, I have been ill and pained from the Levaquin, so I have a lot of work to do to get to where I want to be. I had my left knee replaced on September 14 and had no complications after that one. So, you can never tell.

I am currently in the 4 week wait to see if the infection returns. If it does, I'll have to have the 2 stage revision. If it doesn't, I'll dance for joy!!

As for the wound vac, the wound is packed with foam and covered with adhesive drape. A little hole is cut into this and the suction disc placed over that. The tubing runs from the disc to the collection canister, which is snapped onto the actual unit. I run the tubing up under my pants, and out through my waistband. I put it in the provided holder and wear it around my neck when I go out (which isn't often). Or I set it next to me. It provides 7 days of suction to help the wound close from inside out. It also drains any fluid from the wound into the canister. Mine is changed approx every 3 days. The first 2 changes were painful and caused me to see red, but it's not anything big now. I don't lose suction because it's in a pretty even spot. There's only an issue when I mess around with it!!!

Hopefully my rambling was helpful! Feel free to ask any questions! There are a bunch of pictures on my thread. My wound has gone from about 6cmx5.5cmx7cm to 3x3x1.5 in a little over 2 months.

Good luck with your "hole!"

Jen

 

[ACDCJen]

Oh, I forgot to add that I am fat and young, yet my OS never hesitated to replace my knees. He said it was quality of life.

Jen

 

[GingerP]

@ACDCJen thank you for your wonderful but painful experience to share. I could cry for you. I understand the horror in things going badly and disappointment.
I'm not really sure what to expect from my surgeon today. He wasn't the most communicative person prior to me asking to see someone else and then he got defensive and pulled out the bmi issue. Not at all professional about that, but it's past and he did my knee. The knee is fine, it's the incision that isn't closing that is my problem.
I haven't looked at your pictures yet, but the size sounds just like mine now.
I appreciate you sharing your info with me. I hope to get a few more answers today.

 

[Celle]

@GingerP I hope your session with your surgeon goes OK. Can you take someone with you, as a support person, to speak up for you if necessary?
Before you go, write down any questions and anything you wish to discuss with him. That way, you won't forget anything.
You need to come out of the appointment knowing a plan of action for your wound.

 

[sistersinhim]

Please let us know what your OS says.

 

[KarriB]

I'm sorry action couldn't be taken at the wound clinic. Hopefully the two docs will communicate to find a way to help you. In the meanwhile, has it stopped seeping?

 

[GingerP]

@KarriB @Celle my Dr appt with the surgeon went very well. I told him that the wound dr wouldnt touch the incision due to it being a total knee. I told him, os, that the wound dr thought a wound vac would work best. We discussed approach etc and I told him I felt best if he would talk with the wound dr on Monday and coordinate with him opening my incision and packing it and me getting cross town to get the wound vac applied. He agreeD that the 2 of them need to work out a process. I spoke with the nurse following the appt and said that dr needs to call the wound dr Monday. I followed up with wound clinic staff telling them to be sure dr talks with my surgeon and what the plan was tenatively set up for Wednesday. They are to call with appt times.
You have beeN mentioning probiotics with long term antibiotics use. What should I be taking? It's been nearly 6 weeks and I'm not so sure I might be in need. Thanks all.
@ACDCJen I took most of the day to read through all of the posts of yours. It is helpful information to me since I think I'm headed down the wound vac road soon. @zzevi I appreciate all you had to share too. I spoke with the county nurses office home nurse I had today. She said they have seen great success with wound vacs. If I have them do the dressing changes I will be considered home bound and not be able to go outside of my home. The local hospital has a wound nurse that I could see and that wouldn't have restrictions so I was happy to find that out prior to next week. Living alone, I would hate not being able to go outside my home with Spring weather coming. I'm sure I'm looking at a good couple of months to heal up what is going on. I will know more next week. Jen, don't know if I can take pictures like you but you certainly can see the progress.

 

[KarriB]

I'm so happy to hear everything went well at the OS and they're going to work things out together. I had home nurses change my PICC line, draw blood and check my incision. I did leave the house for drs appt., lunch afterwards and to go to nearby friend's house where I elevated the whole time. However I didn't feel well enough to do much else.

My infectious disease dr suggested I take a probiotic while I was still in the hospital. The antibiotics definitely did a job on my stomach but things are much better with just 100 mg of doxycycline and my probiotic. I now take Probio5 from Plexus (on line only) but three years ago I took Cultrelle.

 

[Celle]

I'm very happy to hear your surgeon was willing to work with the wound centre. I hope they set everything up to happen on Wednesday. Best wishes!

 

[GingerP]

Also, my situation may be a bit more complicated since I am diabetic. I don't take insulin injections but Metformin and diet. It's been at good levels for quiTE some time.
Also, I'm wondering snice my opening right now is just that little hole and the surgeon says he will open up the incision about an inch or so, then pack it and send me to the wound clinic, should I have someone drive me? Or is ce it's might left leg, will I be ok to drive to the other clinice and then a 45 minute trip home? If I'm in a lot of pain from opening the incision I don't know how I can drive. Need thoughts.

 

[Celle]

I think it would be wise to ask someone to drive you. You will probably have the wound opened under local anaesthetic, but you may need some pain killers as well. However it's done, you could feel a bit shaken up afterwards.

I know that after some minor surgeries I have felt a bit shaky, and really in no fit condition to drive safely. You prepare yourself emotionally for the procedure, suppress the anxiety, and then get the shakes after it's over. I had a cyst removed from my scalp about 9 months ago. It didn't hurt, but it required a couple of stitches. Afterwards, I sat in my car outside my doctor's surgery and cried for a while. I think it was just relief of tension, but it took me a while to gather myself together again.