Wound Healing: You Can't Be Too Careful

Some of my readers know that about a year ago--in May of 2025, to be precise--my husband had complex surgery on his leg. It is not a common operation. When he went for physical therapy, therapists who treated him had never worked with someone who had undergone that specific procedure. What was it? Replacement of the proximal tibia. This procedure is often described as limb-sparing.

Here is a picture of my husband as he takes his first walk outside. It's about a month after the surgery.

In the picture he was wearing a full leg brace that did not allow him to bend his knee at all. The dressing, as you can see, extends down to his foot.

The alternative to this surgery is amputation, which I suppose might have been his only option thirty years ago. We had to find a highly specialized orthopedist to perform the operation, and we wanted to have it done at a hospital nationally ranked in orthopedics. We were fortunate on both counts.

Reading from post-surgical notes, this is what was done: part of his tibia was removed and replaced by a:

modular endoprosthetic prosthesis and proximal tibia replacement with hinged knee replacement, with prophylactic fixation of right tibia with cable and intramedullary implant and repair of patellar tendon

That description covers the orthopedist's (bone doctor's) work. Essentially, a metal rod replaced a large section of my husband's tibia. In order to make this implant become a working part of my husband's leg, skin and muscle had to grow over the metal. This, it turned out, was the part of the healing process that would depend on his natural healing ability, luck, and me.

We decided he would not go into rehab after surgery. He had a very large wound that stretched from his knee all the way down his leg almost to his ankle. That wound was from a skin and muscle graft (his own tissue) that was supposed to connect with the other side of his calf and become a unified working system of tissues. A visiting nurse came twice a week to dress the wound, and to instruct me in dressing the wound.

The nurse and I did not get along well at first. We did not get along because my idea of sterile did not match hers. I had read up on this procedure, on what the chances of success were. The greatest risk to my husband at this point was infection. That made sense.

He had an enormous, open wound. I'm not a scientist, but I do know that infections come from pathogens. A pathogen has to be introduced into the wound. I was hell bent determined that this would not happen while the wound was in my care.

The nurse was less committed. I saw germs, the potential for contamination, everywhere. She was a little more casual.

For example. She was careful about using nitrile examination gloves liberally when treating my husband's wound. That protected her from him, but if the gloves were not sterile, how did that protect him from infection? The gloves, coming out of the box, were not sterile.

Here is a picture of the box top, where it clearly states the gloves are not sterile.

When I treated him I would disinfect my gloves with alcohol. I figured that would cut down on the chance of introducing pathogens into my husband's wound.

I hovered when she treated my husband. Sometimes she would touch an object and then touch my husband's wound. I would pounce.

"No!"

She realized she had to be very careful around me, but she was not happy with my vigilance. She did not want a watchdog. And yet, what was my duty?

If my husband's wound failed to heal, he would be in big trouble. The failure to heal happens a lot. Infection could lead to systemic issues, even sepsis, or it could lead to failure of the implant. It could lead to chronic wound on his leg, which would require long-term treatment at a wound care center.

If his wound didn't heal, what kind of mobility would he have?

I liked the nurse but that appreciation would not make me budge on infection control, because I knew the danger to my husband's health.

I took no chances. I opened packages for her so she wouldn't handle those with the nitrile gloves that would touch my husband's wound.

I realized after a time that her relatively casual approach to infection control was not merely a matter of attitude. There was also a matter of economy.

Sterile exam gloves are available, but these are very expensive. Tossing them off routinely would fast become unaffordable.

There came a time, also, toward the end of his healing process, when the plastic surgeon (plastic surgeons perform the graft operation) prescribed a specific surgical dressing: Aquacel Silver. This dressing is treated with an antimicrobial substance that aids in healing and helps the wound resist infection.

The PA (Physicians Assistant) in the plastic surgeon's office wrote up an order for the nurse (see the picture below). The nurse had to submit a request for supplies from the Home Care office.

The nurse and I came to a bit of a contretemps over use of this material. When she first applied it, she cut the surgical dressing in strips and saved some of the strips for the next visit. I was horrified.

I asked her why she was doing that, instead of using a solid fresh patch for the wound.

"We don't want to waste it," she explained.

I read the package instructions. They were clear. Discard unused portions.

This was a sterile dressing. Once opened, it was not longer sterile. Putting it away would only allow bacteria to grow and possibly to be introduced into the wound. Small chance, but still a risk.

I threw away the unused portion so she couldn't use it when she next came. When I changed his dressing, I discarded the unused portion.

When we went to the plastic surgeon and he dressed the wound, I saw him cut a strip. He instructed me to do the same. Save a piece for later.

"But that's not sterile," I protested.

He gave me an odd look. Patients, and patient's families, do not challenge plastic surgeons.

"Sterile?" he said. "As soon as I open it, it's not sterile."

I didn't argue, but actually that was exactly my point. As soon as it's open, it's not sterile, so throw the unused portion away.

I looked up the price of Aquacel Silver. Today Google AI returned a price of between $25 to $35 for each 4"X5" pad. At the time I found a price slightly lower than that. Still, quite expensive.

Now I understood why the doctor and nurse were economizing. But that's my husband's leg. I wanted to order my own, but needed a prescription. Fortunately, the home care center (which was excellent) sent me a supply after I made a bit of a fuss.

My husband's leg wound healed beautifully. It took months, but it was at least on schedule, if not ahead of schedule.

The nurse was proud of herself. She told us as she was completing her service in our home that this was the first large surgical wound she had ever tended. When I heard that I was really glad I had been so vigilant. She also told my husband that without my (neurotic) care, things might not have gone so well.

Today my husband walks with a cane. It's slow going, but getting better. The good news is, he walks. He goes to card games with his friends. He enjoys life.

Although I'm grateful to the doctors who treated my husband, and to the nurses who helped him, I'm writing this blog to remind all of us that though we need to trust them, we must also be responsible for ourselves. That's hard, because we don't have skill. Sometimes motivation and interest can compensate for the skill deficit.

Wishing everyone peace. This is a line I write today with great earnestness as my country goes to war. It is not a happy time.

(All images are mine, taken with my cell phone camera.)

Thank you for reading my blog. Hive on.