a hole in the top of my incision

ok, so my staples came out on 5/18. by last saturday, 5/21, i noticed some drainage on my top. so i have a look at the incision and i see it's coming apart and oozing a clear liquid. so on monday i called the doc and went to see them on wednesday....turns out i have a 4cm deep hole in the top of my incision. the opening itself is about size of the cotton on a q-tip. the NP says it's not uncommon for this to happen and that it's the fat liquifying and not letting the wound heal. so i have to pack it and dress it daily until a nursing agency is engaged to do this....i would have thought by now that someone from an agency by now but i have not heard from anyone. guess i'll be calling the doc again on monday.....ugh.

has anyone reading this had this happen? if so, how long did it take to heal from the inside out?

 I had this happen in a previous surgery, not WLS.  My doctor didn't seem too concerned, so I wasn't either.  I have extensive scarring because of it.  DO NOT WAIT.  If you get a staph infection you will have a problem that isn't easy to solve.  How long did it take for me to heal--I had an open wound on my stomach from July to November.  Mine started as a tiny leaking hole at a staple.  I was told to dress it with an iodine dressing 4x daily.  

Good luck!

wow...4 x daily!!! doc said once a day but i may increase it to twice a day due to the drainage. they said it doesn't look infected (and it's not at all painful) at this point but i go back in two weeks for a follow-up. mine is packed w/the vaseline guaze strips, not the kind w/iodine. then it's covered w/sterile 4x4 gauze and taped. did you do your own dressing packing? i have to run out tomorrow to get more packing b/c what they gave me at the doc won't last much longer. i'm really dreading this but i know it has to be done.

thanks for the info and reassurance.

cindy

 Cindy, mine leaked a clear to yellowish liquid at first.  Like I said, the doc didn't seem too concerned and just had me iodine dress it.  Two weeks later he had to open the incision up and irrigate it.  You don't even want to know what came out of it.  I had pic line IV antibiotics for 2 weeks.  The iodine that I used after he opened me up the 2nd time was not the kind of regular iodine people use.  It was by prescription.  There was absolutely no pain at all.  Not a gross smell, nothing to indicate there was infection.  

If I could do it again I would say if it hasn't stopped weeping within a week, ask for a wound care specialist.

I had open RNY and had several small spots where the incision opened up and oozed the stuff you are talking about.  I cleaned those spots twice a day with plain old anti-bacterial Dial soap, and changed the dressing (my surgeon indicated it was not necessary to pack it (and that packing it might actually introduce bacteria)) several times a day and it healed up just fine.

I also had my tummy tuck incision turn necrotic and once the plastic surgeon had cut out all of the dead skin and tissue over about a 3 week period, I had a giant crater in my belly (you could see the muscle fascia at the deepest spot).  That would have to be cleaned, packed, and covered twice a day.  They were going to have a wound vac put on it after about 2 months (whihc would require a home health care person to clean and repack it a couple of times a week), but by the time they got insurance to approve it, I was traveling for work and it was already starting to fill in.  (It took 6 months for it to completely heal up.)  The reason i tell you that is that one of the things the insurance company needed to know was the dimensions of the wound because they would only cover having someone come in to pack it if it is of a certain size (and eligible for a wound vac)... and some home health care people will not even come out until insurance indicates they will cover it... so it is possible that they are waiting on insurance approval. (Based on MY insurance company's requirement (yours may be very different), your hole is much too small to be covered, so that may be the hold up).  Even when my insurance approved the wound vac and home health care, they would not cover the entire cost, so it was going to cost me well over $100 per week, BTW, so be sure to ask them about that!) 

Call the doctor again on Monday, but in the meantime, do not worry about it... as I said, my RNY incision healed just fine after a few weeks (no serious scarring involved, just a little wider tahn the rest of the incision (my TT scar is another matter entirely, though))...  just keep it clean and protected and packed as best you can (by pushing the gauze in with a q-tip after cleaning it as thoroughly as possible).

Lora

 I got my staples out in February after having surgery to reverse my illiostomy after having a perforated colon in November.  The day after I got home, the nursing agency was at my home.  This actually happened 3 times, since I was in and out of the hospital a 3 times.  Each time, the nursing agency was at my home the next day. If I had come home early in the day, they would have come the same day. There is no reason you should have to wait this long.  The idea is that they are supposed to be packing it at the beginning and eventually they should teach you how to do it, so then you wouldn't need them.   I never heard of the description you gave of the fat liquifying. I was told that sometimes there are parts that just don't heal as well as others and get infected.  For me, I was having terrible pain in one area of my scar and it was a little red and swollen.  It was open a tiny bit but my surgeon said she needed to open it more to get it to drain or the infection would just get worse.  So, she injected me with numbing stuff and then used a scalple to cut the incision open to about an inch.  I felt nothing until it wore off.  Once she opened it, she was pushing down on it trying to get stuff to come out and tons of blood came gushing out.   She packed it and I went home. A few hours later, I was in excrutiating pain from where she cut and having the packing in really hurt.  It had to be changed daily, so when the nurses came they did it.  After a few weeks, they taught me to do it so I could finally leave the house.

I don't remember exactly how long it took to heal but I think it was about 6 weeks but I am not sure.  Towards the end when it got pretty small, my surgeon told me to just cover it and not pack it any more so it could close.  My keeping to put stuff in, it can;t close but at the beginning the packing is necessary to absorb all the gook.

Good luck

Hello,
Did you guys all have open ?  I had mine on 5/3/11 and they stitched it up then put a hard clear super glue thing on all 5 of my incisions.  And when i went for my 2 week f/u she peeled them off which I felt like an idiot because I actually thought they were the scars themselfs about 2 inches long!  When she revealed about 1 inch little things i was so happy.  But I didin't know they did it w/staples too like you guys had.

well it has happened. i think i have an infection in this draining hole in my upper abdomen. when i pull the gauze out of the hole, it has a foul odor to it. i'm calling the doc yet again today to see if they can see me or at least put me on an antibiotic. i'd rather see him, though, so he can culture this thing and see exactly what antibiotic is needed. i did call yesterday at about noon when i noticed the odor. i was told the nurse was at lunch and would call me when she got back. i still had not heard from them by 3:45 so i called them again and left a msg (they close at 4). the nurse called me right back and said to call my PCP to see if they will see me and if not, to go to an urgent care center! i called my PCP office and they absolutely won't touch it. i didn't even bother going to urgent care....i'd rather see the surgeon, not a stranger. i was amazed they even said to go there, but if i got feverish, i would have gone to the nearest E/R.
i just don't want this to become systemic and end up w/a PICC line and IVAB. i just want this to be healed.....ugh.

thanks for letting me get this off my chest (no pun inteneded....lol)

cindy

RUN! Don't walk to a doctor...if your surgeon won't see you then go to the ER over an urgent care.  I'd think you'd have better access to a wound and infectious disease specialists through a hospital ER.  In the meantime, continue to treat it as your surgeon instructed.  Just make sure you're following good hand hygeine before handling the incision....and keep calling your surgeon's office!  Though, if you go to the hospital ER where you had your surgery, the Dr. in the ER may have better luck getting through to your surgeon if he calls them and says he has a patient of his/hers in the ER presently.   Best wishes for you for a speedy recovery! Good luck!

ok, saw my surgeon today. he said it is NOT infected, there is no redness nor heat in the area of the opening but he did put me on Keflex as a prophylactic (and reassuring) measure. i am maintaining good hand hygiene before and after dressing this. he seems to think it will continue to drain for another few weeks, then start to close after that. i'm hoping he's right. i have an appt to see him next week, if i need to, based on how this is draining and if the antibiotic is working.

thanks for your advice and concern.

cindy