Question:
I have an open wound on the top of my right foot that was caused by
stearoid injections from my podiatrist to remove scar tissue from 3
previous neuroma excision surgeries; the tissue died from the inside
out. An ortho and an infectious disease doc were called in and I was
hospitalized for IV antibiotics as I have a MRSA history and the ortho
did surgery to debride the infected area in my foot. I was sent home
on oral antibiotics but within a week of completeing that therapy, the
wound became infected again.
I was hospitilized again and placed on 2 IV antibiotics this time
(Vancomycin and Zosan) and surgery performed a second time. This time
the area was left open. I was released from the hospital 9 days ago
with no antibiotics! The ortho does not fully agree with this, but
deferred to the ID docs judgement.
I was trained to pack my wound 2 times daily and the ortho specified
saline moistened strips. The medical supply company sent Iodoform
packing strips. I just learned this am that this is an iodine solution
and not saline. In the last week, my wound has gotten larger, developed
a sinus tract and I can now plainly see the tendon so I am worried the
fascia has been compromised. I will be seeing the ID doc on Monday and
calling the surgeon.
My question is: does anyone have experience or knowledge of Iodoform vs
saline packing? Could the iodoform have made the wouind worse? My blood
sugars have been well controlled so I don't believe the diabetes has
contributed to it. Could the lack of antibiotics made it worse?
Answer:
Generally speaking the use of antiseptics on wounds is a
compromise. They kill infections, and infections would slow down or
prevent wound healing, but on the other hand in the absence of
infections they slow down healing themselves, and in cases where
healing is slow for other reasons than infection they can prevent
healing and worsen the development of the wound.
There are also kinds of dressing and medication which encourage
healing. If you've got a hard-to-heal wound which has only been
treated with antiseptics I think you need to bring it to the attention
of people with expertise in the healing of persistent hard-to-heal
wounds.
Since you're a diabetic with a hard-to-heal foot wound, it is natural
to suspect the possibility of some vascular shortcomings reducing the
blood supply. There are specific treatments and medications which
which can improve the local blood supply, and others which can reduce
the demand of the tissues for oxygen for purposes other than wound
healing.
I hope your wound hasn't been in the care of someone who just stuck an
bandage on it "because that's what you do". It should be in the care
of someone who is capable of discussing these kinds of issues and
explaining the options, risks, and trade-offs of the various kinds of
treatments and dressings.
