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Old 07-19-2009, 05:45 AM   #1
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Drainage after surgery

Hi,

Sorry, this is kind of long. I posted this in the Foot problems board, but didn't get a response. I thought perhaps I might get some feedback here.

I had surgery on 6/10 to remove the os trigonum from my ankle. I was in a surgical bandage (soft cast?) for two weeks after the surgery. The doctor used dissolving stitches. I was non-weightbearing for those two weeks. The doctor removed the cast on 6/22 and told me that I could start putting weight on my ankle.

I was to begin physical therapy on 6/24. Before the appointment, I noticed some drainage from my ankle. I called my doctor and he told me that it wasn't unusual to have a little drainage. I was told to keep it clean and let him know if it gets worse. Unfortunately, it didn't stop and actually got worse, so I called him on 6/26. He prescribed Amoxicillin. I took it over the weekend, but the incision kept draining fluid. I went in to see him on 6/29. He gave me a different antibiotic (Cephalexin) and said that if it didn't get better that he would prefer to go back in to clean it out. It didn't get better, so he went back in on 7/1 and washed out my ankle.

I saw him again on 7/6 and the wound hadn't been draining since the surgery. He said the sample he took during the surgery showed no infection (possible that the antibiotic took care of it). The doctor also said that he didn't need to remove any tissue. He used nylon stitches this time, so I had to return on 7/13 to get the stitches removed. On 7/7, I noticed that my incision was draining fluid again. I decided to stop walking for a couple days and I also wrapped it extra thick (in case my shoe was rubbing on it). The bandages were clean up until my appointment on 7/13.

On 7/13, there was a spot on the bandage. My doctor was concerned, so he decided against removing the stitches. He also gave me a new antibiotic (Cipro). Since my appointment, my incision has been draining a great deal more. I'm scheduled to see my doctor on 7/21. It is still draining and I think I see a little pus (white cap) on one small portion of the incision.

Has anyone had something like this? Any thoughts on things I could do differently? Would an MRI or some other test be able to see if there is an infection in there? Can the doctor take a sample of the draining fluid to see what it is? Should I find a different doc?

Sorry for the length of this post. Until today, I haven't been worried about this. I'm starting to get concerned about an infection residing somewhere he didn't see during the second surgery.

Thanks.

 
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Old 07-19-2009, 08:48 AM   #2
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Re: Drainage after surgery

Hi Greentea,

I'm not familiar with os trigonium....did that surgery involve surgical manipulation of an area of bone? Other than the stitches, is there there any foreign material (like a metal prosthesis) in your ankle? Persistent drainage after a surgery is often an indicator of infection. If there WAS bone involved, yes an MRI will be able to tell you if you have something like osteomyelitis (i.e. infection of the bone). This is a very difficult diagnosis to make other than taking a bone biopsy.

When an antibiotic doesn't work, there can be a whole host of reasons.
1. It isn't the right antibiotic for the particular organism(s)
2. The drug isn't penetrating to the affected area.
3. The antibiotic wasn't given long enough.
4. Going along with #2, the infection needs to be surgically managed to effect "source control".

When your doctor changed you to cipro, he was probably thinking there were "gram negative" bugs in your foot. From the sounds of your story, I wonder if the original antibiotics were fine, but you're having troubles with #2 and #4 above.

 
Old 07-19-2009, 02:59 PM   #3
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Re: Drainage after surgery

Hi,

Thanks a lot for your response.

The Os Trigonum is an extra bone in the back of my ankle. From what I read, as the talus develops, about 5 to 10% of the population has an extra bone that doesn't fuse into the talus. When I sprained my ankle, I broke that little bone (which is connected to the talus by some tissue) off and it lodged itself against a tendon. The doctor went in and removed the little bone. The doctor went in on the lateral side of my ankle and he said that he had to reach around in my ankle to find the bone on the medial side of my ankle.

I don't think he had to do anything with the bones in my ankle, but I don't know if he may have nicked something or if anything else happened with a bone.

After the second surgery, the incision was clean until the day he was to remove the stitches.

One other question. I have a small black spot on the top of my ankle. It came after the first surgery (it wasn't there before). It is numb around that area (as well as the outside of my foot). I asked the doctor what that spot could be and he said he didn't know. Do you know if there is any chance that it is associate with an infection?

I really appreciate your help.

Thanks.

 
Old 08-11-2009, 01:10 PM   #4
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Re: Drainage after surgery

Just an update.

I found out that the doctor did do some work on the talus to remove the Os Trigonum. I had an MRI two weeks ago that showed a pool of fluid in the back of my ankle (right where it has been draining). The MRI also shows some damage to the bone, but that could be due to the surgery. If I remember correctly, the MRI said something about small areas of bone marrow edema. The report said osteomyelitis couldn't be ruled out.

I had cultures taken a week ago. They were negative. The cultures taken during my second surgery were also negative.

My doctor sent me to another orthopaedist for an opinion. She agreed that it looks like an infection. She suggested another surgery to clean it out. I asked her what would be different this time since we already cleaned it out during the second surgery. She then suggested I see an infectious disease specialist.

I'm still taking Clindamycin. It gives me a weird taste in my mouth, but overall the meds have been fine.

Does anyone have any suggestions on questions I should ask or tests I should request?

Thanks.

 
Old 08-11-2009, 03:23 PM   #5
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Re: Drainage after surgery

Hey there,

Osteomyelitis is a very difficult diagnosis to make. The gold standard is bone biopsy which obviously requires a surgical procedure. To treat it, you have to give antibiotics for an extended period of time, at least six weeks. If the osteomyelitis has been going on for a long time, however, there are areas of dead bone "called sequestra" which are impermeable to antibiotics. In this case you must surgically debride the area and remove the devitalized bone along with the antibiotics.

 
Old 08-17-2009, 07:27 AM   #6
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Re: Drainage after surgery

Hi,

I really appreciate your response.

I went to the infectious disease doctor last week. She doesn't know what it is, but she has recommended another surgery (number 3) to clean it out again. I am off the Clindamycin so they can get (hopefully) a better culture during the surgery on Wednesday. They are going to put a PICC line in and I'll be getting IV antibiotics. She said she would treat me generally for resistant strains if the cultures don't show something specific.

Has anyone had the IV antibiotics? I was told I would probably have a home nurse. I am curious on how the scheduling will work. I was planning to go back to work and I normally go to work pretty early in the morning. I wonder if they are flexible with their scheduling.

Thanks.

 
Old 09-18-2009, 10:17 AM   #7
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Re: Drainage after surgery

Hi,

Just an update. I've been on IV Vancomycin for 4 weeks. I had surgery 4 weeks ago to clean out my ankle. I had the stitches removed last week and the incision didn't close so the doctor put steri strips on my ankle. They came off today and I can see a big hole in my ankle.

In the hole, I see what looks to me like a ball of pus. My ankle is draining really fast and I have to change my gauze 3 to 4 times a day now.

Anyone have a similar experience. My doctor should be award of the hole since he put steri strips on it last week. I asked him yesterday what I should do if the strips fall off and he said it was fine. I didn't realize the hole would be so big.

I am supposed to have two more weeks with the Vancomycin. The drainage hasn't slowed down since this last surgery. I will be seeing the infectious disease doc on Tuesday, but I'm wondering if they'll extend the vancomycin (just as an update, the bacteria they found in the culture is Methicillin Resistant Staphlococcus Epidermidis).

Also, do you think it will be necessary for them to clean out my ankle again since it has had infectious material in there since the middle of August.

Thanks.

 
Old 09-20-2009, 10:17 AM   #8
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Re: Drainage after surgery

Hey Greentea,

Can you remind me...do you still have metal in your ankle?

You mention "methicillin resistant" Staphylococcus epidermidis. We lump this bacteria in the category called "Coagulase negative Staphylococcus (CNSt)". Usually the CNSt found in hospitals is "methicillin resistant", but that does NOT mean it is MRSA, which is a related, but different bug.

If you have metal in your ankle still, they may need to keep that metal there until the bones have aligned properly and then take it out (otherwise the infection will never be cleared). The fact they found CNSt in your ankle makes me think that you've had metal at some point in the past.

 
Old 09-24-2009, 08:48 PM   #9
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Re: Drainage after surgery

I have had a siliar situation. While my ankle was being fused with an external fixator, the lateral side of my ankle became infected (from a bone stimulator). I had 2 debridement surgeries and many weeks of iv anitbiotics. My infectious disease doctors told me as long as the metal was in my ankle, the antibiotics would have to continue.

Step

 
Old 10-05-2009, 11:46 AM   #10
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Re: Drainage after surgery

Hi,

Thanks for your response. Sorry for my late reply.

I don't have any metal in my ankle. We (I guess more specifically, the doctor) removed my os trigonum and sewed it back up. He went in twice more and cleaned it out (debridement). Then I started the IV antibiotics.

I'm going to see the infectious disease doc tomorrow. My PICC line site has started draining fluid that looks very similar to the stuff coming out of my ankle. I don't have a fever or chills. My home nurse is surprised and says that he hasn't seen anything like this. My line was looking good up until the past week. Now that area is draining and I'm itchy all over. There's another area on my ankle that is oozing some fluid that I think is similar to my ankle fluid.

Also, I have a VAC dressing on my ankle now. It's sucking up the fluid from my ankle. I'm getting about 50cc's every two days. It's a small wound, so that seems like a lot to me.

Any thoughts or ideas would be greatly appreciated. Either way, it's nice to talk about it. I definitely appreciate the ideas and information.

Thanks.

 
Old 10-05-2009, 08:41 PM   #11
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Re: Drainage after surgery

I'm happy to hear you are going to see an ID specialist. I would love to hear what they have to say about what is happening. I am healed and recovered now, but I was sick for quite a while. About a year after the bone infection I wrote about earlier - I ended up with another after a bunionectomy. The strange thing is my dr said they were unrelated. Hmmmmmm....

I just don't think drs know enough about these types of infections and why they happen to some people and not to others.

Rest assured - you are on the right path. Keep us posted! And keep talking about what is happening - it helps!

Step

 
Old 10-06-2009, 06:01 PM   #12
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Re: Drainage after surgery

Hi,

Just an update.

My arm was still draining through the weekend, so I called my nurse. He came on Monday and removed my PICC line. Immediately, my arm felt really tired. I was told it was normal. Today, I saw my infectious disease specialist. She immediately noticed that my arm is swelling. I'm now scheduled for an ultrasound tomorrow morning to see if there is a blood clot in my arm. My arm is more swollen now. I'm not sure what to do.

I'm also scheduled for an arthrogram on my ankle in the afternoon. If they find a leak in my ankle, then at least we might have an idea of what to do. If not, I haven't heard any theories from the various doctors, so I don't know what we're going to do.

The ID doc said that she sees no sign of infection now, so I'm done with the vancomycin. I won't miss the PICC line and dripping the meds twice a day. Hopefully, the infection is gone.

I developed a rash from the various bandages and my arm and leg look terrible. The ID doc said it's contact dermatitis and it should go away in a few days. Any thoughts on what I should take for the itching? I've taken benadryl. Put cortisone and calamine lotion on the various sites. Nothing really works for very long. Any thoughts would be greatly appreciated.

 
Old 03-10-2010, 12:00 PM   #13
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Re: Drainage after surgery

Quote:
Originally Posted by harka View Post
Hey there,

Osteomyelitis is a very difficult diagnosis to make. The gold standard is bone biopsy which obviously requires a surgical procedure. To treat it, you have to give antibiotics for an extended period of time, at least six weeks. If the osteomyelitis has been going on for a long time, however, there are areas of dead bone "called sequestra" which are impermeable to antibiotics. In this case you must surgically debride the area and remove the devitalized bone along with the antibiotics.
Hi, I have been diagnosed with osteomyeltis, did have a biopsy done, I am an amputee and this is in an area covered by my prostesis, I have just finishe 60 treatments in a hyberic chamber and 8 weeks of iv antiobiotic, along with intense woundcare at a wound care clinic, the other option hd been a surgical debridement or further amp, I at this point am unwilling to do anything surgically, i know the layup of that type of thing and at this time of my life don't feel emotionally i could go through that again, the amp. was over 30 yrs. ago, from an accident nad in 1981 had a bout with osteo, also went thriough the debridement at that time 6 weeks in hosp. My main concern with wound care and antibiotics how much chance is this to being spread so it is life threating? The Dr's don't really answer that.Thanks

 
Old 03-10-2010, 12:04 PM   #14
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Re: Drainage after surgery

Quote:
Originally Posted by Lady Jayne View Post
Hi, I have been diagnosed with osteomyeltis, did have a biopsy done, I am an amputee and this is in an area covered by my prostesis, I have just finishe 60 treatments in a hyberic chamber and 8 weeks of iv antiobiotic, along with intense woundcare at a wound care clinic, the other option hd been a surgical debridement or further amp, I at this point am unwilling to do anything surgically, i know the layup of that type of thing and at this time of my life don't feel emotionally i could go through that again, the amp. was over 30 yrs. ago, from an accident nad in 1981 had a bout with osteo, also went thriough the debridement at that time 6 weeks in hosp. My main concern with wound care and antibiotics how much chance is this to being spread so it is life threating? The Dr's don't really answer that.Thanks

 
Old 03-11-2010, 07:55 PM   #15
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Smile Re: Drainage after surgery

Quote:
Originally Posted by Greentea73 View Post
Hi,

I really appreciate your response.

I went to the infectious disease doctor last week. She doesn't know what it is, but she has recommended another surgery (number 3) to clean it out again. I am off the Clindamycin so they can get (hopefully) a better culture during the surgery on Wednesday. They are going to put a PICC line in and I'll be getting IV antibiotics. She said she would treat me generally for resistant strains if the cultures don't show something specific.

Has anyone had the IV antibiotics? I was told I would probably have a home nurse. I am curious on how the scheduling will work. I was planning to go back to work and I normally go to work pretty early in the morning. I wonder if they are flexible with their scheduling.

Thanks.
Hi,

I just finished an 8 week course of IV antibiotics for a bone infection, also had hyperberic treatment. I did not have a nurse coming daily, with the pic line they supplied the medications and sterile saleine and i had to inject into the pic line 3 times daily. The nurse came once a week to chage the dressing on the line, I had no real problems and did go to work, perhaps your situation would call for this it is kind of a pain but at least you don't have to be homebound.

Good Luck

 
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