Unstable sternum and wound opening up with terrible scars.

[Tina-marie]

Hi Please can anybody help I am 5wks post op for Aortic valve replacement with open heart surgery and I have been having a lot of problems with the wound. When the stitches were removed the bottom had like a blister which opened up into a deep hole this was followed a week later by 3inches peeling apart and opening up on my top of my chest then an inch near my throat.
I have been having these dressed daily so I was sent back to the surgeon who now says my sternum is grating and grinding and is unstable and I must take it really easy.
I dont know if anybody here has had a similar or the same problem also I am worried about the terrible scars ..Please can you help?
Thankyou
Tina-marie

 

[Greg a]

Tina-MArie, I would not worry so much about the scars as possible infection ....ask /demand regular blood work to monitor white cell counts and ask/demand a wound vac to heal properly

 

[Plumber1]

Tina Marie,

I have no experience with this situation, but am sure others here have -- and bet they will come by with help.

In the meantime please know that I wish you the very best in recovery and am hoping this will pass shortly.

--Mark

 

[Tina-marie]

Hi Mark and Greg
I did have an infection when the wound first opened up which was treated with Antibiotics but since this the nurse has said the wounds are very clean and show no signs of infection also my blood tests were good.
I still have daily wound dressings and my sternum is still moving a lot so when I get tired I cant stand the pain and have really strong painkillers it is getting to me as I thought by now I would be so much better and every thing is OK until I move.
I hate the scars and wear a scarf every where even in the house as I dont own a high necked top as I hate things around my throat.
I am usually a fun person and I hate this way I am and dont understand it.
Thanks for all your help
Tina-marie

 

[kfay]

Tina Marie, I'm sorry you are having problem with your sternum. Like Greg said, my number one concern would be making sure ALL infection is gone. If you had an infection and you are only 5 weeks post op and are off of all antibiotics, I'd have to question if that was long enough of a course of antibiotics. As far as your sternum not fusing, at this point, I'd either demand your surgeon come up with a plan to fix it, or I'd be seeking another opinion. I don't think at this point this is something that is going to take care of itself. Here is a paper you may want to read:
www.wounds-uk.com/pdf/content_9823.pdf

Best of luck to you. Don't give up, be persistent in getting answers and the appropriate care.

Kim

 

[Lynlw]

Im sorry I thought I replied earlier. Im sorry you are going thru this and like the others my main concern would be infection and healing and not what the scar ends up looking like, BUT if it helps Justin had a terrible infection that required extensive surgery, and youll be happy to know that incision looks just like it did after his other heart surgeries.

Since your bones aren't stable, my concern would be the infection is in your sternum bone itself. I know you said your wound isn't showing signs of infection and blood tests are good, I was wonderrring what blood test? Cultures to show if any thing grew in the blood or a Blood count to see if our white cells were high, that would be a sign of infection? Did they culture the wound itself? When did you have the blood work done? Do you have any fevers? Did they do any other tests, like Xrays, echo or ct scan to see if there are any pockets of infection?

Have they suggested the possibility of going to the OR to clean everything up and get good look? Like Kim I wonder about the length of time you were on Antibiotics, if you had an infection in your wound, I would have thought you would be on the antibiotics for a few weeks at least or a months or so. Its hard to guess what is going on or why the surgeons didn't suggest admitting you at least for a few days and possibly cleaning the area (debriment)

Have you been back in to your cardiologist? I dont know how it exactly works, but I would probably try to find out how to get a 2nd opinion on the treatment or ask for a referal to a wound specialist.
I thought the paper Kim linked to looked prettty helpful.Since you are in the UK, maybe if you cant get answers, you could try and contact the doctors who wrote that, and ask for advice

 

[Jason]

Wowza! This would have me pretty concerned. I didn't have issues with the surface wound, but my sternum did take a while to finally stop scraping around. I agree with the others, in that I would want very thorough checks to ensure that infection isn't an issue. I wish you the best as you work through this.

 

[Greg a]

/////////////////my concern would be the infection is in your sternum bone itself. I know you said your wound isn't showing signs of infection and blood tests are good, I was wonderrring what blood test? Cultures to show if any thing grew in the blood or a Blood count to see if our white cells were high, that would be a sign of infection? Did they culture the wound itself? When did you have the blood work done? Do you have any fevers? Did they do any other tests, like Xrays, echo or ct scan to see if there are any pockets of infection?

This is why my concern, I had OHS May 8/07 and my sternum was radically removed Aug20/07

Have they suggested the possibility of going to the OR to clean everything up and get good look? Like Kim I wonder about the length of time you were on Antibiotics, if you had an infection in your wound, I would have thought you would be on the antibiotics for a few weeks at least or a months or so. Its hard to guess what is going on or why the surgeons didn't suggest admitting you at least for a few days and possibly cleaning the area (debriment)

my wires were tightened on June 20/07

Have you been back in to your cardiologist? I dont know how it exactly works, but I would probably try to find out how to get a 2nd opinion on the treatment or ask for a referal to a wound specialist.
I thought the paper Kim linked to looked prettty helpful.Since you are in the UK, maybe if you cant get answers, you could try and contact the doctors who wrote that, and ask for advice

It was a wound specialist that introduced a wound vac

 

[Tina-marie]

Hi All
I left hospital on day 5 and every thing seemed ok on day 7 the nurse came to take out the stitches and said that it wasnt healed enough so they would come out on day 10 it was then that the bottom looked like a big blister and it came open and is now a hole that is packed daily.
On the second week I was cleaning the wound and the scabs came off and the wound on my chest peeled apart like an orange.I went to A&E and was swabbed and had had the wound dressed and given 1wk of antibiotics and told to come back in 2days on returning they said I had an infection and that I should go to see my surgeon as I needed debridement and resuturing so I phoned the hospital who operated on and they said to come at 3pm.
I went to the hospital they got the registrar and nurse who did another swab and redressed the wound and said to come back next week .
I went back and saw the surgeon I asked about more antibiotics and the debridement and resuturing and she said that she would not do this as I had had an infection and said that I was to take extra care as my sterum was grating and grinding and she gave me a cough lok which is a long strap.
I am finding the evenings very painful and my days are taken up with daily wound dressings and packing and now they seem to be healing.
I feel all this will be in vain if I have to have my sternum repaired but my appointment is 24th November to see the surgeon but my doctor and nurse said they should have done an xray I am unsure where to go on this as I just take strong pain killers and manage but its the nights that get me most.
Thank you for all your concern I will keep you posted on my progress.
Tina-marie

 

[Jkm7]

It seems you need someone else to look at this .... someone who has an operating room.
I am not familiar with how your medical system works but I think I would return to A&E (is that your term for Emergency Room ?) and see if you can convince someone there that not enough is being done to address this serious situation.

You must be very frustrated and I certainly feel for you but it seems you need more attention than you are getting. Please go advocate strongly for yourself. Hopefully you will get the right doctor's attention.

Please let us know how it is going.

 

[Lynlw]

It seems you need someone else to look at this .... someone who has an operating room.
I am not familiar with how your medical system works but I think I would return to A&E (is that your term for Emergency Room ?) and see if you can convince someone there that not enough is being done to address this serious situation.

You must be very frustrated and I certainly feel for you but it seems you need more attention than you are getting. Please go advocate strongly for yourself. Hopefully you will get the right doctor's attention.

Please let us know how it is going.

I agree with JK. Especially since the A&E reccomended you needed debriment a couple weeks ago, Do you know why they didn't just admit you then? Did you go to the AE in the same hospital you had your surgery at? If not maybe You could try going that route and seeing if that helps. When Justin had his sternal infection he had 6 WEEKs of antibiotics, so im surprised they only gave you 1 week worth. His surgery was the next day after they found the infection, his CT scan was 10 pm at night and he was in the OR the next morning. Actually when they even THOUGHT he had an infection they admitted him and started IV antibiotics.

 

[piglet]

Tina Marie,
I agree with Lynlw, I would go back and be alot more assertive. this is not a time to be polite. Have you tried calling your general paractitioner, maybe he/she can get something done.

 

[Bina]

I realize that it is late night in the UK right now, but hopefully Wednesday will bring a phone call to another
specialist or back you go for more assessment. Good Luck

 

[Tina-marie]

Hi everybody
Yes all of this has been a nightmare I am currently being treated by my general practitioner who has done blood tests and helps me manage the pain and looks after my wounds.
I have been to A&E at my local hospital but my surgery was done at another hospital my swabs were grown and antibiotics were prescribed for a further 2wks but I was told that there was no sign of infection by then and that my wounds were starting to heal so not to take them as it may lower my resistance to antibiotics.
I was prepared to be admitted when my wound first came open but I was sent away until the following week.
My HB was 12.5 and my white blood count was 7
I am seeing the surgeon on 24th next week for a full check up including an echo and ecg but I feel its weeks I have lost and suffered in the mean time and dont feel the surgeon is doing enough.
I will let you know how I get on and thanks for your kindness and concern.
Tina-marie

 

[Tina-marie]

Hi All
I saw my surgeon on 24th November and even though my wounds are now healed mostly by second intention the scars are red very wide and long and the bottom one which was a deep hole is now a large healed dent which I now have silicone sheets for scars.
With regards to my sternum it is still not joined but I have had a good tip for this by getting a small hot water bottle and wrapping it in a towel it works in two ways it soothes the pain and it keeps your sternum flat.
I have to see the surgeon again on 22nd December with regards to this problem and at present I am not allowed Cardiac rehab due to this.
Thank you all for your kind input and I will keep you all posted with the results of my next appointment.
Take care
Tina-marie

 

[Duffey]

Hi All
I saw my surgeon on 24th November and even though my wounds are now healed mostly by second intention the scars are red very wide and long and the bottom one which was a deep hole is now a large healed dent which I now have silicone sheets for scars.
With regards to my sternum it is still not joined but I have had a good tip for this by getting a small hot water bottle and wrapping it in a towel it works in two ways it soothes the pain and it keeps your sternum flat.
I have to see the surgeon again on 22nd December with regards to this problem and at present I am not allowed Cardiac rehab due to this.
Thank you all for your kind input and I will keep you all posted with the results of my next appointment.
Take care
Tina-marie

Thanks for letting us know how you are progressing. I hope there is significant progress by the time you see the surgeon on the 22nd.

 

[Tina-marie]

Hi all

Its been a long time since my original post so I thought I would let you all know how I am now.

Thank you all for all your your help during this difficult time and I would like to say I have come a long way since this and I am now 8mths post surgery.

I have another appointment with my surgeon next month and I will let you know my sternum results, but with regards to my scars they are still awful and I look like I have been butchered by a meat cleaver...lol

My INR is very stable and I now go every 6wks for blood tests.

I have used silicone sheets and now use a derma roller and find these have helped a lot.

Thank you for all your kind words and encouragement

Tina-marie

 

[escargome]

Tina-marie,
Thank you for the update. I hope that your appointment with the surgeon proves positive and your sterum has healed. As to the scars, I guess I would suggest to keep doing what you are doing. Sometimes it takes those suckers a long time to not be so red and mean looking. I will keep you in my thoughts.