Question for the medical pros here

[wdfifteen]

MrsWD had carpal tunnel surgery 4 weeks ago Tuesday. 10 days ago the wound on her palm had still not healed. The doc said it was leaking synovial fluid and not healing because she had had the same surgery done at the same site 30 years ago (he had a term for that that i cannot recall). He showed her how to wrap it so the dressing maintained a little pressure on the wound and had her soak it in a special soap and water twice a day, always drying it with some sterile gauze. AND he told her to do absolutely nothing with the hand - don't get it close to anything not sterile, don't work, don't stress it, stay out of the pool. He stressed that this is a very serious condition.
After 10 days of doing nothing but reading and drinking wine she is climbing the walls and I'm not far behind, and the wound is only slightly better.
Is there anything else she can do to make this damn thing heal up?

Here is a picture of it from 10 days ago. For scale, the open part is about 1/2 inch long. It looks a little better now, but not a lot.

[Crowbob]

Tmi

[Eric Coffey]

Not a doc, but...

Bulk up on natural proteins, and vitamin C/A/Zinc, etc.
Might look into a topical nitro patch/ointment, but obviously ask your doc about that.

[Tobra]

If it is leaking synovial fluid, it communicates with a joint. This presents the opportunity for a septic joint, which is indeed very serious. That might need to be revised, or some high power wound care products may need to be brought to bear.

You can see maceration, the whiter looking skin, adjacent to the wound. You at the very least need to have something that will manage the drainage better. Gauze is not going to get it done. That does not look to me like a wound that is likely to heal, and I do a lot of wound care.

[Noah930]

Odd. I haven't run across this before. It doesn't look infected, but if it's still leaking fluid (it shouldn't be synovial fluid--there's no joint involved, and tendons don't make enough synovial fluid to ever leak it), then perhaps the wound edges have epithelialized. Meaning the wound might not heal, and it may be better just to do a second small procedure to excise the wound edges, and re-close the wound.

[dentist90]

Serous fluid perhaps? Just clear tissue fluid. But that does look like a dehiscence that may not close spontaneously. It’s good to have drainage initially to avoid swelling and this will probably heal from the inside out, but it might leave a noticeable scar. Like Noah said, if after a few weeks there is still a deep defect removing a thin layer of skin on either side and resuturing should get primary closure.

[wdfifteen]

Originally Posted by Noah930

Odd. I haven't run across this before. It doesn't look infected, but if it's still leaking fluid (it shouldn't be synovial fluid--there's no joint involved, and tendons don't make enough synovial fluid to ever leak it), then perhaps the wound edges have epithelialized. Meaning the wound might not heal, and it may be better just to do a second small procedure to excise the wound edges, and re-close the wound.

He may have said sebaceous fluid.

She goes back tomorrow for a third checkup on it.

[Tobra]

No, he said serous fluid.

As above, that looks like it will not be healing, see how it appears that the skin is grown down into the hole. Converging semi-elliptical incisions, remove the little wedge of skin so you have fresh edges, primary closure. Maybe wear a wrist brace for a week. Easy, peasy office procedure, sooner rather than later.

[mepstein]

There are people and clinics that specialize in wound care. Might be worth a second opinion.

[Tobra]

Will be faster to just revise the incision, much, much faster.

[pwd72s]

Wow! Just wishing her well here...

[wdfifteen]

Just got back from the doc. The wound is much better, but still sleeping fluid from a pinhole. He confirmed that it is synovial fluid emanating from tendons in her hand. Said the presence of the fluid is what has impeded healing, and the flow of fluid is abating as the post-op irritation diminishes. There is no sign of infection so he relaxed some of the restrictions on her use of the hand and predicted it will be closed in a day or two.

[wdfifteen]

Originally Posted by pwd72s

Wow! Just wishing her well here...

Thanks. It’s been a bit of a challenge, but things are looking up.

[Zeke]

Drinking wine does not help. Just sayin'.

[wdfifteen]

Eight weeks out and the hole in her hand has not sealed. The surgeon was on vacation 2 weeks ago and we saw his partner, who said give it a few more days. Saw the surgeon 6 days ago and he said “give it another two weeks.” The hole is wider than it was in the photo above. You can see right into her hand. After thinking it over we decided to get a third opinion from our family doc. Saw him yesterday. He was incredulous. He said the skin had already healed itself at the edges of the cut and it wasn’t ever going to come together on its own. He congratulated her on keeping it from getting infected for 7 weeks. He called the surgeon. I don’t know what he said, but tomorrow we have an appointment with the surgeon to have the healed edges of the skin cut away and have the two sides sewn together.
We’re really pissed at the surgeon.

[jhynesrockmtn]

Yikes, best of luck, good on your family doc for kicking some butt.

[Tobra]

Like I said 2 weeks ago

[Arizona_928]

I had a hand surgery done the beginning of August. I ended up using it more then I should have and got the Damn thing infected.
Kudos on keeping it clean for that long.


Also tobra called it...!

[speeder]

Originally Posted by Zeke

Drinking wine does not help. Just sayin'.

As a non-professional, that was my only take away from the OP. When an older person’s body is working overtime trying to heal a wound, drinking alcohol all day can’t possibly be advisable.

I hope it heals.

[smokintr6]

Originally Posted by wdfifteen

Eight weeks out and the hole in her hand has not sealed. The surgeon was on vacation 2 weeks ago and we saw his partner, who said give it a few more days. Saw the surgeon 6 days ago and he said “give it another two weeks.” The hole is wider than it was in the photo above. You can see right into her hand. After thinking it over we decided to get a third opinion from our family doc. Saw him yesterday. He was incredulous. He said the skin had already healed itself at the edges of the cut and it wasn’t ever going to come together on its own. He congratulated her on keeping it from getting infected for 7 weeks. He called the surgeon. I don’t know what he said, but tomorrow we have an appointment with the surgeon to have the healed edges of the skin cut away and have the two sides sewn together.
We’re really pissed at the surgeon.

Wouldn't you be ready to see a *different* surgeon by now? No way I would let that person cut me again.

Good luck, hopefully smoother sailing this time around.