Day 17 since surgery

We are still inpatient, but have been on his "regular" floor for 8 days now.  Peter is doing very well physically, but the two surgical wounds are not.  We tried wet-to-damp dressings for a few days, then silver impregnanted Aquacel, and then on Wednesday, the surgeon decided we needed to go to wound vacs.  Peter had two wound vacs placed over the surgical sites on Wednesday evening, and we are here to make sure that they actually do get the wounds to turn around and heal enough to go home.  Peter's wounds not only did not heal, but the skin began to open back up and there was yellow slough covering the wound beds, despite measures to keep that under control.  Both wounds were producing a fair amount of drainage and ended up opening up all the way down to the fascia in two areas, and each time we would change the dressings (twice a day) the wounds would look the same or worse, no progress. 

Dr. Jennings is quite apologetic that the wounds are not healing, feeling like the issue may be as a result of the wound catheters that were used for pain management.  He needn't apologize though, as we all thought the wound catheters were a good idea, as a wound catheter is what made Peter have so little pain after his surgery in April.  He also mentioned Peter's ascites as possible cause for the wounds to open as they did.  Peter has had an abdominal binder on since he was extubated, and his ascites has gone down quite considerably, but for awhile he was HUGE and it was difficult to get the fluid off him.  A thirteen hour surgery is a lot on any body, so swelling post-op is expected, but as Peter is so prone to ascites, he stayed big there even once the fluid began to leave the rest of his body.

Peter has healed quite well with his last two surgeries, so there is not a reason to think he will not heal from this one.  His liver numbers had a few days of a rise, but they have been trending down nicely over the last two weeks, as has his BUN and creatinine (indicators of kidney health status) which went up a bit right after the surgery.  Nutritionally, his TPN has been loaded with extra protein, zinc, and vitamin C.  He is on Cipro IV for some bacteria in the wounds, however the bacteria should not have caused this much tissue damage, and is likely due to the probing and poking that was done after we noticed the wounds not healing.  Tomorrow, Dr. Jennings will take the vac dressings off and we will get to see what the wounds look like for the first time since Wednesday. 

This admission has been hard on Peter.  He has been asking to go home for days and days.  His daddy came up here with two of his siblings to surprise Peter (and me) over the weekend.  The visit was such a boost to Peter's morale!  He has been smiling and back to some of his silly antics again, which I really had not seen so much of before their visit.  Hopefully there will be huge progress in the wounds when the dressings come off tomorrow, and we can plan our trip home!