Question about wound drainage

  1. About 6 weeks ago, my wife underwent abdominal surgery (she had a gastroplasty). About a 2 weeks post-op, she went for a follow-up visit to the surgeon who opened up her incision to allow drainage from fat necrosis. Since then, twice a day, I've been packing her wound (lightly packing) with wet to dry normal saline dressings (sterile technique).

    The problem . . . it's still draining. The surgeon actually opened up the incision a little bit more about 4 weeks post-op to allow continued drainage of this fat necrosis. Overall, the wound is healing nicely. There is, of course, this small deep area where I continue to pack with the normal saline-soaked gauze. The drainage has remained about the same in color and amount. The surgeon said that it does take time to heal. So far, much to my relief, there are no signs of infection.

    My question. What the heck causes fat necrosis??? My wife asked the surgeon this question during her last visit. Unfortunately the surgeon said that she basically didn't know the answer. My wife did say that she had two siblings who had some kind of reaction to stitches in the past. Could this be the cause?

    Is there any way to help speed the process of correcting this type of drainage? Any special medication or technique in doing dressing changes???

    Thank you in advance for your time.

    Sincerely,

    Ted Fiebke
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  2. 4 Comments

  3. by   nursedawn67
    Ted, I wish I could help you two out, but I really do not know. I am glad to hear she is healing with no infection. i wish her a speedy and healthy complete healing.
    Take care, Dawn
  4. by   prmenrs
    I'm not an expert. [Although I play one on TV] oops, sorry.

    I have 2 theories. (I did do Infection Control for 7 years, and this was a "forever" discussion w/ the surgeons and the ID docs going at it ad infinitum and nauseum)

    The 1st is that there is not very good circulation in adipose tissue, and that is not conducive to good wound healing.

    the 2nd is that the surgeons don't handle that tissue very gently, i.e., leaning on it (with retractors), grabbing big clumps of tissue to tie off bleeders, or using a lot of cautery, which leaves a lot of dead tissue to be dealt with by the body along with the wound healing.

    I'll bet it's a little bit of both. It sounds like it's healing ok now, and wet to dry NSS is a very gentle form of debridement. A WARM, not hot, heating pad for short periods of time (cover the wet dressing w/ Saran Wrap) might increase circulation to the area. I don't know if she's on a special diet, but see if you can make sure she gets enough vitamins, esp C, to help her heal.

    A nice bouquet of flowers and a big kiss wouldn't hurt! Best wishes, Ted.
  5. by   kids
    Originally posted by prmenrs
    ...make sure she gets enough vitamins, esp C, to help her heal.
    And a zinc suppliment (NO mega dosing) for 30 days.
    And flowers, often

    I do agree with the idea of a reaction to stitches...my oldest son and I both 'fester out' about 50% of our disolving sutures...intact, with the size and consistancy of angle hair pasta. I went back to work 2 weeks after a TAH-with the incision open 3"...I would fluff a 2" roll of kerlex into and over it, then a folded 8X10 ABD, tape it down, put on a pair of control top panty hose and pray it didn't soak through. It never occured to me I needed to get a release to go back to work...I mean I felt OK so it must be OK, right?

    I wish you both luck continuing with no infection (great Nursing care!) It can take a long time, then suddenly without warning it will be healed.
  6. by   Ted
    Thank you for the replys!

    prnenrs: The theories that you mentioned make sense. She was in surgery for over four hours (because of a "bleeder" from a nick on her liver). That's four + hours where there was a lot of poking/prodding and retraction of skin and adipose tissue.

    kids-r-fun: A 3" open abdominal incision!?!? Wow! My wife's open area is about 1 cm in diameter. I have to take the normal saline-moistened gauze and make a "wick" out of it in order to insert it into her open wound (I use a sterile cotton tip applicator to help with the insertion).

    What really seems to help the drainage is when she lies on either side (she slept on her back for over a month because it was the most comfortable position for her). She also carefully allows the shower water to help cleanse her wound (per surgeon's instructions).

    The vitamin and mineral supplements are well worth investigating! Because of her gastric bypass, my wife already takes a small handfull of vitamin pills which fills her up rather quickly. I know that the pills do contain Vitamin C. I don't know if they contain zinc, though.

    With regards to the flowers, I gave her a couple of bouquet of flowers while she was hospitalized. Also gave her a Teddy Bear for her to squeeze when she was uncomfortable. All seemed to brighten her spirits. Actually, my wife perfers back rubs and cuddling. She gets a lot of that!

    Again, thanks

    Ted

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