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  • Do you suture a 2-3cm wide MRSA infection?

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    Old 12-18-2008, 10:08 AM   #1
    Steve8822
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    Do you suture a 2-3cm wide MRSA infection?

    What is the protocol for MRSA infections that have antibiotics on-board for nearly the whole course of treatment and the pt still has a 2-3cm diagonal and deep hole with slight drainage of nearly clear fluid and some thin blood at times. most signs and sx of infection are gone except the hole and some blood which i assume that is still not clotting from the anticoagulase endotoxin that this strain is producing.

    Can the doc suture this soft tissue infection and if so will that help the wound with preventing secondary infection.

    thanks!!

     
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    Old 12-18-2008, 10:27 AM   #2
    harka
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    Re: Do you suture a 2-3cm wide MRSA infection?

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    Originally Posted by Steve8822 View Post
    What is the protocol for MRSA infections that have antibiotics on-board for nearly the whole course of treatment and the pt still has a 2-3cm diagonal and deep hole with slight drainage of nearly clear fluid and some thin blood at times. most signs and sx of infection are gone except the hole and some blood which i assume that is still not clotting from the anticoagulase endotoxin that this strain is producing.

    Can the doc suture this soft tissue infection and if so will that help the wound with preventing secondary infection.

    thanks!!
    It depends--often deep wounds like that which are infected, it is preferable to keep the wound open, allow the antibiotics to work, and then let the wound close by "secondary intention"...i.e. you let the wound close up on its own and you don't stitch it.

    How did you get this wound? The clear fluid and thin blood is not from the coagulase--it is likely just a mixture of serous transudate mixed with old blood. There shouldn't be endotoxin there if the bacteria are treated. If there is, then they need to open the wound and make sure it's totally drained and any dead tissue is removed.

     
    Old 12-20-2008, 08:36 PM   #3
    Steve8822
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    Re: Do you suture a 2-3cm wide MRSA infection?

    well the toxins were present before but it seems that there is not any sign of infection at this point. the only problem is that there is so much adipose tissue hanging out of the gaping wound that i dont see how this is going to heal unless it is stitched up or continually covered for the next 2-3 month. Additionally it seems to me with my treatment of diabetics with foot sores that it will become reinfected if not closed back up well before the time it takes to heal by secondary intention.

    I got the wound from some sort of insect bite followed by self inoculation by scratching it. As far as I can tell. The wound is clearly clean at this point, with no sign of the necrotic puss and other lovely things that came out of it for about 4-6 days after Abx were started. My only concern is that it is much deeper than I think and I am feeling more pain now from the adipose tissue that is just hanging out of the wound and sticking to the non-stick bandages that I have to cover it with than when it was actually infected.
    Thanks for your info, i was afraid that you would give me the old secondary intention answer. any ideas on how i convince the doc to stitch it up? or manipulate for that matter? j/k not serious on the manipulate part.

     
    Old 12-21-2008, 12:02 AM   #4
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    Re: Do you suture a 2-3cm wide MRSA infection?

    Quote:
    Originally Posted by Steve8822 View Post
    well the toxins were present before but it seems that there is not any sign of infection at this point. the only problem is that there is so much adipose tissue hanging out of the gaping wound that i dont see how this is going to heal unless it is stitched up or continually covered for the next 2-3 month. Additionally it seems to me with my treatment of diabetics with foot sores that it will become reinfected if not closed back up well before the time it takes to heal by secondary intention.

    I got the wound from some sort of insect bite followed by self inoculation by scratching it. As far as I can tell. The wound is clearly clean at this point, with no sign of the necrotic puss and other lovely things that came out of it for about 4-6 days after Abx were started. My only concern is that it is much deeper than I think and I am feeling more pain now from the adipose tissue that is just hanging out of the wound and sticking to the non-stick bandages that I have to cover it with than when it was actually infected.
    Thanks for your info, i was afraid that you would give me the old secondary intention answer. any ideas on how i convince the doc to stitch it up? or manipulate for that matter? j/k not serious on the manipulate part.
    Adipose tissue hanging out of a wound is more of a cosmetic thing than anything, though debriding it will allow for less obstruction to the tissues healing.

    The "old secondary intention" answer is not my answer. It has been used by surgeons for decades. The reason people use secondary intention to allow wounds to heal is exactly the reason why you are mistakenly thinking stitching it up will prevent--infections. Secondary intention allows wounds to heal by having as little tension on the wound as possible, as well as allowing it to fill in completely AND deal with the small amounts of present bacteria at the same time. If you were to stitch it together, the surface of the wound looks closed, but there are often pockets below the stitches (even with subcutaneous stitching) which can harbour bacteria, and result in abscesses. This is especially true given the fact the wound was infected deeply in the first place.

    I sympathize with your thoughts about stitching the wound up--especially given the fact it is cosmetically much more desirable--but given how deep your wound was, secondary intention healing IS the way to heal the wound with the least chance for infection. If HUGE abdominal wounds on surgical patients (much larger than yours) can heal through secondary intention, so can your wound....actually, come to think of you, you didn't mention where on the body your wound is!

    Last edited by harka; 12-21-2008 at 12:03 AM.

     
    Old 12-21-2008, 08:13 PM   #5
    Steve8822
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    Re: Do you suture a 2-3cm wide MRSA infection?

    back of the head just below the hairline left side. ok decided to just do a little investigation on the "adipose" tissue and although it looked just like the fat I have seen come out of others wounds it did not end up being adipose. it stuck to the bandage this am as I was pulling it off and it just pulled out. now for 4 days it has hurt like hell to change bandages due to the tugging on this fatty looking substance. however this am no pain and as it stretched and finally pulled free it seemed to have the end stuck into a small hole in the sub q tissue. the only reason i mention this is b/c a lot of the mass of this "stuff" was not what was hanging out but what was still wrapped in the tissue below it. After it came out attached to the bandage it appeared to be just a thicker form of the necrotic puss that was just pouring out of the wound for the first 4-5 days of Abx treatment.

    I agree with you for the most part but I have got to go back to work monday and I have to work in a sterile environment (biological not aerospace) and assuming that I do not carry any MRSA into the clean area (impossible I know as they are in my and most ppls nose at all times) what am I supposed to do with a wound that is wide open like this while wearing all the CR gear? I have to watch out for my own cells just as much as the bacteria that we all harbor and transmit around the world every day. To cover this thing is getting to the point where I am starting to lack skin in the places where the adhesive sits and is pulled away over and over and over...you get the idea. I cant move where the bandage sits due to the hairline and that it will not stick to hair.

    enough whining about this thing I am just praying that they close it up monday and I can end this not so great chapter in my life. i think i will start treating my DM pts with diabetic foot sores with a little more compassion, or maybe a LOT more.

     
    Old 01-10-2009, 02:07 PM   #6
    xinerevelle
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    Re: Do you suture a 2-3cm wide MRSA infection?

    My MRSA infection was in my c-section incision (wide and deep!) and I had a nickel-sized boil that opened up on my belly. Both were treated by pouring sterilized saline solution on it 3-4 times a day (at first... then down to 2x day) and packing with gauze, allowing the gauze to hang out of the incision and wick moisture out. I kept both covered at all times, and only uncovered it to change dressing or to shower. I would use a blow dryer on it to dry after showering (per doctor's orders). Eventually it healed up.

    Best of luck to you!

     
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