Question regarding abdominal dressing change.

  1. Hi:

    My wife had abdominal surgery about two weeks ago (had a gastric by-pass). The incision seemed to be healing just fine with the exception of one small spot where a constant serous drainage occured (the drainage showed no signs of infection and the surgeon said it was due to fat necrosis).

    At any rate, when my wife visited the surgeon for a two week post-op appointment, the surgeon opened up the incision about one inch to allow the wound to drain and heal. The plan now is to do moist wound packing (lightly packed with Normal Saline moist dressings) twice a day. The surgeon also said that my wife could take showers and allow the water from the shower to cleanse the wound.

    It's the shower thing that has me concerned. Although the town water is chlorinated, the water is often light brown from iron that's in the town's water supply.

    Any thoughts and/or suggestions regarding showering while having an open abdominal wound? With iron water??

    I do cleanse the wound with normal saline. So far the wound still shows no signs of infection (thank goodness!).

    Thanks ahead of time for your thoughtful input.

    Regards,

    Ted
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  2. 3 Comments

  3. by   hoolahan
    First Ted, I have seen several wounds with the type of drainage you describe due to fat necrosis and it can go on for some time.

    Second, better out than in, so opening up the wound to promote drainage, is always appropriate.

    Third, I have frequently had clients who have showered with thier abdominal wounds. These people live in the projects and drink our city water, which a family friend has long described as "Chlorinated, urinated, flourinated, city water." We have never had a pt develop a complication due to this type of irrigation. What would be worse would be a bath, being upright in the shower allows gravity to do the irrigation. I am sure it seems gross b/c of the iron, but I am sure since your wife has had exposure to this water in many ways for some time, her body will not react to it in a harmful way.

    Bottom line, it sounds like the wound care is appropriate. But, if you are uncomfortable with it, you could certainly use a syringe and irrigate the wound with NSS if you wanted to instead. Nothing wrong with that.

    On a final note, the only time I have ever seen a pt who had a wound of this kind that just wouldn't heal that last little bit is when, not to scare you, but there was something left inside the cavity. We had a woman on service for 2 months like this. Finally her primary nurse asked a wound nurse to see her, the wound nurse really probed into the tiny hole and pulled out some gaggable long-forgotten peice of packing about 3 inches long. From the hospital dressings I like to think. But, it could have been from one of our nurses, who knows. Anyway, she pulled this gagger out, the wound healed, problem solved. Had another pt with a simialr story, a sponge left inside. It does NOT sound like this is your wife's problem!! I only mention it b/c you should think about it if the drainage doesn't stop after about 6 weeks.

    I had one man who had his ear removed from cancer, and one wouldn't think you had too much fat on your head right? Well, that fat continued to liquify for 2 months before easing back. It did eventually, and the pt was fine.

    Hope your wife is feeling well.
  4. by   Ted
    Thank you, Hoolahan, for your input!

    My wife has been showering but with the packing in. I'll suggest to her she allow the shower water cleanse the wound.

    I don't have any home wound care experience. Must admit that the surgeon's instructions seemed odd at first. So far, though, the wound does look clean and also appears to be healing well.

    Again, thanks.

    Regards,

    Ted Fiebke
  5. by   hoolahan
    Hi Ted, maybe I should clarify, I wouldn't have her bend over backwards and allow the water to gush into the abd cavity, just to shower naturally, w/o the dressing, and to let what water run where it may, and then by gravity run back out. Do let the water get to the wound area, just running in a vertical direction, do you know what I mean (ie, not bending back and letting water get in a pool there, which would be more like a bath.)

    I'm glad it is healing well. My aunt had a wound after her lap, and the tissue looked gorgeous and pink and healthy, but when the wound RN suggested using carrington gel, I thought, ewwww, inside the abd cavity?? She assured me it would be fine, and she healed up like magic. Your wife's wound needs to stay opne though until the drainage stops.

    Glad things are going well. :-)

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