<p>My mother just had a hernia surgery, leaving her with an open abdominal wound. She is obese, so the wound is quite large and deep. </p>
<p>I did an internet search for open abdominal wound and found a support column for recent weight loss surgery patients where they discuss having to do with something similar.</p>
<p>Have any of you or have any of your parents had something like this, and what was their recovery like?</p>
<p>It boggles my mind that my mother can be alive with this wound, but the wonders of modern medicine. She is on a trach now, so the hope is to have her breathing on her own, but this open wound will still be there.</p>
<p>I’m trying to educate myself that this is a normal occurrence nowadays and bring it down to a normal situation, but this is extremely upsetting to see my mother in this condition.</p>
<p>My dad had this after removal of a gangrenous gall bladder. If I remember correctly, it is called a Wound V.A.C. (his had a device attached that provided negative pressure, I think.) He went home that way, and home health came in to check on it. It healed beautifully, much to my surprise.</p>
<p>Yes, after the trach is removed and Mom is breathing on her own, this wound will still remain.</p>
<p>She is not on the Wound VAC. She has a pigskin mesh where the surgery was performed. Freaky, as I thought I was looking at her stomach in her open abdominal cavity. The nurse packs the wound with gauze, puts a maxi pad looking thing over the wound after the packing, and then there is a girdle that has velcro that is closed over the wound. </p>
<p>Right now, she is only receiving IV nutrients. She does not want a feeding tube. Don’t know if that will be an option, but we discussed last year that she did not want to ever be in a ventilator or a feeding tube. </p>
<p>Unfortunately, she’s on a trach, which I know she wouldn’t have wanted, but the doctor convinced my siblings that this would help her heal. Don’t know what call I would have made had I been there, but I’m definitely not happy with the condition she’s in right now. She’s 79 years old, wheelchair bound due to multiple plates and screws from fractures, so she’s not going to be doing jumping jacks anytime soon.</p>
<p>But, since I saw this blog about post obesity surgery patients dealing with something similar, I was wondering if any of you could offer anecdotal information, tips, advice.</p>
<p>Only commenting on the open abdominal wound. When I was 38 and otherwise fit and healthy, I had to be reopened 1 week after a c-section. They did not sew me closed again. They said I would heal for the inside out. I had a couple of visits from a visiting nurse and learned how to change the bandages (really interesting materials that were developed for burn victims). I healed pretty quickly and while it seemed barbaric at the time, it worked out well.</p>
<p>Indeed. I once worked in the surgical ICU of a county hospital. One patient had really severe pancreatitis. The leaking enzymes from the pancreas would have eaten away at his intestines, so they removed the intestines from his abdominal cavity and set them on top of his stomach in some kind of clear sterile bag. That really amazed me and I can’t say I have ever seen anything like that since. Your mom’s wound, horrific as it seems, is not incompatible with life by any means.</p>
<p>When my husband had hernia surgery they put in a mesh thing but they sewed it shut. I can’t imagine leaving it open. I hope her wound heals quickly.</p>
<p>In 2004, I had to have dire-emergency surgery at Mt. Sinai to fix a high-grade intestinal obstruction. About 4 or 5 days later, the incision burst open from a post-operative infection, as I was returning to my bed after using the bathroom. It was quite disturbing to me to have a giant opening in my abdomen with God knows what coming out of it, but nobody seemed that concerned. The only thing they did right away was send a resident to my room with what looked like an industrial-grade staple remover; he stuck his hand inside the opening and yanked out all the internal stitches. (It would have been nice had he warned me how much it would hurt, but he barely spoke English – when I complained, he just pointed to the morphine pump and said “Push button”! Gee, thanks.) </p>
<p>After that, they just left it open to allow the infection to clear up (they also gave me IV antibiotics for a while), and let the opening close up gradually by itself from the inside out. They packed it with gauze, but the only thing they covered it with was a gauze dressing fixed in place with tape, and they sent me home when it still looked like an open crater, several inches long and with the two sides about 2-3 inches apart at the beginning. (I never really wanted to know exactly how deep the opening was – but I do know that my then-partner, who was not the least bit squeamish, happened to be there when they changed the dressing one time early on, and almost fainted at the sight.)</p>
<p>For the first week or so after I got home, because I weighed only about 90 pounds (down from 120) and could barely walk, let alone change the dressing myself, a visiting nurse came every day to clean out the wound with saline, and change the gauze packing and dressing. After that, I was able to do it myself. It took at least a couple of months for it to close up, and I remember that when I went back to work it was still open. The whole experience was rather unsettling, but I got used to it, and once I was back at work, the only downside was that sometimes fluid would leak out around the gauze and stain my clothing. </p>
<p>So, in and of itself, I don’t think it’s that unusual to leave an opening. At least temporarily.</p>
<p>Thank you all for your anecdotes. Up to now, I just figured she’d be in the grave before I have to worry about her daily living with an open wound. Now I see there will be challenges with daily living for her, being wheelchair bound, living with this open wound. She will definitely have to go back to her skilled nursing unit, and they will have to have someone on staff to clean the wound, as her disability will not allow her to do it herself. As I look for places for her to go after the LTAC unit, I will make sure that they are aware and are able to provide this care for her.</p>
<p>As for the size, right now, it’s 25 by 13 cm, and 6 cm deep. Very frightening. I’m reminded of those Civil War movies where the soldier took a cannonball in the stomach. I wonder how many of our poor boys, and girls, over in the Middle East are coming home with this kind of injury. Perhaps that is how we got the practice and learned how to treat this kind of wound.</p>
<p>This is done routinely with incisions which are in difficult areas, such as abdomen, risk of abscess, or because of an abscess. If you google the term wound healing by secondary intention, you can read all about it, and the why. It has been done for over 20-30 years, probably much longer, have seen it as long as I have been in the field. </p>
<p>We would even have post aortic aneurysm heal this way on surgical floors. They always heal, it looks horrendous, but it does close.</p>
<p>Often a deep wound is left open so it heals from the inside out, or from the bottom up. S1 had surgery to remove a pilonidal cyst and that is how it healed.</p>
<p>H has had 3 abdominal surgeries in the last year. The first 2 incisions opened up a couple days after he left the hospital, and were left to heal, like VH describes, from the inside out. It takes a while but eventually heals. With a pretty wide scar…</p>
<p>Have you spoken to your mother’s physician about the wound healing process? It sounds like she’s going to need some help with the dressing and visiting nurses should come and help her. Ask for this. Also, there are wound clinics that have staff who are skilled in wound care and have a variety of therapies to help wounds heal. I had hardware removed from an ankle two years ago and the incision split–I wound up going to a wound clinic. Those folks were amazing–all they did was focus on wounds. See if that’s an option for your mother.</p>
<p>Agree with Bromfield. The Wound Clinic associated with H’s hospital was also amazing. Even H’s surgeon was in awe of their knowledge. So many different options of dressings which are the best for the specific situation. They will give detailed instructions to your home care nurse. They also carefully measured the wounds and kept track of the healing process at regular visits.</p>