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Leg wound not healing

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Leg wound not healing

Postby RogerS » 10 Jan 2022, 23:09

Some of you may remember me mentioning that a 65kg larch plank dropped onto my left calf and gouging out bits of flesh. Well that was Dec 1st. Since then I've had two doses of different antibiotics and finally a swab that confirmed that there actually was no infection.

But it ain't healing. OK...a lot is down simply to Anno Domini but I am somewhat frustrated by the lack of continuity between the nurses in the Community Care team. I see a different one each time. They each seem to want to try their own preferred approach. No continuity. No records taken as far as I can see. OK..difficult times, Covid, staff shortages etc and which is why I always prefer to take a bit more of a steering role in these situations. But here I am running into lack of information.

NICE state that any lower leg wound that hasn't healed in under two weeks is classed as an ulcer. But that is semantics. If you do any Googling around leg ulcers you always get venous ulcers (not in my case), pressure ulcer (not in my case), none of the standard definitions apply.

Now the last nurse is talking about a compression stocking but again Googling only brings up venous ulcers etc and it bleedin' well ain't that and so why talk about compression stockings? If you read up on them it's all about improving venous return. But I haven't got a venous problem. I bashed it. It's an effing scrape FFS.

But I really have no idea where/who/what to do. Perfectly willing to go privately if need be. But who to seek ? Dermatologist ? They all seem to talk about skin cancer and acne on their CV's.

Can anyone suggest anything ?

I can send a link to photos of the wound. They're on my Flickr site.
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Re: Leg wound not healing

Postby droogs » 10 Jan 2022, 23:32

try putting a big splodge of Savlon on it and cover over with a pad and lave for 5 days, you may be surprised at the outcome. This is my go to remedy
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Re: Leg wound not healing

Postby Trevanion » 11 Jan 2022, 00:06

Brown paper and paraffin oil is the only cure for a contrary leg!
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Re: Leg wound not healing

Postby Alf » 11 Jan 2022, 07:21

Sorry to hear you're having so much bother with this, Roger. Larch can apparently cause contact dermatitis and similar allergic reactions - I'm wondering if that could be a factor here?
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Re: Leg wound not healing

Postby AJB Temple » 11 Jan 2022, 08:48

Alf has a point here perhaps. I have been prone to allergies, including wood tar, all my life and wounds from some woods can take forever to heal, even with cortisone creams to help me along (betnovate and dermovate).

I find that age is a significant factor - I heal far more slowly than I did when I was 30 and quite often had sporting injuries. Lower leg healing is much worse if you carry excess weight or have a tendency towards diabetes. Can take three months.
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Re: Leg wound not healing

Postby RogerS » 11 Jan 2022, 09:06

Possibly, Alf. How does one check ? Google doesn't help much.

Adrian..I agree re age. I'm not overweight nor diabetic. From the research that I have done, it would seem that one can get leg ulcers if the venous return is poor. Causative. But not in my case.

However, if one causes damage to the leg (as I have done) AND the venous return is not as good as it should be but not bad enough to cause ulcers in the first place...then healing can take time.
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Re: Leg wound not healing

Postby Cabinetman » 11 Jan 2022, 09:20

Hi Roger, it sounds like the blood supply is deficient, you need lots of oxygenated blood to help it heal, you can look it up yourself but basically if you’re a smoker pack it up, more exercise as in walking, drink plenty water and compression stockings.
You may want to research blood flow resistance training which might seem a little contradictory but it’s to do with tight bands which restrict the flow of blood for a while – the good stuff occurs when you take the band off, and the other thing you might like to look at is the same but it’s referred to as KAATSU. Best of luck. Ian
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Re: Leg wound not healing

Postby wallace » 11 Jan 2022, 09:27

My sister suffers from sarcoid and has problems with leg ulcers, she bumped her foot 7 months ago which still hasnt heeled. It was only in the last 2 months we managed to get regular visits from district nurses. Their is a total lack of continuity with one doing one thing and others doing other. One recently said she would try honey on the next visit then a different nurse came and did completely different. A higher ranking nurse came out recently, didnt wash hands or wear gloves or apron, didn't wash area and stuck a dry dressing on a oozing mess. Naturally when the next nurse came it had become part of the wound and needed to be pulled of with much pain.

I had a wound that needed stitches and after the stitches were removed it opened up and became messy. For weeks I kept dressings on to no avail so in the end I gave it a good scrub to make it bleed and left it open to the air, within a day or two it had formed a nice big scab and within a week was healing nicely.
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Re: Leg wound not healing

Postby Phil Pascoe » 11 Jan 2022, 09:43

^^^ a simple one to try is honey. Whether manuka is worth the money is open to debate -I wouldn't pay for it. Oh, and ensure your leg doesn't get cold - circulation slows. Speaking as a leg expert. :lol:

Incidentally, maggots work well if you've got a few spare. :lol:
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Re: Leg wound not healing

Postby Andyp » 11 Jan 2022, 12:53

Far me it for me to give advice but my secondhand experience of district nurses is that they need to be told what to do by a clinician and not left to their own devices.
Would a visit to a dermatologist not be in order?
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Re: Leg wound not healing

Postby Sheffield Tony » 11 Jan 2022, 13:01

I'm no medic, the nearest I get to it is "O" level biology. But IIRC skin repairs by skin cells dividing. A narrow cut heals fairly easily. A shallow graze heals by skin cells in the bottom of the hair follicles spreading over the skinned area. A deep, wide wound has to heal in from the edges, so is slow. This is why bad injuries can need a skin graft.

I realise this isn't much help. Is it worth going back to the GP ?
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Re: Leg wound not healing

Postby wallace » 11 Jan 2022, 17:16

Andyp wrote:Far me it for me to give advice but my secondhand experience of district nurses is that they need to be told what to do by a clinician and not left to their own devices.
Would a visit to a dermatologist not be in order?


I think alot of them can make decisions on the best coarse of treatment, because they deal with this type of thing every day and know what works. Problems arise when you have multiple nurses with there own go to methods.
You do get the odd numpty who seems clueless and there is regularly a lack of supplies which should not happen.
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Re: Leg wound not healing

Postby RogerM » 11 Jan 2022, 17:36

Roger - a few years ago I got a scrape injury down my shins that behaved exactly as you have described, and I think we are similar ages. It would keep partially healing but then spread again. Savlon had zero effect. It didn't bother me unduly, but in the end, when I was wearing shorts, I got fed up with people saying "OMG - what have you done to your leg!" Apparently replying "Nothing, now go and make love elsewhere 'cos it's none of your business!" is NOT a socially acceptable reply, so I went to the doc, which was before they started hiding from their patients and you could more or less get in for a face-to-face appointment the same day. He prescribed "Betamethasone Valerate 0.1%" cream, and healing started immediately and was complete inside a couple of weeks. I'm not sure if you can buy this over the counter, but if you can't get in to see a doc, maybe speak to a decent pharmacist. They are extraordinarily knowledgeable about these things.
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Re: Leg wound not healing

Postby RogerS » 11 Jan 2022, 18:06

Thanks Roger. Was yours a 'superficial' scrape or did you take out a chunk of flesh ?

I got a response to my eConsult submission and am seeing a GP on Friday (albeit not my preferred GP). We may have a bit of a 'tussle'.
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Re: Leg wound not healing

Postby RogerM » 11 Jan 2022, 18:09

RogerS wrote:Thanks Roger. Was yours a 'superficial' scrape or did you take out a chunk of flesh ?.


It was from the front of my shin Rog, so not much flesh to dig out. I reckon it went down the the bone in places though. I remember it really b***** hurt when I did it! Glad you've got in to see a doc though, 'cos medical qualifications are not amongst those that I can pin to the wall along with my cycling proficiency and 25m breat stroke certificates.
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Re: Leg wound not healing

Postby 9fingers » 11 Jan 2022, 18:36

I've used Betnovate/Dermovate as above with good results for eczema flare ups but latterly Synalar ointment or cream has had a similar effect and I've used it to accelerate healing for non-eczema related open wounds.

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Re: Leg wound not healing

Postby Doug71 » 11 Jan 2022, 18:53

On the last day of term before the summer holidays my 9yr old was running along the pavement and tripped taking a fair chunk out of his elbow (shoelaces undone, told him a million times).

It was taking ages to heal despite trying a few different things including "letting it breathe", I think part of the problem was whenever he bent his elbow it would open up again.

A friend who is to do with a medical firm gave us some special plasters to put on it which sealed it up and kept it moist, was told to leave it on for at least 7 days. You could see through the plaster there was a lot of oozing going on and it was full of a yellow/brown liquid. Swapped the plaster for a clean one after a week (it wasn't smelling great), when that second plaster came off a week later it was healed!

I know 9yr olds heal quickly but the advice we got to keep it covered and moist for as long as possible worked well.
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Re: Leg wound not healing

Postby Lons » 11 Jan 2022, 19:06

I had a few accidents in my teens, scraped my finger to the bone just in front of a knuckle, cycle accident, about 1/2" wide wound and it was treated daily for about a month by a district nurse simply bathing, sticking on a dressing then ripping it off the following day along with the scab and repeating then my mother took that over and by around 3 months the wound had built up and healed, did the same on a stone wall but that was my shin and it took a lump of bone as well so the would healed eventually but left a depression.
It will be interesting to hear what the GP says but I think as long as it's not infected it will likely be ok and just take a long time. Like Tony said cuts heal quickly holes don't.
My mother used to spread honey over our numerous cuts and grazes and it seemed to work well.

Email me a photo Roger and I'll ask my wife and daughter what their opinions are.
Last edited by Lons on 12 Jan 2022, 00:57, edited 1 time in total.
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Re: Leg wound not healing

Postby RogerS » 11 Jan 2022, 19:29

Lons wrote:...

Email me a photo Roger and I'll ask my wife and daughter what their opinions are.


Thanks, Bob.
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Re: Leg wound not healing

Postby Phil Pascoe » 12 Jan 2022, 09:27

I live with sores that are in danger of ulcerating. Ask your nurse or doctor if they will prescribe Activheal Hydrocoloid dressings. You put them on and leave them for a week, they are totally waterproof so you can shower or bath with them in place. They are brilliant. I get my retaliation in first.
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Re: Leg wound not healing

Postby Phil » 15 Jan 2022, 10:37

Rog, sympathy with your leg (you must have been sober :lol: :lol: )

Years ago I fell with my mountain bike when I hit a rock on a trail, took out a chunk below the left knee.
The nursing sisters (RNS) at the factories where I visited cleaned it and dressed it 3 times a day. Betadine was used, and back at home I did the weekend changes. took nearly 2 months to heal.
(it was extremely painful especially when I sat trying to get all the crap out of the wound)

Also years ago a mirror fell and shattered with a piece slicing open the leg just above the right ankle.
Same procedure as above with the RNS and Betadine. Also took 2 months the heal.

Agree with the advice of exercise and getting oxygen into the blood.

{Edit - forgot to add the tetanus injections! }
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Re: Leg wound not healing

Postby Artiglio » 15 Jan 2022, 18:11

Age and low oxygen levels are it seems massively influential in healing. Whilst a completely different injury , i broke my humerus in 2018 at 53 years old , consultant said that had i been 10 years younger it’d have healed in 6-8 weeks , if i were 10 years older/ smoker/unfit/overweight/ poor diet not all just one or two he’d have given it 4 weeks and if not happy with progress pinned it, which basically was a big spike driven down via the shoulder. Which apparently makes a right mess of the shoulder.
As it was it took 16 weeks to heal enough to be able to even sleep in bed and 20 weeks before i could drive.

I was a saturation diver, knocks and bumps to the hands were part of the job, at storage depth in the chambers healing was a slow process and regular diving meant you had to put up with it. During decompression O2 levels are elevated, you could fall asleep with an annoying weepy cut and wake up with it apparently fully healed.

If you don’t get any healing soon ask if your nhs trust has access to elevated oxygen treatments in a decompression chamber, it can have almost miraculous results. The chambers are usually operated by organisations involved in diving or caisson work and nhs buys treatment time.

https://www.hyperbaricoxygentherapy.org.uk/find-chamber
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Re: Leg wound not healing

Postby RogerS » 15 Jan 2022, 18:21

Artiglio wrote:Age and low oxygen levels are it seems massively influential in healing. Whilst a completely different injury , i broke my humerus in 2018 at 53 years old , consultant said that had i been 10 years younger it’d have healed in 6-8 weeks , if i were 10 years older/ smoker/unfit/overweight/ poor diet not all just one or two he’d have given it 4 weeks and if not happy with progress pinned it, which basically was a big spike driven down via the shoulder. Which apparently makes a right mess of the shoulder.
As it was it took 16 weeks to heal enough to be able to even sleep in bed and 20 weeks before i could drive.

I was a saturation diver, knocks and bumps to the hands were part of the job, at storage depth in the chambers healing was a slow process and regular diving meant you had to put up with it. During decompression O2 levels are elevated, you could fall asleep with an annoying weepy cut and wake up with it apparently fully healed.

If you don’t get any healing soon ask if your nhs trust has access to elevated oxygen treatments in a decompression chamber, it can have almost miraculous results. The chambers are usually operated by organisations involved in diving or caisson work and nhs buys treatment time.

https://www.hyperbaricoxygentherapy.org.uk/find-chamber


:text-goodpost:

That's fascinating. I've never heard of that before.
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Re: Leg wound not healing

Postby RogerS » 17 Jan 2022, 19:23

Ha! Spent an hour overdue past my scheduled time today only to be told it was now too late in the day for the PAD test. :(

"Oh and your wound is healing too quickly and is over-granulating !"
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Re: Leg wound not healing

Postby Lurker » 17 Jan 2022, 20:49

RogerS wrote:
"Oh and your wound is healing too quickly and is over-granulating !"


I asked her majesty about that as it sounded a bit strange, but she says that it’s a reasonably common issue. She says that your district nurse should be able to access a particular dressing to deal with it.
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