23 February 2022
I just got off the phone on a conference call with Dr. Tong and Joyce. Earlier today Dr. Tong took a look at the wound when Cat the Physician's Assistant changed the dressing and she wanted to consult with us about what to do next.
The first point she made was that Joyce doesn't need another debridement right now. The yellow slough is gone and the tissue is pink. The muscle doesn't look great but it's not as bad as it was, she added. The Wound VAC is doing it's job.
But the wound hasn't healed enough yet to risk putting the Integra in. The Integra just wouldn't bond to what pink tissue is there.
There's no point in keeping Joyce in the hospital while we wait, though, Dr. Tong said.
So in a few days, Joyce will come home with an IV in her arm and a Wound VAC for her leg.
With a Peripherally Inserted Central Catheter or PICC ("pick") line, Joyce would be able to get intravenous antibiotics. And with a portable Wound VAC, she would still keep the yellow slough at bay.
Dr. Tong also brought up the idea of going to St. Francis Hospital for hyperbaric oxygen therapy, helpful for wounds that don't heal as quickly as they should.
She warned it would be a daily trip to the hospital for several hours for a few weeks, however long they determine is necessary. No problem, I promised. We want to give the wound every chance to get closed.
But St. Francis is not Kaiser, so she has to get approval for the therapy and Kaiser tends not to approve it, she said.
So in a few days, Joyce will come home with an IV in her arm and a Wound VAC for her leg. In-home nursing will return three times a week to check vitals and take labs (Dr. Tong was worried about kidney damage from the antibiotics). We'll send her photos of the wound so she can tell when it might be ready to go back to the hospital for the Integra, which might be an outpatient procedure.
If any yellow or white tissue develops, it's back to the hospital. Otherwise it's wait for the pink tissue to grow a bit more, especially around the edges, so the Integra has something to grab onto.
If we get as far as the Integra with a Wound VAC, it will take about three weeks to see if it has adhered. But she'll be home for that.
I was relieved that Dr. Tong hadn't given up on the Integra after seeing the wound this week. It's Joyce's best change to have the wound closed.