Argh! Incision opened

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Blueheron
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Date Joined Feb 2010
Total Posts : 720
   Posted 11/22/2010 7:41 PM (GMT -6)   
I am currently two weeks post-permanent ileostomy surgery. Things were going so well until this weekend. Two days after getting my staples removed from my incision, I started to get lots of drainage out of the incision site. A few hours later the seam split open with a 2-inch long, 1/2 inch wide and at least 1-inch deep wound. Yikes! Apparently there was some fluid in there that was preventing healing and had to come out. Today I went to the wound nurse and she showed me how to pack it with gauze. I guess they cannot stitch up the wound for risk of infection, so at this point, I need to let it heal from the bottom up which could take a long time. I was told this was all caused by Prednisone. I was on 30 mg during my surgery. I am now down to 20mg and will be at 10 mg starting on Thursday. Also because of Prednisone, my stoma has also separated a bit on one side from the neighboring skin where the stitches still are, though this wound isn't nearly as worrisome as my incision one. I have an appointment with my surgeon tomorrow, as he has not seen the incision wound yet, but it sounds from talking with the nurse that packing the wound open is probably my only option for healing.

Has anyone else had there incision open like this? It is really difficult because the moisture from the wound drainage and wound irrigation makes my appliance not stick well and leak, but then I also have to be careful to not get stool in the wound. This is really daunting, as I am going to have to deal with this for quite a number of weeks if not months. I am having to change my appliance every day or so and am going through pouches like crazy. I am trying to stay positive, but it is hard.

betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 11/22/2010 10:22 PM (GMT -6)   
my incision wound reopened too. Not nearly as badly as your sounds though. I had oozing really bad even after the staples were removed for about 10 days and then it was all done. or so i thought! the bottom reopened to about 1/4 inch deep and about 3/4 inch long and 1/2 wide. It took about 3 weeks for that to close up, but its been 4 1/2 now and it still oozes daily. but less and less. You'll be surprised at how fast it reheals and closes in, but the oozing continues for a while afterward. I was told the same thing about it happening because of the prednisone. My surgeon looked at it after my ostomy nurse told me to start packing it and he said it was a beautiful would LOL! i said what does that mean and he told me it looks nice and clean and should heal up with no problem and it did! but yes it's slow. Mine was at the base so i had no problems with it being near my stoma. Did you talk to your nurse about having the change your pouch so often? you should be getting at least 3 days wear, otherwise your skin will become irritated. Not needed to change so often would help in keeping the wound clean. Are you using sureseals at all? those might help keep the moisture away from your wafer. I hope it all works out! hang in there!!
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-Now IBD is indeterminate tests will be done after healing if still UC J-pouch surgery, if Chron's take down of colostomy

pswift520
Regular Member


Date Joined Sep 2010
Total Posts : 91
   Posted 11/23/2010 7:08 AM (GMT -6)   
I had something similar to what you are discribing, but mine ended up much worse. I was over 2 weeks post op from a colon resection and my wound started seeping and then started smelling like poo. My doctor said it was probably just a wound infection. Ended up mine was a fistula. I ended up on TPN for about 8 weeks before they finally decided that it was not going to healing. (after we had thought it had healed and then it come open again.). That was some of the worst part of my summer. I hope you have better luck than I did. Let us know what the doc says.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 11/23/2010 11:58 AM (GMT -6)   
Mine always does and I have to pack about a two inch section...never fails!

You can trim the wafer on that side...that will keep the paper/tape part away from the open wound and allow it to stay adhered. Do you have a Sure Seal? You can also trim that so that it is just about a 1/4" larger than the wafer on that side...doing that should help you keep it dry. You can also wear a belt for added security.

I customize the outer edges on one side of my wafer to accommodate my scars (I take off about 1") without problems!
Crohn’s dx 1989
some terrible years before my
temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 11/23/2010 1:19 PM (GMT -6)   
     Oh yes..the culprit prednisone.  I was also on prednisone for about two years prior to my operation.  Tried to taper down but flared around Memorial Day and had to increase it to 40 mgm. At the time of my operation, I was down to 20 mgm.  The surgeon didn't want me to taper less than that because he said he would rather I be on prednisone than in a flare for the operation.  I was able to taper off the prednisone completely by the first week of August.
     I never had to have staples removed.  I believe I was just stitched from the belly button to private parts.  about six weeks post op the last two stitches popped and pus was oozing out.  My ostomy saw it, as did my family doctor and doctors who took care of me in one of our local hospitals because I became dehydrated a week afterwards.  None of them did anything about the popped stitches!  They just covered it with gauze and a bandaid.  When I went to my surgeon in September, for an entirely different reason....pressure in the anus (which was not sewn closed), I showed him the popped stitches.  He immediately put something on it....I never noticed what it was but it burned a bit and covered it up with a bandaid.  By the following week it was healed.  It isn't very attractive looking...not like the other stitches which are just about invisible now.
     I still have issues with pressure inside the anus and mucus still coming out..ugh.  I had an MRI last week, waiting for results.  Doctor cannot figure out why I am having this problem five months post op.  I think it is just taking longer to heal because of my extended prednisone use.

Blueheron
Veteran Member


Date Joined Feb 2010
Total Posts : 720
   Posted 11/25/2010 12:29 AM (GMT -6)   
My incision wound kept getting longer and deeper, so I made an appt. to see my surgeon on Tuesday. After seeing it, he said it went all the way down to the muscle layer, and that some of the stitches in the muscle had also torn out of the tissue due to Prednisone. I was sent right over to the hospital from his office where I underwent a second surgery to repair the incision last night. I now am all stapled up again and my incision looks great. Fortunately, I only had to be in the hospital overnight, though I am now back to square one pain/healing-wise.

betsaronie
Regular Member


Date Joined Oct 2007
Total Posts : 318
   Posted 11/28/2010 6:06 PM (GMT -6)   
well at least you get to skip the packing! that's something right? :) I hope it stays closed this time!!
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-Now IBD is indeterminate tests will be done after healing if still UC J-pouch surgery, if Chron's take down of colostomy

Blueheron
Veteran Member


Date Joined Feb 2010
Total Posts : 720
   Posted 1/20/2011 9:31 PM (GMT -6)   
I had to get yet another surgery on my incision last week.

In the beginning of December, just as I was to get the staples removed from the 1st incision repair surgery, a 1.5 inch section began to drain and open up. This wasn't a big deal. Once the staples were removed, most of the incision looked great and we simply packed the little opening with gauze. It seemed to be healing well by Christmas time. Then, though the wound opening was getting smaller and smaller, it started to tunnel under the skin. First, towards my belly button, which we still tried to pack with strip gauze. Then, in the opposite direction where I began to get a really painful swollen bump. Last week my surgeon decided we would have to open the whole thing up again to see what was going on. So back to surgery I went. Turns out I was having a reaction to a certain type of suture material that was used in my abdominal muscle wall. My tissue had refused to heal properly around the sutures and an abscess had also formed. My surgeon had to remove all those sutures and completely clean out the wound. Where the muscles hadn't healed completely enough, he put in new sutures made out of a different material. So my poor healing ended up not being caused by Prednisone after all.

Now I have a huge open wound on my belly that needs to heal from the bottom up. It is terrifying looking... about 7 inches long by 2 inches wide by 1/2 inch deep. I can see my muscles at the bottom. Yikes! I am hooked up to a wound vac which is super painful, but will hopefully heal things up quickly. It is depressing to be 10+ weeks out of surgery and still dealing with almost as much pain as the original procedure. Especially when my energy level is so great otherwise.

Before the surgery I was so afraid of what life with a "bag" would be like. Turns out that the ostomy portion has been the easiest part of the surgery for me to deal with. I just want this incision to be healed up so that I can go out and start having adventures again and figure out how to do all my favorite activities with an appliance. I am starting to feel like this healing time is never going to end. I am quite glad I decided to go the permanent ileostomy route. I can't imagine having to go through two more surgeries and recoveries.
-Officially diagnosed with UC in 2006, though had symptoms since 1999.
-Had mild/moderate symptoms continuously until severe flare in autumn 2010 which required 2-week hospital stay
-Took Asacol, Rowasa, Canasa and Prednisone to manage flares but meds stopped working
-Tried 1 infusion of Remicade but had excruciating joint pain and discontinued
-Had permanent ileostomy surgery 11/8/2010

Chevypower1930
Regular Member


Date Joined Sep 2009
Total Posts : 254
   Posted 1/21/2011 1:28 AM (GMT -6)   
Yup... definitely from the prednisone... with my ileostomy surgery my incision opened and was an absolute mess due to my 60 mg dose of prednisone pre op....

I Just had the J Pouch surgery 2 weeks ago :D ! And I was healthy and not on prednisone and after 2 weeks it's already healing up very nicely and is completely closed.... Idk how to help with the incision but I went to the doctor when it happened and one of my surgeons doctors put some kind of black paste IN the incision and packed it with gauze and it healed up very nicely
20 Year Old Male

Diagnosed with Moderate/Severe Ulcerative Colitis May 2008
3 Flair ups (first flair- 2 months/Second Flair- 2 months/ Third flair- One week, then surgery)

Full Ileostomy surgery done on july 22!

Living with an ostomy bag right now and loving feeling healthy again! Finally have gotten this horrible disease OUT of my body!

windy city
Veteran Member


Date Joined Dec 2010
Total Posts : 607
   Posted 1/24/2011 3:37 PM (GMT -6)   
Sorry to hear this. I had same thing occur. July 2010, had open total colectomy (diverticulitis) and ileorectal anastomosis. Didn't work out. Was then in ICU for sepsis, blood clot and an ileostomy was performed. Due to the clot meds, my wound bleed. Now it was open. Was in hospital for 39 days. Came home with 32 lbs weight loss and all these issues. The nurse came 2x/day for only 2 days and then I was to do wound care myself and gradually she came every other day. In the hospital I had the wound vac. While home, it was wet/dry for several days until nurse used Aquacel. WOW, speedy healing!! After 2 weeks home, the wound vac arrived and I declined it due to the speed of the Aquacel. But then the nurse ordered another alginate product and it was very slow. Was pissed!! My wound was also 7" long and 3" wide. It took 2 months to close. So, from surgery to closure, about 3 months. When I came home, I didn't know what was worse, the wound or the ileostomy. I didn't know how to handle the ileostomy and a hellbounding 2 weeks to find an appliance to work more than several hours. I was horrified when it broke because it went in the wound,again several times a day of both wound care and appliance changing. It was an experience I'll never forget, no words to describe it!!!

With you being on the wound vac, it will heal faster and the pain will slowly deminish. Good luck and it will be over soon. Will be thinking of you.
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