Silvadene has worked wonders on some of our issues. There’s another creme (it is really a gel) called Regranex that regenerates new skin growth. We used it in one instance when gangrenous tissue was removed - which took a podiatrist a long time literally whittling away at it bit by bit. I wonder if that was what your Dad used. It was a miracle medicine, and VERY expensive...like $400 for a tube that more than half as small as a travel tube of toothpaste.
We’re struggling now with an ulcer issue again, though, but I have not been impressed with this round of Wound Care specialists, unfortunately.
We tried a new skin graft, called the apligraf. http://www.apligraf.com/ It looked like it was going to work, but it didn’t.
This evening I visited with my Dad and he gave me his treatment notes about his wound care. He has always maintained very meticulous notes concerning his healthcare. These details are in Dad's words. Hopefully his notes will offer some new ideas that you may want to discuss with your doctors.
6/2001 VAMC-KC. Prescribed Cam Walker (boot) to address pain in achilles tendon, suspected torn. Surgery was abated due to leg vein used for triple by-pass heart surgery. Believed tendon would heal on its own with immobility.
Continued to wear the Cam Walker daily until a small wound developed (which looked like a pressure sore) just above the R Ankle, first noticed 5/04.
7/8/04: VAMC-KC Wound Clinic. Ulcerated wound size, 1/2 of a collar button, treated w/Betadine.
8/2 & 8/12/04: VAMC-KC Wound Clinic. Wound larger, treated with Aquacel.
9/3/04: VAMC-KC Same Day Clinic (Urgent Care). Wound much larger (about the size of a quarter) and infected. Prescribed Cephalexin 500mg, QID x 10 days and bandaged with Restore CX dressing.
9/9/04: Treated with Aquacel while in SICU, after pacemaker implant.
9/13/04: VAMC-KC Wound Clinic. Dr McAnaw prescribed Amoxicillin 875/Clav K 125mg Tab (augmentin) BID x 7 days. Said Cephalexin did not work on me. Also prescribed Bacitracin 500/Polymyxin 1000U/GM PWD and Collagenase 250 UNT/GM TOP OINT, for treatment of wound. Shown how to treat and change dressing daily. Weekly follow-ups. Referred to the Vascular Clinic for consultation.
10/6/04 VAMC-KC Vascular Clinic. Dr Cherian w/PA Rita Boswell, diagnosis: Venous Stasis dermatitis with a 1.7cm venous stasis ulcer. Recommended 2 weeks in hospital, on antibiotics with leg elevated for a skin graft, beginning 10/18/04. (Cancelled on 10/13 and 10/14 after seeing Dr. Stephens at Hyperbaric Wound Center.)
10/13/04 St. Joseph Hosp, Hyperbaric Wound Center. Dr Thad Stephens has had good success in treating wounds of this kind on an out-patient basis. Prescribed Cipro XR 500mg x 7 days and pain meds. Treated with Aquacel-Silver and a 4-ply compression wrap from mid-foot to just below knee. Told to keep leg elevated whenever possible. Weekly follow-ups. Referred to Dr.Chu for consultation regarding Venous Stasis condition.
10/21/04: Wound smaller and healing. Area numbed and debrided. Treated with Aquacel-Silver and 4-ply compression wrap again. Continue elevating leg. OK'd to use exercise bike for 15 min sessions.
10/27 thru 11/29/04: Weekly follow-ups with same treatment and instructions until healed on 11/29/04.
10/27/04: Surgical Consultants of KC (and) Laser Vein Center of KC. Dr Peter Y Chu did an Ultrasound of all veins in both legs, in addition to examining the varicose veins leading to the ulcerated wound. The Greater Saphenous vein in the R Leg was diseased causing significant reflux. He recommended Endoluminal Laser Ablation of the Saphenous vein (ELAS) to help heal the present ulcer, reduce pain and to prevent reoccurrences. Procedure scheduled for 11/30/04.
NOTE: Ultrasound revealed that my Blood Clots in 4/02 and 10/03 were in Superficial Veins only, and not DVT's.
11/30/04: Dr. Chu performed the ELAS procedure, ablating the Right Greater Saphenous vein. Then, a 4-ply compression wrap was put on the entire leg. Prescribed Levaquin 500mg X 2 days, and pain meds, Lortab 5 Tab. Was encouraged to walk and resume normal activities as much as possible.
12/3/04: Compression wrap removed. Right leg veins were checked with ultrasound. Fitted with a thigh-high chap style compression stocking. Instructed to wear it constantly for 7 days. After that time, allowed to remove it at night for sleeping and for bathing.
12/17/04: Leg checked with ultrasound. Compression stocking no longer required.
1/5/05: Dr. Chu ligated 3 perforator veins which were still causing reflux. A compression wrap was put on from mid-foot to below the knee, to be removed 1/8. 1/20: Leg checked with ultrasound.
2/8/05: Dr. Chu closed a smaller perforator vein with a Sclerotherapy injection. Instructed to wear a knee-high compression stocking as much as possible for 2 weeks. 3/1: Leg checked with ultrasound. Released from current treatment. To return in 6 months for a follow-up examination.
9/8/05: Examined with ultrasound equipment. Advised to wear knee-high compression stockings when I feel swelling and when traveling. Released from treatment.
11/29/05: VAMC,KC,Mo, Cardiology. Dr. Gupta read these treatment notes, looked at my leg, and said the results of the ELAS procedure was very impressive.
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Dad adds that a wealth of information can be found at http://medlineplus.gov/ and http://pdrhealth.com/home/home.aspx