Wow. Gruesome. But I had to look...

It's weird. If I roll upon the scene of an MVA and there are people banged up, lacerated, avulsed, abraded, and blood everywhere, it doesn't affect me like looking at (no)static pictures of a wound like Todd's. I've never said "ick" or had that pre-pre-pre nausea twitch in my stomach like photos like these cause.

All the best for a timely and complete recovery, to you and your girl.

JP

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?

Knowledge is good. But to find a Dr that uses it, fat chance. Look after yourself and complain loudly, very loudly if you have any doubt about how you are healing.

thanks for all of the great info. I went to see my primary care doc today, and he sent me across the hall to his plastic surgeon colleague (who interestingly enough was a student of my friend who checked me out on Monday). My primary doc is going to find me a wound/plastics guy near me and wants me to see him/her once a week to check the progress. No more peroxide, but instead saline rinse. He kept me on keflex but also added bactroban for the wound site. He said it looks pretty good at this point, and while there is some places for the baddies to hide, the topical and rinsing (along with what appears to be a good cleaning in the ER) should hopefully keep things going in the right direction. The other reason they want me to be checked every week is that evidently the placement of the wound is a little tough to heal as it moves ever time the knee moves. I'm trying to keep it as still as possible and may go to an open top brace at some point. But if it doesn't close up properly he said they might have to go in and do some surgery on it.

So at this point I'm keeping my fingers crossed and staying the course. Oh, and my doc also wrote me a script for 100 vicodin. Pain management good. And I tolerate it pretty well...no constipation, nausea, etc. Me an opiates get along well.

Todd:

My wife works for a respected plastic surgeon in Pasadena. If, at any point, you feel unsure about the direction things are going, I am sure he would be happy to take a look at any photos of your wound. Just shoot me a pm if you feel the need.

Meanwhile, keep up the positive attitude. This too shall pass...

Sincerely,

Mike

Feel better, Buddy!

-Eff

well, since someone revived this, here is how they look today:

http://nostatic.com/images/knee.jpg

http://nostatic.com/images/foot.jpg

no grafts...just slowly grew in. Did my first track weekend (in the car) last weekend. Still a little stiff and weak, but good to be back.

Must have been the Chinese herbs....

And, not trying to pry, but what happened to your chinese herb?

at least you've got one area you won't have to worry about when you shave your legs ;)

Wow, looks great, amazing.

Other than the shock of sliding down the highway with cars all around it looks no worse than most bicycle racing injuries :) I lost way way more skin and flesh training on the SDSU road racing course above Desanso.

Glad it all worked out.

she wants kids. I've btdt. Both of us went along seeing if we'd change our mind and while I moved a bit, she came to a point where she felt she had to act. So there ya go. We're still friends which is cool as she's amazing. But we're both moving on...

Wow! Nice heal up job there Nostatic. Compared to the first pictures it looks great.

great heal, todd. i'm amazed.

So... what's your next bike gonna be?

Remember, 12 oz. curls and titty bars...
Glad you're feeling better.
Nasty scrape.

LMAO... it's a bit like wrecking a 911... then you start thinking what you could do for the encore that's faster/better/meaner :D