Suggest Treatment For A Open Wound On Left Buttock Post A Surgery

Posted on Fri, 18 Mar 2016

Question: Hi, I have a dear friend named XXXXXXX who has suffered for months with a tunnel wound on her left buttock bear her vagina. She is a paraplegic so she's in bed or in her chair all the time. She had to wait weeks for a wound care doctor at Catholic Medical Center, in XXXXXXX NH to schedule a surgery and to perform it. They told her initially they would open up the wound, clean it out, and do plastic surgery with a skin flap after they cleaned it out. They did the surgery yesterday, and instead of closing it up they have left a huge, grotesque open wound packed with gauze that goes all the way to her bone, roughly the size of a softball in diameter. She is not scheduled for plastic surgery for 6 weeks (leaving the open wound for whatever reason) and she is in horrendous pain, as well as very worried of infection. They have her now on a vancomycin IV and they planned to send her to a skilled nursing care facility today, but she is in such agony they have held off until after the weekend. She's used to 90 MG of oxycodone pre-surgery due to her previous pain levels, and right now they're only giving her 0.5 ml of Dilaudid every 2 hours. What can we do to get her better care? Also, can I send you a picture of the open wound so you can see it? Please help, my heart is breaking for this girl. XXXXXXX

Answered by Dr. Dr. Kakkar (4 hours later)

Brief Answer:
I suggest a more concentrated firm of injection dilaudid HP

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query abd I have also reviewed the image.
Since it is a big wound and would have been infected therefore closing it immediately is not the right thing to do. Packing and daily dressing would help resolve infection, aided by antibiotics, as well as encourage formation of healthy granulation tissue from the walls of wound cavity so as to reduce the size of wound.
As far as pain is concerned she is obviously opioid tolerant. I wuld suggest dilaudid- HP injections which are a more concentrated form of hydromorphone than plain dilaudid. The dose can be titrated according to the severity of pain and her previous opioid dosing with oxymorphone. Hydromorphone and oxycodone are almost equipotent therefore she would require approximately the same daily dose Or higher of hydromorphone as she was used to with oxycodone prior to surgery to maintain adequate analgesia.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (5 hours later)

Thank you for your reply. Your help is appreciated. Apparently this type of wound care is appropriate, but I just had a hard time believing it was safe. Thank you for your info on the HP dilaudid, we'll request that tomorrow. They upped her dose to 4mg by oral and allowed her use of her regular oxycodone. They also infused atavan and started her on 75 mg of Lyrica. After 3 hours of this she was considerably more comfortable. Thanks again!

Answered by Dr. Dr. Kakkar (2 hours later)

Brief Answer:
you are welcome

Detailed Answer:
Thank you for writing to us

regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar