hard to heal wounds after breast surgery

[rickshaw]

I had breast reduction surgery a full year ago and the wounds have still not healed. Although they partially healed, the scar tissue still breaks down and I still need dressings done every day. I am 65 years old and wonderered if anybody else has experienced wounds taking so long to heal after surgical procedures or can offer advice on the subject

[alijangra]

Not personally, but from a nursing perspective I find breast wounds to be particularly difficult to heal due to their location. If the dressings are being done daily Im assuming there must be a lot of exudate soaking through? This could be due to infection (have you been swabbed?) or possibly due to incorrect dressing choice. If there is not a lot of soakage on dressings then they should be changed less often. Would you mind sharing with me the dressing products that are being used, and also the method of cleansing the wound? I would be very happy to give advice as wound care is my specialist subject area.

[rickshaw]

There is still quite a lot of exudate which is why I have to have the dressings changed daily. (My husband has to do this for me). I see the practice nurse at my doctors weekly and she has sent swabs for analysis but they have been clear, although in the first three or four months they did show bacterial infections which was treated with antibiotics at the time and this cleared up. Different types of dressings have been used before (silver, inadine and aquacell). More recently honey was advised and tried but this seemed to make matters worse. What I do at present is shower daily, keep the dressings off for an hour after showering and then just N/A Ultra onto the wound area and a dry gause bandage held in place with mepore tape. Bactroban has also been used to prevent further infections but only if there is pain, a smell or visual signs of infection

[alijangra]

The current dressing choice does not make sense to me as you need something more absorbant than N/A ultra.

By leaving the dressing off after showering you are allowing the wound to cool and dry out. This is actually the opposite off what you want to be doing as an optimum healing environment is a warm moist one. Forget 'letting it air' and using dry dressings, that practice went out with the ark. Obviously it is hard for me to make a recommendation as I cannot see the wound to assess it. Your basic principles are to:

cleanse the wound disturbing the wound bed as little as possible (do not rub with gauze, cotton wool etc). I feel this is best achieved by irrigation with warm saline. You can get cans of this on prescription.

Base your dressing choice on the type of wound. A dry wound bed will require rehydration using a hydrocolloid or gel dressing. A wet wound will require a highly absorbant dressing that 'draws in' excess exudate whilst still maintaining a moist environment. The worst possible thing for the wound is mismanagement of exudate as this remains on the skin and causes further breakdown.

If there is suspicion of bacterial load in the wound, a silver based dressing can be useful, iodine based dressings are also very good.

I feel it is wrong that your husband is having to do your dressing, in light of the fact that it is a problematic wound you really should be being attended to by a nurse on a daily basis and I know for a fact that would be the case if you lived in my area. Have you been referred to a Tissue Viability nurse? If not, I would ask if this is possible and hopefully you have one in your area.

[alijangra]

I see you have said you have used both silver and iodine in the past, but what is important is a variety of types of dressings are available with both of these products in them so it is important to make sure the dressing choice is correct.
Is it the practice nurse who chooses the dressings? Try asking her why she has chosen that particular dressing and hopefully she can give you a comprehensive answer. If she cannot explain, then Im afraid she is bluffing it (as many nurses do when it comes to wound care unfortunately!)

[Solarjunkie]

It is important to tackle the situation from within as well, vitamin c plays a very important part in wound healing, start taking several grams a day, any excess is merely excreted.
Vitamins A, E and B complex are also important.
Best of luck.

[alijangra]

Very true Solarjunkie, smoking can also have an adverse affect on wound healing.

[rickshaw]

Thank you Alijangra and Solarjunkie for your comments which are very much appeciated. I shall certainly discuss the issues you have raised with the practice nurse on my next visit.