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Forum Name: Surgery Topics

Question: 1+ year post-op drainage


 yourstruly452 - Mon Dec 18, 2006 7:34 pm

my mother (52 y/o) has had several abdominal incisional hernia surgeries within the past 5-6 years. 2 surgeries ago, the surgeon was finally, but barely able to attach the mesh, and the hernia problem itself has seemed to go away. however, during or shortly after this surgery, she developed an obstructed bowel, and another surgery was done to correct this in september of 2005. these surgeries were all laproscopic, and while most of the incision sites healed with little to no problem, one site has had a "discharge" for over a year now. in the last 3 months, she has been on a v.a.c. to attempt to close the wound, but no such luck and it has in fact gotten bigger. there is fluid coming from the wound--kind of a taupe-ish tan color. any ideas??? her doc keeps prescribing antibiotic after antibiotic, but this obviously isn't working and her labs are coming back normal (maybe it's me, but serum labs ought to come back normal during intense Ab therapy???).
 yourstruly452 - Mon Dec 18, 2006 7:59 pm

[quote="yourstruly452"]my mother (52 y/o) has had several abdominal incisional hernia surgeries within the past 5-6 years. 2 surgeries ago, the surgeon was finally, but barely able to attach the mesh, and the hernia problem itself has seemed to go away. however, during or shortly after this surgery, she developed an obstructed bowel, and another surgery was done to correct this in september of 2005. these surgeries were all laproscopic, and while most of the incision sites healed with little to no problem, one site has had a "discharge" for over a year now. in the last 3 months, she has been on a v.
a.
c. to attempt to close the wound, but no such luck and it has in fact gotten bigger. there is fluid coming from the wound--kind of a taupe-ish tan color. any ideas??? her doc keeps prescribing antibiotic after antibiotic, but this obviously isn't working and her labs are coming back normal (maybe it's me, but serum labs ought to come back normal during intense Ab therapy???).[/quote]

***sorry, also forgot to mention that she has recently been experiencing some lower extremity edema (takes norvasc and lipitor daily, and i believe lasix 1x/2x a week, but now dose has been upped)...could there be a correlation???
 Dr. Tino Anthony Solomon - Sun Jan 07, 2007 3:05 pm

Hello there,

From your description, it appears that either the wound has broken down or a fistula has formed after repeated operations. A fistula is an abnormal connection or passageway between organs or vessels that normally do not connect. As body tissue is invasively handled as is done in surgery, the immune system reacts to produce proteins which help heal wounds internal and on the skin. This can often be excessive, especially after repeated operations and can cause organs to stick to one another, known as adhesions. If organs adhere to the abdominal wall, then a passage can be created which can lead to wound breakdown and exposure to harmful bacteria which further break down the wound by secreting chemicals. Furthermore, a superimposed infection may have set in. An infection may have acted as a catalyst for the wound break down. You will need to give us more details about your mothers overall health status. What other medical conditions does she suffer from? Is she on antihypertensive drugs and anti-cholesterol drugs or has she ever suffered from heart problems in the past? Is she diabetic? Does she have any autoimmune conditions such as arthritis?

The reason I ask these questions relates to their relevance to wound healing. After any type of wound, in this case surgically inflicted, the body starts a process in which physiological changes occur in the organs and healing factors are released into the bloodstream and directed towards the wound(s). For this process to occur effectively, optimal conditions must be present. To list these individually would be exhaustive, but include factors such as nutrition status, age, current medication (as some alter the immune system which plays a vital role in healing), smoking status (as this limits the oxygen delivery to the wound site), and personal hygiene.

The purpose of the VAC pump is to clean the wound by removing dead tissue and infected cells, whilst drawing blood to the site to try to encourage healing by attracting chemical mediators of healing that the body possesses.. This was the function that placing maggots in wounds served in the past and in fact still do. It is important to be aware that this may be a long process and your mother can make the utmost effort to aid healing by following your surgeon's guidelines on lifestyle factors and hygiene. Please keep me updated with any progress.

Kind regards,

Dr. Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery
 yourstruly452 - Sun Jan 07, 2007 5:14 pm

thank you for your response! in the past few weeks, her surgeon has found that it is actually the gore-tex mesh that is infected, so that has to come out and be replaced with an antimicrobial mesh (if there's anything left for it to be attached to...if not ???). the swelling in her right leg was also found to be a result of vein (or artery--mom's not too specific as to which one) compression, so a stent needs to be placed and will be as soon as the plavix works it's way out of her system from the mesh replacement surgery. she does have hypertension and high cholesterol, so i'm sure all these things will come into play during the procedure and recovery. again, thank you for responding!

kate
 Dr. Tino Anthony Solomon - Tue Jan 09, 2007 12:41 pm

Hello,

I am glad to know that the source of the problem appears to have been found. However, it is now imperative that she follows her surgeon's instructions meticulously. Please keep me updated on her progress.

Kind regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery

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