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Old 08-16-2007, 12:17 PM   #1
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Woundcare - Looking for a good doc

Okay, some of you folks may have experience with healing open wounds. Heck, folks with roadrash should have advice. Do you have a good doctor that I could go see? Preferably West, NW, or North Houston.

My family doctor took one look at my foot and gave me phonenumbers for two plastic surgeons for a skin graph. That was two weeks ago and of course, I haven't seen a plastic surgeon yet.

My gash in my foot is healing slowly. I have new skin growth coming in from the outside of the wound. So far so good. The hole I had is grown up to the height of the rest of the wound. I could just give it time and see what happens when the new skin keeps growing in, but here is the problem:

In the middle of the wound, there is a patch of thick white skin, about an inch wide and two inches long. It had black marks on it right after the crash but that had disappeared. The emergency doc had said it would eventually come off like a scab but it is actually dissolving and being replaced by red good cells. The dead white skin feels like rubber and doesn't hurt when being touched. I can cut it but eventually it connects to good flesh or is interweaved by healthy red cells so I can only remove that much.

Since I used to be a vet tech and have seen similar injuries on dogs who fell of trucks and were drug on asphalt for a while, here is what I would love to do. Find a doctor that can just numb that area and trim out that entire no-use white dead skin. That way, the healthy new skin can grow and I have one scar.

My family doc is no help here. He looked grossed out just looking at my foot and wimped out with the plastic surgeon referral. :confused1 Do I need to see a dermatologist for this or who can do help me?
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Old 08-16-2007, 12:28 PM   #2
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dunno... thought my did something similar, but I just let it go and lived with the scar.
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Old 08-16-2007, 12:28 PM   #3
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man ... I'm feeling a little queezy just reading about your injuries ... I think this is why I'm an engineer and not a doctor ...

Good to hear you are getting better ... was really nice to see you at the track last week.
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Old 08-16-2007, 12:31 PM   #4
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Quote:
Originally Posted by Faylaricia View Post
My family doc is no help here. He looked grossed out just looking at my foot and wimped out with the plastic surgeon referral. :confused1 Do I need to see a dermatologist for this or who can do help me?
Just hearing your description would do the same for me, sorry.

I say leave the calous skin so that way in the future you would feel no pain in that area.
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Old 08-16-2007, 12:31 PM   #5
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dunno... thought my did something similar, but I just let it go and lived with the scar.
The white no-good-for-nothing skin eventually totally dissolved?

I just think it is delaying the entire healing process. How long did yours take again?
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Old 08-16-2007, 12:34 PM   #6
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i can numb it and cut it out. i skin animals all the time id say im pretty skilled!
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Old 08-16-2007, 12:34 PM   #7
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Quote:
Originally Posted by JETG View Post
Hey sorry no referrals. I do have an idea, will bring over a 5th of alcohol. You will drink the alcohol to numb any feeling related to your foot. I will be more than happy to cut it all off for you, I am not queezy at all with wounds or what not. Blood dont bother me.


J
me and jet can tag team the surgery
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Old 08-16-2007, 12:38 PM   #8
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The skin needs a base to grow. That is why when a cut heals, it heals from one end to the other, it just doesn't start growing from the middle. First, do not use Peroxide, as it breaks down the colagulation (sp) of the blood that hardens and the skin uses that to heal. Next, use saline and sugar as a base. The sugar breaks down into a very fine mesh, and it alows for the skin to grow accross. It will itch, but keep in covered, put some neosporin on top of the sugar/saline solution, and the skin will start to grow over. This works, it just takes time. This should be done once a day. Clean with mild soapy water, dry just by air, apply saline/sugar mix, add neosporin, cover with bandage. Repeat daily. Hope this helps!!!
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Old 08-16-2007, 12:41 PM   #9
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Hey sorry no referrals. I do have an idea, will bring over a 5th of alcohol. You will drink the alcohol to numb any feeling related to your foot. I will be more than happy to cut it all off for you, I am not queezy at all with wounds or what not. Blood dont bother me.


J

Regular treatment for callous skin states to soak it in water and take a stone to it to rub it off. I soak my foot every night for about an hour and after that, try to take some of it off but then it starts to hurt. If I could just find a way to numb it enough. Anyone know someone to get us some lidocain? :icon_bigg

If not, Jet, you'll have to make me real real real drunk. I'll probably be hung over for days but I'll do it if it is worth it.
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Old 08-16-2007, 12:45 PM   #10
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Clean with mild soapy water, dry just by air, apply saline/sugar mix, add neosporin, cover with bandage. Repeat daily. Hope this helps!!!
Here is what I do: Hydrotherapy in the morning, soaking at night, after each, I scrub it with betadine or surgical scrub every other day, I let it air dry, add neosporin, cover with bandage. So, I do this twice a day.

The saline/sugar mix is new to me. I know sugar is healing and totally forgot about that. We actually used honey on wounds, when I was a kid.

How do you compose the mix?
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Old 08-16-2007, 12:50 PM   #11
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Hey I am serious, I can and will help. That stuff dont bother me one bit, might even be able to get some lidocain also. Someone I know works at a hospital.
When I was a vet tech about a decade ago, we got doggies healed up in no time. Numbed, scrubbed, cleaned on a daily basis, after a couple of weeks of hopitalization, done.

It is amazing how easy it is just to have an all-around medical person to fix things versus a specialist for this and a specialist for that. Family doctors sure became nothing but brown-bag givers and 'take this pill for your flu' or 'take this for your allergy'.
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Old 08-16-2007, 12:54 PM   #12
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i dont like covering wounds with bandages. i put neo sporen on it and leave it alone. no infections yet
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Old 08-16-2007, 12:58 PM   #13
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Quote:
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The white no-good-for-nothing skin eventually totally dissolved?

I just think it is delaying the entire healing process. How long did yours take again?
honestly I could tell you...and there are a couple minor differences.

Myne was smaller, and was result of surgery... (spike through the bottom, surgeon whent in through the top to clean). Id guess couple months before before it was healed over.
I think, towards the end when it was near the surface the dead 'top' with the edges formed more into a scab/calous that I was later able to...remove and let it reheal. Remind me next meet and I'll show you the scar.
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Old 08-16-2007, 01:27 PM   #14
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Quote:
Originally Posted by Faylaricia View Post
Okay, some of you folks may have experience with healing open wounds. Heck, folks with roadrash should have advice. Do you have a good doctor that I could go see? Preferably West, NW, or North Houston.

My family doctor took one look at my foot and gave me phonenumbers for two plastic surgeons for a skin graph. That was two weeks ago and of course, I haven't seen a plastic surgeon yet.

My gash in my foot is healing slowly. I have new skin growth coming in from the outside of the wound. So far so good. The hole I had is grown up to the height of the rest of the wound. I could just give it time and see what happens when the new skin keeps growing in, but here is the problem:

In the middle of the wound, there is a patch of thick white skin, about an inch wide and two inches long. It had black marks on it right after the crash but that had disappeared. The emergency doc had said it would eventually come off like a scab but it is actually dissolving and being replaced by red good cells. The dead white skin feels like rubber and doesn't hurt when being touched. I can cut it but eventually it connects to good flesh or is interweaved by healthy red cells so I can only remove that much.

Since I used to be a vet tech and have seen similar injuries on dogs who fell of trucks and were drug on asphalt for a while, here is what I would love to do. Find a doctor that can just numb that area and trim out that entire no-use white dead skin. That way, the healthy new skin can grow and I have one scar.

My family doc is no help here. He looked grossed out just looking at my foot and wimped out with the plastic surgeon referral. :confused1 Do I need to see a dermatologist for this or who can do help me?
if its growing and closing up, just be patient (no pun intended), keep it clean, strip old skin out and be careful not to create more damage.
screw the plastic surgeon, its a foot, its healing. me personally, I wouldnt kick ya out of bed for a foot scar, it adds character
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Old 08-16-2007, 01:34 PM   #15
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let me talk to my mom she does all types of skin care, ill see what she can do for you.
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Old 08-16-2007, 01:38 PM   #16
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The cosmetic surgeon would be the best route. Most of them should be very fimilar with this. If you want another referal let me know...we've been using the same one for years and he's been amazing with Jerreds wound care.

Jerred has been dealing with this very same thing since his amputation. Looked for quite a while now that he was going to require skin grafting. However his cosmetic surgeon thinks that it's healing very well on its own now and may not actually require the grafting. Starting out the wound was about 4" wide by about 2" long with the thick hard tissue developing in the center. Now the area is pink and healthy looking and has shrunk to about 2" wide by about 1" long. Anyway, what we've been doing to his wound is called a wet to dry dressing. You take a kerlix roll and roll out about 12". Cut off the 12" section and completely saturate it with saline. Place the saturated pad onto the wound and wrap the remaining kerlix bandage around the foot to keep the saturated pad in place. Repeat 3x a day. When you remove the bandage, any dead tissue should come along with it. However dont rip it off like a band aid. The reason for doing this dressing change so often is that is gently debreeding the area. You're not going to see all the dead tissue come off all at once. I am with cobracbr in regards to staying away from peroxide, although in all the years of dealing with wound care I have to say I've never heard of the sugar bit. But if it works then great. Also, I wouldn't recommend putting triple antibiotic ointment (neo sporin) on the wound yet. Once all the healthy tissue has filled in, you can start put coconut oil on the wound to help minimize scaring. Anyhow, not sure if this is the type of reply you were hoping for...but just thought I would give you my .02
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Old 08-16-2007, 03:11 PM   #17
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I have been searching for your ankle photo and I can't find it anywhere! In '92-93 I performed wound care at NWMemorial hospital and Cy-fair hospital. Wasn't the most favorite part of my job as I delt with some pretty nasty wounds ranging from post burn victims, gangrene, debridement, decubitus ulcers(bedsores), and witnessed a few resectioning procedures. As a physical therapist assisitant, that was part of our job. Very slow process wound care is of course depending on the severity.

If I remember correctly, Betadine in a whirlpool setting was kind of OK cause it was greatly reduced by the water, but it is supposedly damaging to new growth/the granulation process!
Trying to remember exactly how your wound is~ darnit! Front of the ankle, moderate skin loss, especially noted where the ankle extends/flexes.
It's most important as you probably already know that diet is going to play a grand part in healing! Extra protein for cellular regeneration for starters, and from a standpoint of PT, working the ankle in it's operable range of motion, perhaps even a stationary bike to work the ankle passively, anything to get blood flow going at the capillary level, henceforth faclilitate regeneration!

There are products, kind of a second skin containing the right components to maintain/facilitate granulation to fill in and scar tissue growth. I believe something called Apligraf or go to www.apligraf.com and you may have an alternative to a skin graft. I'm not sure, buy you may need a script to get it, but so what! get it started asap!
Hope this helps!
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Old 08-16-2007, 03:59 PM   #18
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I have been searching for your ankle photo and I can't find it anywhere! In '92-93 I performed wound care at NWMemorial hospital and Cy-fair hospital. Wasn't the most favorite part of my job as I delt with some pretty nasty wounds ranging from post burn victims, gangrene, debridement, decubitus ulcers(bedsores), and witnessed a few resectioning procedures. As a physical therapist assisitant, that was part of our job. Very slow process wound care is of course depending on the severity.

If I remember correctly, Betadine in a whirlpool setting was kind of OK cause it was greatly reduced by the water, but it is supposedly damaging to new growth/the granulation process!
Trying to remember exactly how your wound is~ darnit! Front of the ankle, moderate skin loss, especially noted where the ankle extends/flexes.
It's most important as you probably already know that diet is going to play a grand part in healing! Extra protein for cellular regeneration for starters, and from a standpoint of PT, working the ankle in it's operable range of motion, perhaps even a stationary bike to work the ankle passively, anything to get blood flow going at the capillary level, henceforth faclilitate regeneration!

There are products, kind of a second skin containing the right components to maintain/facilitate granulation to fill in and scar tissue growth. I believe something called Apligraf or go to www.apligraf.com and you may have an alternative to a skin graft. I'm not sure, buy you may need a script to get it, but so what! get it started asap!
Hope this helps!
dne'
I thought this was only used for chronic wounds or wounds that weren't healing properly. I'm not sure if a dr would prescribe this at this point in time.
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Old 08-16-2007, 04:08 PM   #19
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Old 08-16-2007, 04:09 PM   #20
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Her's apparently isn't healing properly.
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