A special query for those trained in surgery. please help.?

Question

I had a r.tibial fracture mended thru external fixation. when surgeon removed fixator rods, there were 5 skin holes overlying the tibial apertures. he said they never stitch them shut, they must stay open for weeks to drain blood from within the bones. & they did. When blood finally ceased, ortho said the skin holes (only 1/4 in.thick) will close thru secondary intention.
some did, but others remained soft weak scabs & never skinned over. 1 of the holes began to drip water in a constant stream. the water pressure within pierced the scab. This comes cause I have severe CHF w/ water overloaded in my tissues. (NOT lymphedema) It began soon after fixator removed & bone healed. I ask you: can any surgery close this raw, painful sore wound, with stitches - Wouldn't the constant flow of water from the tissues around the hole keep the site wet & soggy & prevent healing? the flow is unstoppable. 1 gallon daily. Can a cautery, silver nitrate or other, seal off the tissues leaking the water?

CALBEARL- thanks for your kind reply. The flow is truly cold, clear plasma. not pus. My body is non-responsive to Lasix & the other drugs. Not a drop of urine comes out. I am now, seeking ULTRAFILTRATION - but meantime, my ortho is bewildered by this flow. He has seen no case like it. I will see a plastic surgeon soon, but I believe the constant water flow from the tissues will impair skin healing, despite stitches. I wear mens' incontinnence pads, wrapped around my leg, taped to absorb this water, I have to change pads 8 times daily.I cannot remain elevated, I must stand & walk or my legs will atrophy. I am in torment from this flowing water. When blood ceased, I asked ortho to stitch them or steri-strip the wounds, he said NO> I am scared from this dilemna. Could a cautery be of any value?

Answer 1

unfortunately you are in a somewhat unusual circumstance. first of all, the holes are left not to "drain blood from within the bones". they are left open because they usually close fairly quickly on their own and all it takes is a couple of steri-strips. and also because the external fixator/pins can be a source of infection (especially after having them on for 3-4 months) so it wouldn't be a good idea to close off a potential infection and better to let it drain, if any.

more importantly, you need to be certain that it is indeed "water" that is draining and not pus (an infection). i don't think that it would unreasonable to suture close the hole/wound if it is not infected, however, you may still have issues healing. another option would be a wound vac that keeps the wound sealed and applies a constant suction, this is usually pretty good in expedite healing in a open wound. don't know if it'll work so well with "1 gallon daily" pouring out.
what about your cardiologist/internist? can't they do a better job with your diuresis? compressive stockings? water pills? elevation?
but i would certainly ask your orthopod if he/she would suture it close.
good luck

Answer 2

Hi there, it sounds like lymphorrhea drainage, lymphorrhea is any open area or break in the skin that will cause lymph fluid to weep or drain, it could be that if the surgical drain hole was not there, you would have lymphedema along with the chronic heart failure. You need to be very careful of infection.

You need to keep the area very clean, try to moisturize around the opening because the constant leaking is irritating and breaks down the skin, you need to apply a non sticky absorbant dressing, you need to elevate, apply pressure bandages, and if it does not stop leaking, your doctor needs to refer you to a wound treatment center. It may need a skin graft to stop leaking but then you might also run the risk of swelling of the lymph fluid in the leg, hence lymphedema.

Lymphorrhea is highly caustic to the skin tissue that it come into contact with. Untreated wounds with this drainage can very quickly become large gaping areas that may eventually lead to the need for skin grafts.