Note: Many of you were included in a group distribution list that received almost weekly updates of Peter's progress throughout the last three months. This will be redundant to you, but I wanted to share a summary of what's available in the field of Wound Care these days for others.
Postings to Open Window have been irregular lately because Peter and I have been in a marathon of wound care since April 24th. Earlier in the year, Peter had some bumps that were on the inside of his right ankle biopsied and we learned that he had basil cell cancer. After much research, we decided the best path to take would be to have a well-established, well qualified, local, plastic surgeon do the required surgery and manage the subsequent wound care.
Wounds on the lower extremities are difficult to heal even on a young patient, because they are so far from the heart and the veins have to work really hard to get the blood that the arteries deliver to the site back up to the heart. Given venous insufficiency, and being a "pre-diabetic" 70 year old only exacerbates the challenges of healing.
Surgery happened on April 24 and took longer than expected because once all of the cancer was removed, the doctor found calcification underneath. Calcification occurs when tissue has been traumatized over a period of time; the tissue doesn't like it and decides to turn to bone. Peter had had these "bumps" for a long time and they were frequently inflamed. The results of a previous biopsy were negative, thus nothing was done earlier. The surgeon also removed the calcification, and then the healing process began.
We were so fortunate that Stony Brook Southampton Hospital has a Wound Care Center, which was co-founded in 2005 by Peter's surgeon. The wound was the size of a large silver dollar and it was ¼ of an inch deep throughout. First there was an Unna boot to which was added a wound vac the following day.
An Unna Boot is a compression dressing, usually made of cotton and treated with a zinc oxide paste which promotes healing at wound sites, keeps the area moist, and eases skin irritation. This was then covered with a self-adherent elastic bandage called Coban and finally this was covered with a non-adhesive bandage so he wouldn't stick to everything. Peter wore this medley of wraps for 86 days (nearly 3 months).
The day after the surgery, the insurance company approved a Wound Vac as part of Peter's wound care. A wound vacuum device removes air pressure and gently pulls fluid from the wound area over time. This can reduce swelling, and helps clean the wound and remove bacteria. A wound vac also helps pull the edges of the wound together and can stimulate growth of new tissue that helps the wound close. It is a truly remarkable little contraption consisting of several parts.
A gauze dressing is put directly on the wound and an adhesive film covers and seals the dressing and wound. A drainage tube leads from under the adhesive film and connects to a portable vacuum pump which is about the size a ladies clutch purse, and this is all worn 24/7! Peter and this companion of his were attached for six (6) full weeks. The dressing, wound vac container, and the Unna boot were replaced each week by an incredible team of nurses at the hospital.
Twice during the first month a biologic dressing was added to the mix. Peter was treated with Grafix dressings which are "cryopreserved placental membranes in which the structural and cellular integrity of fresh placental membranes is preserved". "Biologic dressings promote wound healing by retarding the formation of granulation tissue, providing and maintaining a moist environment that is conducive to cell regeneration, and acting as a bacterial barrier to protect the wound from infection." These dressings are the Ferrari of wound care and cost $5,000 for a 5x5 cm piece!
The final arrow in the Wound Care Center's quiver was Hyperbaric Oxygen therapy, which is guaranteed to promote healing. Peter did five (5) dives, two just before his second surgery, a skin graft to cover the healing wound, and three immediately after it. Hyperbaric oxygen therapy, affectionately referred to as HBO, involves breathing pure oxygen in a pressurized tube. You've probably heard of this as a treatment for decompression sickness, a hazard of scuba diving. It is also excellent for wounds that won't heal as a result of diabetes. Each dive lasted nearly 2 hours. In the HBO chamber, the first ten minutes get the occupant to the correct pressure level (2.0 atmospheres equal to about 33 feet or twice normal pressure, AND 100% oxygen), the treatment is then an hour and a half, and finally the last ten minutes bring the occupant back to normal pressure. Under these conditions, lungs gather more oxygen than is possible breathing pure oxygen at normal air pressure, and the blood then carries the oxygen throughout the body, helping to fight bacteria, and stimulating the release of growth factors and stem cells, which promote healing.
I was able to stay in the room while Peter was in the chamber and even spoke to him on a phone attached to the bed. He explained later that it’s quite noisy in the chamber and, of course, given the pressurization your ears pop a lot, especially going down and coming up. Sadly these things make it challenging to hear the television, and the warp in the glass ceiling (yup, he’s found his "glass ceiling”) makes it hard to clearly see the TV. All of this adds to the tediousness of the entire procedure.
I am so happy he is healed. Your explanation was magnificently explained Claudia!! Bravo!!!
It is unfortunate you had the opportunity to be in a position to know so much about all of those modalities but your blog readers and friends are now the happy recipients of your expertise.
Yes, I agree it is truly amazing what technology currently exists to heal. And that you had it so close is such luck for you both.
Fingers crossed that his ordeal is at it’s happy conclusion.
Xo
Posted by: Ally | Monday, July 23, 2018 at 03:27 AM