[Tobra]

Tried to PM back, but lost 1st half of message in process.

Exposed tendon and potentially bone is not the best wound bed, tyr google KCI or negative pressure wound healing or wound vac THis will promote granulation tissue, the beefy red tissue you see when you scrape your knee, but not to bone. It is like trying to grow grass in a parking lot trying to grow skin over tendon. Every time you move it, you disturb the wound bed and disrupt the new, delicate epithelial tissue.

It appears the edges of the wound are undermined a bit, this provides a nice little pocket for an abcess to form. Generally in this situation, I order packing the area loosely to allow it to heal from the inside out. No, Xeroform/vaseline gauze is not appropriate for this purpose.

As far as antibiotics, exposed bone is potentially big trouble, but at the same time, a healthy fellow like you may do just fine with good wound toilet and the initial ABx you received at the ER in the butt cheek(probably received anyway) and the keflex orally. Keflex has sort of shitty bone penetration though(IMHO< AUgmentin 875 bid would be better empiric choice), and if you abraded your patella and violated the periosteum(tissue that is closely adhered to surface of bone) you are at risk. Thing is, you can't just look at it and tell, and an x-ray will not show changes until the proverbial horse is out of the barn.

You want to take a sniff of the dressing every time you change it. If it smells foul and is watery, that is bad, e coli or klebsiella likely. If the drainage is cloudy/opaque, this often indicates staph, which is most common and can be very bad, particularly with resistant bug. If the drainage is greenish and smells sort of sweet, good chance it is pseudomonas, which is some very nasty stuff as well. Clear, straw colored drainage is normal, and it looks like that is what you have at this time.

If you are seeing your primary care doc for this, request a referral to a wound care specialist. After reading this, it is very likely you know about as much regarding wound healing as they do, scary eh?