For the Doper Doctors: Wound healing (long)

This is for all of the medical Dopers out there: My wife has an open abdominal wound that never seems to heal properly. A little background.
It started after she had a crash C-section when the wound became infected with staph, strep and e-coli and dehisced, leaving a wound about 16 cm diameter and 10 cm deep. The infection ate through the fascia layer giving her a ventral hernia. The doctors didn’t want to fix the hernia until the wound had healed.
After 6 months of wound therapy, she had the hernia repaired with mesh. She developed a seroma requiring the wound to be reopened. Through wound therapy and debridings they tried to close the wound but it turns out she had developed MRSA in the mesh. The only choice was to remove the mesh.
The docs attempted a tension closure of the hernia but she developed smaller hernias. They tried another hernia repair with a different mesh but she was allergic to the material so that was removed. This time they replaced it with a bio material (some kind of de-natured pig membrane) to assist the tension closure. Her body rejected it within a couple weeks causing another infection to develop. Fortunately, so far, the hernia appears to be holding. However, she is back to another open wound about 7 cm diameter and 8 cm deep.
We’ve done wet-to-dry packing, e-stim, pulse lavage and vacuum sealing. The wound heals but very slowly.
This has been going on since November 2002 and we are very worn out by it. Between the hernia repairs, mesh trimming and wound debriding she has had over 20 surgeries in the past 4 years. Is there a biological equivalent of the spray foam insulation that might be used to fill this wound? I know there is an organic “superglue” surgeons use to seal aneurysms and surface cuts. I had found an article about a collagen-based substance that was being tested about 6 years ago but it never received FDA approval. I am trying to find a way to fill the wound so we can just graft over the hole and she will be healed. Any help or suggestions would be appreciated. I think we’ve exhausted every other resource so I thought I would find the real experts. Thanks.

I am sorry that you have had such a bad experience with this, erie774. Sadly, as you know, there is no easy solution to your problem. It sounds like you have already run through the major avenues: primary closure, permanent mesh, and biomaterial. There are cyanoacrylate glues used to close incisions, but they are not effective on large wounds with a well-establish bacterial presence. Fibrin glues can be used to fill small space defects in some situations, but are usually used not as an adhesive but as a sealant to stop bleeding from a raw surface. I do not know of any ‘bulk-type’ agent that can be used to fill a defect as large as the one you describe. Certainly any skin grafts must be placed over a bed of well-vascularized living tissue in order to ‘take’, so you can’t graft over mesh.

As far as repair of the hernia goes, you didn’t mention anything about laparoscopic placement of Gore-tex sheet on the inside of the abdominal wall. This method can work in patients who have failed with other techniques, since you don’t reopen the old wound but rather go in through several small (<1") incisions elsewhere in the abdomen. Your surgeon(s) may have already discussed this with you - or you may have tried it already. This would be a major operation, and while simple in theory it can be complex or even impossible in practice.

In my (non-wound-specialist) experience, wound vacs have done the best job of promoting the growth of granulation tissue and shrinkage of wounds. They are unquestionably a major hassle to use properly over a long period of time, however. If a good bed of granulation tissue can be established, and the wound is properly shaped (shallow and without crypts), then skin grafts can be placed and have a fair chance of taking.

You don’t mention whether your wife has any associated health problems, but issues like diabetes, hypothyroidism, and anemia should be managed aggressively to optimize wound healing. If either of you smoke, you should stop (this can be a huge factor). Nutrition can become a limiting factor in some chronic wounds - even if caloric intake is sufficient, folks can become depleted in micronutrients like zinc, and adequate intake of protein is essential. I hope that you are getting coordinated health care - some wound care centers are multidisciplinary and can deal with nutrition, psychological support, insurance issues, etc. If you can, you might consider a call to your nearest burn center for advice or consultation on these issues.

Best of luck to you and your wife.

As serious as the problem sounds have you taken her to see the very tippy top specialists in this field? Sometimes they are best with the really difficult stuff as that’s mostly what they see. People will go years with failed conventional therapies and finally get healed when they go to the “top of the mountain” so to speak.

See John Hopkins Wound Center

Thanks for your concern. The wound care specialist we are seeing actually worked for a while at Hopkins, studying under Dr. Lazarus (doesn’t that name just inspire confidence). He created the wound clinic at the hospital we have been working with.
The problem hasn’t been with getting the wound to heal, really. It works but very slowly. The hernia has been a problem but it seems to be fixed now, knock wood. I’m just trying to see if there is some way to seep up the healing process. Spackle or styrofoam packing peanuts don’t seem like good ideas. My wife is just sick of repacking her belly with gauze several times a day.
My wife does have type 2 diabetes that is effectively controlled by medication. She quit smoking a couple years ago so that should not be a factor. She is also on multi-vitamins so I hope that helps.
I guess I’m just looking for a quick fix where none exists.

I’m not a doctor or healthcare provider of any kind, and I have no idea if there are contraindications in your wife’s case that might preclude it’s use, so grain of salt and all that, but have you discussed hyperbaric oxygen therapy with the doctor at all? It’s used to help wounds heal faster in some cases. From this site

Like I said, I couldn’t say if it would be helpful in your wife’s case, but you might ask your doctor about it.

I’ve read material on Hyperbaric Oxygen Treatment and it helps heal wounds and skin grafts that don’t want to heal. I’m sure it was used on my uncle when he was in a coal dust explosion, and had all those burns and skin grafts to heal. Maybe a doctor could comment on it’s use. I would try to find a doctor that knows about this treatment, if none step up to bat in this thread. Talk to a doctor that works with a burn unit, if you need to find out more information and can’t find a starting point. Maybe the moderator should change the title to get the right readers. (Surgery wound refuses to heal after many attempts. Desperate for solution.)

This is of course up to you about changing the title. You don’t give it the urgency that I’m sure would increase your views.

I really feel for your poor wife and you in this situation and wish you both success in finding a solution.

I swear Mishell hadn’t posted when I wrote my comment.