Wound Not Healing

[Anniegirl95201]

My mother is 92 and she has a wound on bottom right leg where she dropped the water hose nozzle on it.   It got infected even tho she took antibodics, and then she had to take another antibotic for 10 days, and I had to do wet to dry bandages.   She is finished with the antibotic (Bactrium) and now the wound burns like fire she says when I change the bandage, which it didn't before.   Could it still be infected?   I have to take her back to her dr. in one month.  They said it should be healed by then.   She is not a diabetic, but has poor circulation in her legs, so she is wearing TED hose.  Thanks

[gorbutt]

I completely agree that there are no contraindications to the hyperbaric oxygen.I have seen alot of excellent results with its use and infact have referred patients to the wound care center for its use. I am simply saying that with a 92 y/o pt that there tends to be alot of other health conditions that are present also. Aside from poor circulation to the lower extremities ,and the fact that there is no hx of diabetes very little is known about her mother. When tx a pt which I am not trying to do .This is simply advice. You must look at the pt as a whole mentally and physically as well as the families abilities to provide the needed tx.

[caregiver222]

There are absolutely no contraindications to hyperbaric oxygen.

While there are whole body systems, ideally the treatment unit only encloses the leg to be treated. With one hundred percent oxygen the problem is that with people having chronic COPD, common in the elderly, the breathing rate may decrease. In fact breathing may cease. That is why the nasal cannula is generally used by first responders and in a hospital environment. That is why a 100 percent non-rebreather is generally contraindicated.

With the leg treatment hyperbaric system the only skin surface exposed is from the hip down. The oxygen is forced transdermally into the skin.

[gorbutt]

Hi I am new to this forum.  After I read your question it brought back memories of receiving the same question during my 17 years of nursing. 8 years of which focused on wound care in the elderly.I completely agree with drnee. There needs to be a culture and sensitivity done on the wound and one that does not just culture the bacteria at the top of the wound for your body can have its own natural flora of bacteria. Second smell of the drainage can often indicate the type of infection present. Where I know this may sound gross to you, certain bacterias require more than one antibiotic to treat due to the fact that one antibiotic may mask the infection and the combination of two will actually treat the infection as needed.I agree that the hyperbaric oxygen is a good form of treatment but you must also take into consideration  your mothers age and the fact of whether or not she would be able to tolerate it. Also poor circulation just adds to the problem of the wound healing. You can probably expect a longer wound healing time and  as the dr said debridement if needed. Hope this helps and good luck.

[caregiver222]

Doctornee has explained things nicely.

I would locate the nearest wound care center and head there.

I am not a happy camper with the month interlude before she is to be examined.

A treatment that has proven effective is called hyperbaric oxygen. This is a high-pressure chamber in which the leg is inserted. These treatments are well-established and generally available at reasonable cost. You bring her into the facility and she enters what is essentially a mini-diving chamber. Oxygen is forced into the tissues. Before the day is over, find a facility nearby to get this treatment. It usually takes several treatments.

Oral antibiotics do not diffuse well in the extremities. Often intravenous antibiotics are the only way to treat such a wound, and they don't always work.

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Yes, poor circulation can cause non healing ulcer especially since there is low oxygen and blood supply for rejuvenation. Your mother will need a culture sensitivity of wound scraping to know what antibiotics will suit the infection. If there is underlying dermatitis, then this needs to be taken care of. Wound debridement would be required along with plastic repair. If there is severe atherosclerosis preventing blood supply to wound, then this needs to be diagnosed by angiograms and treated.
Hope this helps. I think you should discuss these possibilities with your doctor. It is difficult to comment beyond this without examining. A comprehensive investigation is required keeping all the points in mind. Please let me know if there is any thing else and do keep me posted. Take care!