I don't know what's with these incisions lately. I got to th | Figure 1

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I don't know what's with these incisions lately. I got to this pt home & he told me a staple "popped". I took dressing off to find this. He said it was redder than yesterday & I found peri-incision warm to touch. The dehiscence opening tunnels 4 cm at 12 o'clock.I sent him to surgeon same day to assess and client was sent right back home with order to cleanse with Betadine, pack with dry "sponges" daily. He pulled out the JP drain also. And that surgeon told pt he was going to try and "hold onto the black tissue". I don't think there is a way the eschar will ever "recover". Frustrating.

Last update to case: ostomy mostly healed although significantly smaller and will end up flat or inverted. Necrotic tissue is gone. Still detached but only shallowly, output is good. Surgeon told patient he did not think a revision would be necessary but that they could discuss that further after she completes chemo. Unknown when chemo will start since rectal incision is not healing well, I&D done 10 days ago has closed 1/2 way and stalled (she didn't want picture of this) Very poor intake.

Pt was sent home on PO bactrim x 10 days and to perform daily wet to dry DRSG changes.Image #2 wound on day 7 of bactrim.Cellulitis has gone down HOWEVER the wound would not close.A thin crusted layer would develop. Image #3 is what the wound would look like following the daily hibaclens shower. On day #10 of bactrim (the pt’s last dose), the pt had called the surgeons office to report new onset of severe headache, light sensitivity and had a temp of 103. Surgeon recommended pt go to urgent care/PCPs office for a rapid flu swab because the presenting symptoms correlated w/ flu symptoms. The surgeon did state that they felt that the new onset symptoms were NOT related to wound...The pt was taken to her PCP. Upon arriving to PCP the pt had newly broken out in a full body rash. PCP did a rapid flu/MRSA of the nares and decided to still (even though ABX finished) obtain a culture of the wound and send off to lab. Pt sent home with wound culture vial. Upon removing gauze pt stated wound “had opened and was sloughing away” (image #4) wiped with sterile gauze, noted something shiny and with sterile tweezers a vicrel suture was removed with no resistance. Image #5 wound after spitting suture evacuated. Ingrown hair noted at base of wound and deep sutures also visible.I&D performed in office days later. Knot of suture found/removed and visible sutures removed/new sutures in place.Looks great now!

Paitent presents to ER for what appears to be blood accumulating under the incision he complains of pain and discharge from the incision during evaluation I noticed what is in the images above I have never seen this before help me??

Update to previous case: much improvement to stoma after second in office debridement by surgeon and increasing intake. Mostly pink now, stoma is pulling in and getting a bit on the small side though. I&d of rectal incision was also done in the office and a large amount of "smelly stuff" drained per patient, incision approx 4x0.1x4cm and beefy. Now on dual abx therapy.

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