Cath Lab Digest

W ound care professionals deal with necrotic wounds daily. We instruct patients in self-care as a routine task in our management plan. The expectation is the patient will do as instructed and the wound will likely progress to healing. We are aware that the necrotic wound needs to be debrided or “cleaned up” — what we often do not acknowledge is how distressing necrotic tissue can be to the patient. As a wound care specialist, I decided to share my experience with a necrotic wound for two reasons. First, despite my education and training, when my body was involved I did not want to look at let alone care for the necrotic wound. Second, I want to encourage other specialists to be more aware that the patient’s feelings about caring for the wound can affect compliance and motivation.

Background

In August 2003, I elected to have abdominoplasty to address what exercise and diet could not. To prepare for the surgery, I worked with a personal trainer — I followed an abdominal program for 6 months and lost 10 pounds. Although these are accomplishments, people asked me if I was pregnant, something I had heard for 10 years and continued to find rude and upsetting. I went forward with the surgery to put an end to these comments; I cannot express how distressing the question is, especially because I have never been pregnant.
I had been on Nadolol for 7 years for supraventricular tachycardia. Before surgery, I had an exercise stress test for a piece of mind before having anesthesia — my brother had recently had a heart attack at age 54. Imagine my surprise that I could go off my medication. At the very least, the exercise and weight loss at least paid off for my physical health.
Anticipating liposuction, I did a good deal of research before choosing my physician. I asked other nurses about their surgeries and outcomes, assessing patient satisfaction uncensored and literally seeing the results. Once I made my decision, I went for a preoperative visit, asking the usual questions regarding infection rate, surgery failure rate, complications associated with the surgery, anesthesia personnel, and whether office staff were advanced cardiac life support-certified. The physician disclosed that occasional infection was a rare complication. Knowing that not every surgery goes perfectly, I was relieved he was forthcoming about possible postoperative complications. Plus, as I wanted, the surgery would be performed in his office. I believed this decreased the chances of my acquiring an infection compared to having the surgery in the hospital.
Although I had mentally prepared for liposuction, the physician explained that I would be left with the skin causing the distressing pregnancy comment, even if I continued the abdominal program and lost more weight. The problem could be resolved, however, by abdominoplasty. I was agreeable to a different procedure — anything to end the comments.

Clinical Problem/Treatment

The surgery was uneventful. I woke, as anticipated from my training, with two pubic drains. I took ciprofloxacin daily until the drains were removed. Three days post op my drains started leaking. I secured gauze split around the tube but the wound continued to leak through my clothes. I split a semi-occlusive foam dressing to fit the drain site and changed it twice daily, eliminating the strikethrough. The drains were removed at day 7 and I used the foam dressing a few more days until the sites sealed.
Complications arose. My umbilicus, transplanted as part of the surgery, became necrotic. I found out about it the day after surgery when my husband helped me change my compression garment. Because circulation had been impaired from the edema, my bellybutton was black. I released compression and watched the area. When I called the surgeon 4 days later, he agreed with my assessment and management of the situation and asked that I continue to watch the wound.