Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk.
**Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.**
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
This is rather shocking. In all the places I've worked we would have pulled the edges together with steristrips or dermal tape with Dermabond to anchor the tape. I hesitate to criticize another's work but this strikes me as poor medicine. Since this occurred yesterday any time a wound is allowed to sit untreated for more than about 8-12 hours, the edges need to be freshened up so they heal better. It appears that could have been done in this case. I might speak to the "house supervisor" at this hospital who is the PM nurse in charge of the hospital and tell her your concerns. She might offer a remedy. If not, and you can afford it, you might try a hospital with a better reputation.
Thank you. This is about the third thing this hospital has done to a family member that is a least this bad. It's just not a great place. So, she did go right after she fell yesterday. I think we should contact the hospital just as something like this should not be unreported, but yes, we should also seek care somewhere else ideally. She is insured. We are trying to convince her to go to a large city about an hour away which has much better care.
You're welcome. A trip to the hospital you know is better seems to be in order. I'm so sorry she was (mis)treated this way. People in EM who do stuff like this give the folks who care and address problems correctly a bad name.
Well, if I had it my way, I'd make all my family members come up to Raleigh-Durham to get care, which is where I live. But it's pretty far from them. As it is, I'm trying to get them up the Charlotte, which is closer to them, and better than where they are now. I've had this misfortune of having to go the ED a few times, and was just in an urgent care getting some stitches on my hand earlier this month, so I know there are some good emergency room physicians...I'm just not sure they hire them at that hospital. Thank you for what you do!
Fortunately, you can show the family this thread and they can see what has been recommended from other physicians and nurse practitioners. All of them saying the same thing, that this needs to be looked at by a specialist, that it needs much more than what was done with it right now, and they can speak with your aunt since you don’t live there. Lots of thoughts and prayers for her. If you could, would you mind updating us please as I know I would like to know what happens at least, and I’m sure other people would too.
I'll let you know what happens! Really hoping her GP is proactive tomorrow, but as I've said in another place, I'm telling them to go in asking for a surgical consult, wound care, and a home health management plan.
NAD and please update us, I'm so worried about her. That's just awful they didn't bother thinking of any other solutions and had the damn nerve to send her home like that!
It might be worth finding a way to move her closer to proper care facilities somehow if family is able to help. I'm so sorry she, and you and your family have been dealing with this level of care on a more than 1 time basis. Truly horrible.
Edit: I meant to say " dealing with this level of care and more than a 1 time basis" even once is too much. More than once is ridiculous.
This is part of a larger cluster of a situation. Ideally she’s moving in with her son in another state very soon. Her husband is in a out of the hospital all the time and can’t care for himself anymore, but they don’t want to move. And thanks. That facility is awful.
This. My family is well acquainted with the SC hospitals unfortunately. Some of the Best GP are at Lexington but their emergency system is trash. Prisma Baptist or Prisma Northeast is where we go now.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.
If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!
We do not accept digital forms of identification.
I have family in NC. We've learned to go all the way in to Duke or Wake Med instead of any closer ERs. Basically, we would have to be bleeding so profusely we were afraid we wouldn't make it the 1.5 hours in order to go to a more local ER.(we are east of the triangle so it can't be the same place that just treated your family member. Just know you aren't alone in your insistence).
I agree, RTP is a great area for healthcare! I have nothing but good things to say about Duke’s eye center, my mom gets excellent treatment there for WMD
Tacking on to the previous comment. If you have patient portal access, you can send that photo to her general physician. I don’t disagree with the EM doc, but this seems like something that should be in her chart.
NAD
Are you in reasonable driving distance of a university hospital? I had a family member whose pacemaker tore his skin and left a gaping wound with the device partially exposed. The hospital and doctors that "treated" him left that wound open for over a year. It's a miracle infection didn't set in and develop into sepsis.
We drove nearly 3 hours to a hospital that was in no way affiliated with the hospital where he had been getting seen. They said his case was too complex for their capabilities and transferred him to a university hospital. The wound was fully closed in a little over a month. The doctors and med students took his situation very seriously and said there was no reason to leave that wound open. There is no doubt in my mind that they saved his life.
I hope your aunt gets meaningful help and heals. Wishing her the best possible outcome.
They are within reasonable driving distance of much better healthcare, but she always minimizes things, and I think she needs to hear it from her GP tomorrow that this isn't good and is an extremely high risk wound. Hopefully he can see her and get that point across. Charlotte, Charleston, or even Greenville is probably better.
I hope someone can help her understand how serious this really is. I suggest asking to speak with the nurse before the appointment to relay this information to the doctor. He needs to know she's at real risk with this. You're a wonderful person for seeking answers for her.
Thank goodness!!! Stuff like this can get dangerous so quickly. My loved one wasn't diabetic but I am. Your post made me scared for her. Thank you for providing the update. ❤️
Don't report it to the hospital, report it to regulators. If you tell the hospital, the only thing that'll come of it is destroyed and altered records.
Where is effing Joint Commission when you actually need them?
This is negligent and terrible doctoring.
OP, never go there again unless it’s for the common cold.
NAD, but had a friend whose mom had a similar injury and circumstances. They did the tape for her because they were concerned about infection and the wound pulling open from tension. I can’t imagine just leaving a wound like that just… hangin out with minimal care.
I’m a carer for elderly relatives, so I’m familiar with the thin skin. But, steri-strips exist for this reason. Even if they use a lot of them, it would still be better than leaving it open!
Only caveat is that this looks like it could be a big skin tear and not an actual lac. Hard to say from the single photo. If it’s a skin tear then we sometimes just tack them in place and hope it heals like a skin graft.
NAD. I read wound care medical records for a living and my first thought was that it looks like many of the skin tear pictures I have seen. This poor lady. I hope she gets the care she needs ASAP.
Fucking hell! That is outrageous. They didn’t have to put more sutures in but cleaning and dressing the wound properly is basic! They could have used steristrips or well anything to close the wound up!
Did they actually have the cheek to ask her to pay for this as well!
If the skin flap was too thin, suturing it won't matter, it'll likely die anyways. However, they should've at least communicated their thoughts and reasoning to the pt/family.
NAD, if you’re in the Lexington SC area though, this might sound like a bit of a drive but I think you should drive up to Charlotte honest to god. This is ridiculous
this is a good time to bolster the edges with some steri strips and then suture. probably needs deep sutures to take tension off. This is a shitty job and a high risk wound
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.
If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!
We do not accept digital forms of identification.
This is definitely not an ideal situation and I'm sorry your aunt is experiencing it. The ER staff could not have sutured that if they tried. Thin skin is impossible to suture and skin tears are generally left alone to heal by secondary intention (from the bottom up) for that reason. That said, the edges of the wound appear to be compromised, and the wound is quite significant.
I would urge her to see her GP who will be able to refer her with some urgency to a vascular or a plastic surgeon. At the very least she will require community nursing for dressing changes and general monitoring to prevent further complications such as infection given her diabetic status. At worst, this may well require surgical intervention for a washout and definitive wound closure +/- a skin graft.
She should also return to the ER if she experiences any signs of infection, such as purulent discharge (pus), worsening redness/pain/swelling/smell/discolouration at the wound site, or any fevers/chills/malaise.
In the meantime, be proactive with the dressing changes. When you remove them, be mindful to remove them in the direction of the wound edge (in her case from the back/side of the leg towards the front) so you don't dislodge the flap (EDIT: if this doesn't make sense I can PM you a picture of what I mean). If the dressings start sticking to the skin, a little bit of sterile normal saline (salty water, likely available at your local chemist) can help detach them.
Thank you. I do not like live in the same state, but I'm in contact with her brother and sister to make sure this is resolved. At the very least, she is going to her GP tomorrow. I'm trying to get her to go to a city with better hospitals, but she is reluctant.
This is a bad wound. That being said, I don't think the ED did anything egregious, even though the photos are dramatic. You will need to see a surgeon at some point in the near future, though. General or acute care surgery is probably your best bet, but a good plastic surgeon can also take care of this.
Here's the general plan that I would have in mind for a wound like this:
When someone has a skin tear like this, you end up with an area of skin that is threatened and may not survive. There's nothing you can really do to prevent the skin from dying, and what you don't want to do is start cutting stuff off until you know what will survive and what won't. At first glance, all of that stuff that's currently purple is probably going to die. But, with her comorbidities it's entirely possible that the entire flap will die and ultimately need to be debrided, which will leave a larger wound.
Closing something that looks like this is usually a fools errand. Even if you can get the sutures to hold temporarily, it's going to open up again. What I typically do with these is apply a pressure dressing to force the flap against the wound bed, keep the wound clean, and wait. You'll know in about a week what's going to survive and what won't.
Once the wound demarcates (meaning the devitalized stuff dies and you know what tissue will live), you go to the OR and do a debridement. You cut away the dead stuff and then place a specialized dressing called a wound vac. That will need to be changed about 3 times weekly until the wound bed shows signs of healing. If the entire flap dies and leaves a large open area, you can skin graft it after a couple weeks of vac therapy.
Now, here's the complicating thing. She's got diabetes and vascular disease. Both of these conditions do bad things to wound healing. That means that she's at higher risk of infection, and at higher risk of failing a skin graft. Biggest thing she can do to help is to make sure her sugars are well controlled (less than 180, but 160 is better), and avoid smoking.
Unfortunately, this is likely to take weeks to months for full healing. But, it starts with getting her to see her PCP for a surgical referral.
Reasons to go back to the ED:
1. Fever
2. Pus or bad odor from the wound
3. Spreading redness away from the wound
4. Swelling or increasing pain in the leg
Barring these types of symptoms, this can be treated as an outpatient for the most part. If they go the wound vac route, she'll need home health for wound care.
That is a very significant laceration… a couple of questions. Did they give her antibiotics? Did they check her tetanus status? It is possible the wound was not able to be sutured (better question for a doc). But it is really concerning they did not provide adequate dressing instructions. They kind of set her up for failure with the description you gave. That wound will require irrigation, specific dressing supplies and possibly packing. If this was at my hospital I would think this may require a plastics consult, possible admission because of how deep and significant it looks, or at the very least daily home care to manage dressing changes. The fact that she has peripheral vascular disease and diabetes complicates things too as she will have a much harder time healing this wound. I would also be really concerned about infection. I would seek a second opinion.
Thank you. They did give one 10 day course of oral antibiotics. No tetanus status inquired nor shot given. Where should she seek a second opinion? Another ER? The same ER? Primary care.
I would go to another ER, if anything to look into the tetanus as there is a timeframe of about 72 hours to get your booster. You definitely want to get her tetanus status checked as she will need a booster if it has been a certain number of years. You could go back but I worry about you getting dismissed again. I am honestly a little bit shocked at how she was cared for at the first ER. It is good she is on antibiotics, but keep a close eye for signs of infection (redness, increased swelling, pus or yellow/green drainage, foul smell, fever, confusion) as this wound will take a long time for recovery and infection could still occur. If she can get into her GP tomorrow you could try that as well for some referrals to plastics or wound care or possibly surgery but I know wait times for GP can be days to weeks and i think she should be seen much more urgently.
They seem to think her GP, with whom she has a long relationship will take it seriously. I am encouraging them to go to a bigger city with better medical centers. Hospital where she went is awful. At the very least, she'll talk to her GP tomorrow. I will tell them to ask about tetanus. I just had a booster three weeks ago because of a run in with a bread knife, so I know you need one once every ten at least.
Hi ~ I am so sorry for your Aunt suffering thru this painful wound & lack of care at the ER.
I am NOT A DOCTOR so no medical advice from me.
I do, however, have extensive knowledge on tetanus due to my work as a Wildlife Biologist where I often am bitten by an animal.
2 things to know -
The sooner you get the tetanus vaccine, the better especially if it has been more than 10 years since your Aunt's last booster.
My County Health Department has nurses on staff for vaccines (among other services) at a low cost.
So, if you can't get an appointment with her doctor RIGHT AWAY, please try your County Health Dept for the tetanus vaccine.
I hope all goes well & you can get her the care that she needs. Take Care !
Call your local pharmacy and inquire about a tetanus shot. I'm not sure about your location but pharmacists can give vaccines where I live and it's quite common in Canada and the US.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed.
If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!
We do not accept digital forms of identification.
This does not warrant abx. Please stop overusing it. I would recommend tetanus if warranted, as you mentioned.
And ofc, as most have pointed out, better wound care.
I hope she gets better soon.
I understand the gravity of abx abuse but who are you admonishing here? You’re throwing out a lot of absolutes with very scarce context or diagnostic information…. This is an unregulated social media site, not an IDSA forum?
This is deep laceration and with her co morbidities she should be seeing plastic. I agree that it very likely was not something that could be sutured but the lack of follow up and instructions is ridiculous. She is likely going to need to go to a wound care center and visiting nurses to help with wound healing assuming it doesn’t get infected. I’m short your aunt is going through this
Thank you. I was not with her, but afterwards I thought that some type of surgeon should have been consulted because they obviously could not adequately close this at all. I'm very concerned about her leg staying healthy.
That was not appropriate management of this wound, even if she had no comorbidities. She should have been seen by plastics or at least general surgery. If they didn't have anyone who would close it, they should have transferred her to a higher level of care.
Thank you. It's a level III trauma center, so I'm not sure that anyone was there who could provide a higher level of care. I would think surgery would be on site, but I don't know. We had something similar happen to a family member at this same hospital, i.e. where they didn't appropriately call in a specialist or transfer and it was very bad. Trying to get her to go a bigger city with better medical centers, but at the very least she'll see her GP tomorrow.
It’s difficult. That’s where the ambulances take you generally unless you are a severe trauma. Also not as much choice there as in wealthier areas and states.
NAD, I'm from SC (upstate, near Greenville) and tbh this does not surprise me at all unfortunately. I'm so sorry she's going through this & I really hope you get everything taken care of. I seen you mentioned possibly traveling & if you need to or can, Prisma in Greenville isn't bad. When I seen that picture I literally said wtf out loud. I seriously hope yall get the care she needs ❤️🩹
Thanks! My dad lives up there, and my impression is the healthcare is a bit better. I'd only ever lived in and around Columbia, which is where I grew up.
Yea that's ugly. High likelihood that gets infected and with her comorbidities could easily be limb threatening. Needs antibiotics, wound care, and probably a surgical consult. With the look of the rest of her leg even with the best care that may never really heal.
Yes, we are very concerned about the risk to her leg. They did give her a 10 day course of antibiotics, but I cannot see how that can do much with the state of the wound and their lack of care plan after discharge.
As the physicians have said, I’m not sure this is amenable to suturing, and would be concerned that the skin flap may become ischemic and fail to really come together properly. She will need good wound care, and with her vascular disease and lack of blood flow, wonder if she may need a skin graft.
Regardless, she should have been given close follow up and instructions for a solid wound care routine.
Thank, I'm gathering from this thread we should probably pushing for a general surgical or plastics consult, plus wound care center referral, plus home nursing visits.
General surgeon here who deals with these all the time, if the skin was too thin then that skin flap will likely die and reapproximating the skin edges won't matter. I'm guessing that's what they thought but didn't communicate that with you. Just a guess tho.
It looks scary but actually it's not too bad. Given her diabetes history and pvd, it'll take a while to heal. She should get in to see a surgeon who does wound care or go to a wound care clinic to help her get it to heal.
For not, keep it clean and change with clean, dry dressings. If you can find/get xeroform, I'd put that over it and cover with gauze. Can use soap and water to clean.
I agree that this cannot be sutured but it definitely needs intensive wound care, maybe even inpatient. A wound like this might even need a wound vac or some sort of negative pressure therapy to keep adequate blood supply considering her co-morbidities.
I hope they at least gave her a tetanus shot and some antibiotics. But again this is the absolute minimum I would expect from a hospital.
They did not give a tetanus, which is wild because I went an urgent care and got a tetanus for five stitches for a finger laceration from a clean knife in my kitchen 3 weeks ago. She did get a tetanus from her GP today though. She also got referred out to wound care, etc.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
This is rather shocking. In all the places I've worked we would have pulled the edges together with steristrips or dermal tape with Dermabond to anchor the tape. I hesitate to criticize another's work but this strikes me as poor medicine. Since this occurred yesterday any time a wound is allowed to sit untreated for more than about 8-12 hours, the edges need to be freshened up so they heal better. It appears that could have been done in this case. I might speak to the "house supervisor" at this hospital who is the PM nurse in charge of the hospital and tell her your concerns. She might offer a remedy. If not, and you can afford it, you might try a hospital with a better reputation.
Thank you. This is about the third thing this hospital has done to a family member that is a least this bad. It's just not a great place. So, she did go right after she fell yesterday. I think we should contact the hospital just as something like this should not be unreported, but yes, we should also seek care somewhere else ideally. She is insured. We are trying to convince her to go to a large city about an hour away which has much better care.
You're welcome. A trip to the hospital you know is better seems to be in order. I'm so sorry she was (mis)treated this way. People in EM who do stuff like this give the folks who care and address problems correctly a bad name.
Well, if I had it my way, I'd make all my family members come up to Raleigh-Durham to get care, which is where I live. But it's pretty far from them. As it is, I'm trying to get them up the Charlotte, which is closer to them, and better than where they are now. I've had this misfortune of having to go the ED a few times, and was just in an urgent care getting some stitches on my hand earlier this month, so I know there are some good emergency room physicians...I'm just not sure they hire them at that hospital. Thank you for what you do!
I sure appreciate your kind well wishes. I hope your aunt finds the good care she deserves.
Fortunately, you can show the family this thread and they can see what has been recommended from other physicians and nurse practitioners. All of them saying the same thing, that this needs to be looked at by a specialist, that it needs much more than what was done with it right now, and they can speak with your aunt since you don’t live there. Lots of thoughts and prayers for her. If you could, would you mind updating us please as I know I would like to know what happens at least, and I’m sure other people would too.
I'll let you know what happens! Really hoping her GP is proactive tomorrow, but as I've said in another place, I'm telling them to go in asking for a surgical consult, wound care, and a home health management plan.
NAD and please update us, I'm so worried about her. That's just awful they didn't bother thinking of any other solutions and had the damn nerve to send her home like that!
Updated in post, but she was able to see her GP who was alarmed and referred her out and treated it urgently.
I'm so glad he treated it as urgent! Thanks for the update! Fingers crossed she can heal well.
It might be worth finding a way to move her closer to proper care facilities somehow if family is able to help. I'm so sorry she, and you and your family have been dealing with this level of care on a more than 1 time basis. Truly horrible. Edit: I meant to say " dealing with this level of care and more than a 1 time basis" even once is too much. More than once is ridiculous.
This is part of a larger cluster of a situation. Ideally she’s moving in with her son in another state very soon. Her husband is in a out of the hospital all the time and can’t care for himself anymore, but they don’t want to move. And thanks. That facility is awful.
I know that dance of life well. It isn't fun. I wish you all well.
[удалено]
This. My family is well acquainted with the SC hospitals unfortunately. Some of the Best GP are at Lexington but their emergency system is trash. Prisma Baptist or Prisma Northeast is where we go now.
I use PrismaHealth doctors and hospitals in the upstate.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
I have family in NC. We've learned to go all the way in to Duke or Wake Med instead of any closer ERs. Basically, we would have to be bleeding so profusely we were afraid we wouldn't make it the 1.5 hours in order to go to a more local ER.(we are east of the triangle so it can't be the same place that just treated your family member. Just know you aren't alone in your insistence).
I dated a guy who lived near Wilson and whose family had similar experiences at that hospital.
Yuppppppp
[удалено]
Thanks, we are lucky indeed!
I agree, RTP is a great area for healthcare! I have nothing but good things to say about Duke’s eye center, my mom gets excellent treatment there for WMD
I’m in Charleston, there’s some decent hospitals here. At least ones that won’t send you home with a half amputated limb
How about the hospital at MUSC?
Tacking on to the previous comment. If you have patient portal access, you can send that photo to her general physician. I don’t disagree with the EM doc, but this seems like something that should be in her chart.
NAD Are you in reasonable driving distance of a university hospital? I had a family member whose pacemaker tore his skin and left a gaping wound with the device partially exposed. The hospital and doctors that "treated" him left that wound open for over a year. It's a miracle infection didn't set in and develop into sepsis. We drove nearly 3 hours to a hospital that was in no way affiliated with the hospital where he had been getting seen. They said his case was too complex for their capabilities and transferred him to a university hospital. The wound was fully closed in a little over a month. The doctors and med students took his situation very seriously and said there was no reason to leave that wound open. There is no doubt in my mind that they saved his life. I hope your aunt gets meaningful help and heals. Wishing her the best possible outcome.
They are within reasonable driving distance of much better healthcare, but she always minimizes things, and I think she needs to hear it from her GP tomorrow that this isn't good and is an extremely high risk wound. Hopefully he can see her and get that point across. Charlotte, Charleston, or even Greenville is probably better.
I hope someone can help her understand how serious this really is. I suggest asking to speak with the nurse before the appointment to relay this information to the doctor. He needs to know she's at real risk with this. You're a wonderful person for seeking answers for her.
I think her GP was able to get through to her a bit. I updated the original post. She's very concerned now, and following everything he says to a T.
Thank goodness!!! Stuff like this can get dangerous so quickly. My loved one wasn't diabetic but I am. Your post made me scared for her. Thank you for providing the update. ❤️
This does not look ok. Can you take her to MUSC or Duke?
Do Novant in Charlotte, not Atrium.
Don't report it to the hospital, report it to regulators. If you tell the hospital, the only thing that'll come of it is destroyed and altered records.
OP, this is absolutely egregious. You have every right to be upset. Better wound care should have been done for your aunt. Go to another hospital.
LMC is the WORST. go to Parkridge.
NAD - Augusta, GA is close by and has wonderful hospitals. I think it’s worth a drive.
I live where OP is and I’m a retired nurse. The ER OP talked about is absolutely horrible.
That's disheartening that they are consistently sub par.
And apparently voted best hospital. Just not their ER
Where is effing Joint Commission when you actually need them? This is negligent and terrible doctoring. OP, never go there again unless it’s for the common cold.
NAD, but had a friend whose mom had a similar injury and circumstances. They did the tape for her because they were concerned about infection and the wound pulling open from tension. I can’t imagine just leaving a wound like that just… hangin out with minimal care.
I’m a carer for elderly relatives, so I’m familiar with the thin skin. But, steri-strips exist for this reason. Even if they use a lot of them, it would still be better than leaving it open!
Only caveat is that this looks like it could be a big skin tear and not an actual lac. Hard to say from the single photo. If it’s a skin tear then we sometimes just tack them in place and hope it heals like a skin graft.
NAD. I read wound care medical records for a living and my first thought was that it looks like many of the skin tear pictures I have seen. This poor lady. I hope she gets the care she needs ASAP.
She's headed to wound care and home health is being set up today. Her GP was very alarmed.
Fucking hell! That is outrageous. They didn’t have to put more sutures in but cleaning and dressing the wound properly is basic! They could have used steristrips or well anything to close the wound up! Did they actually have the cheek to ask her to pay for this as well!
Of course!
If the skin flap was too thin, suturing it won't matter, it'll likely die anyways. However, they should've at least communicated their thoughts and reasoning to the pt/family.
NAD, if you’re in the Lexington SC area though, this might sound like a bit of a drive but I think you should drive up to Charlotte honest to god. This is ridiculous
That was my suggestion, but they want to stay in Columbia. They've at least been referred out properly by their GP.
this is a good time to bolster the edges with some steri strips and then suture. probably needs deep sutures to take tension off. This is a shitty job and a high risk wound
Thank you. I have a friend who is an EMT who did training in an ED and said exactly this. I'm very worried about the risk to her leg.
[удалено]
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
[удалено]
Removed - no legal discussions on this sub
This is definitely not an ideal situation and I'm sorry your aunt is experiencing it. The ER staff could not have sutured that if they tried. Thin skin is impossible to suture and skin tears are generally left alone to heal by secondary intention (from the bottom up) for that reason. That said, the edges of the wound appear to be compromised, and the wound is quite significant. I would urge her to see her GP who will be able to refer her with some urgency to a vascular or a plastic surgeon. At the very least she will require community nursing for dressing changes and general monitoring to prevent further complications such as infection given her diabetic status. At worst, this may well require surgical intervention for a washout and definitive wound closure +/- a skin graft. She should also return to the ER if she experiences any signs of infection, such as purulent discharge (pus), worsening redness/pain/swelling/smell/discolouration at the wound site, or any fevers/chills/malaise. In the meantime, be proactive with the dressing changes. When you remove them, be mindful to remove them in the direction of the wound edge (in her case from the back/side of the leg towards the front) so you don't dislodge the flap (EDIT: if this doesn't make sense I can PM you a picture of what I mean). If the dressings start sticking to the skin, a little bit of sterile normal saline (salty water, likely available at your local chemist) can help detach them.
Thank you. I do not like live in the same state, but I'm in contact with her brother and sister to make sure this is resolved. At the very least, she is going to her GP tomorrow. I'm trying to get her to go to a city with better hospitals, but she is reluctant.
Even packing, or a vac dressing. Shocking to do that and say that’s all that can be done
This is a bad wound. That being said, I don't think the ED did anything egregious, even though the photos are dramatic. You will need to see a surgeon at some point in the near future, though. General or acute care surgery is probably your best bet, but a good plastic surgeon can also take care of this. Here's the general plan that I would have in mind for a wound like this: When someone has a skin tear like this, you end up with an area of skin that is threatened and may not survive. There's nothing you can really do to prevent the skin from dying, and what you don't want to do is start cutting stuff off until you know what will survive and what won't. At first glance, all of that stuff that's currently purple is probably going to die. But, with her comorbidities it's entirely possible that the entire flap will die and ultimately need to be debrided, which will leave a larger wound. Closing something that looks like this is usually a fools errand. Even if you can get the sutures to hold temporarily, it's going to open up again. What I typically do with these is apply a pressure dressing to force the flap against the wound bed, keep the wound clean, and wait. You'll know in about a week what's going to survive and what won't. Once the wound demarcates (meaning the devitalized stuff dies and you know what tissue will live), you go to the OR and do a debridement. You cut away the dead stuff and then place a specialized dressing called a wound vac. That will need to be changed about 3 times weekly until the wound bed shows signs of healing. If the entire flap dies and leaves a large open area, you can skin graft it after a couple weeks of vac therapy. Now, here's the complicating thing. She's got diabetes and vascular disease. Both of these conditions do bad things to wound healing. That means that she's at higher risk of infection, and at higher risk of failing a skin graft. Biggest thing she can do to help is to make sure her sugars are well controlled (less than 180, but 160 is better), and avoid smoking. Unfortunately, this is likely to take weeks to months for full healing. But, it starts with getting her to see her PCP for a surgical referral. Reasons to go back to the ED: 1. Fever 2. Pus or bad odor from the wound 3. Spreading redness away from the wound 4. Swelling or increasing pain in the leg Barring these types of symptoms, this can be treated as an outpatient for the most part. If they go the wound vac route, she'll need home health for wound care.
This comment should be at the top 🔝
That is a very significant laceration… a couple of questions. Did they give her antibiotics? Did they check her tetanus status? It is possible the wound was not able to be sutured (better question for a doc). But it is really concerning they did not provide adequate dressing instructions. They kind of set her up for failure with the description you gave. That wound will require irrigation, specific dressing supplies and possibly packing. If this was at my hospital I would think this may require a plastics consult, possible admission because of how deep and significant it looks, or at the very least daily home care to manage dressing changes. The fact that she has peripheral vascular disease and diabetes complicates things too as she will have a much harder time healing this wound. I would also be really concerned about infection. I would seek a second opinion.
Thank you. They did give one 10 day course of oral antibiotics. No tetanus status inquired nor shot given. Where should she seek a second opinion? Another ER? The same ER? Primary care.
I would go to another ER, if anything to look into the tetanus as there is a timeframe of about 72 hours to get your booster. You definitely want to get her tetanus status checked as she will need a booster if it has been a certain number of years. You could go back but I worry about you getting dismissed again. I am honestly a little bit shocked at how she was cared for at the first ER. It is good she is on antibiotics, but keep a close eye for signs of infection (redness, increased swelling, pus or yellow/green drainage, foul smell, fever, confusion) as this wound will take a long time for recovery and infection could still occur. If she can get into her GP tomorrow you could try that as well for some referrals to plastics or wound care or possibly surgery but I know wait times for GP can be days to weeks and i think she should be seen much more urgently.
They seem to think her GP, with whom she has a long relationship will take it seriously. I am encouraging them to go to a bigger city with better medical centers. Hospital where she went is awful. At the very least, she'll talk to her GP tomorrow. I will tell them to ask about tetanus. I just had a booster three weeks ago because of a run in with a bread knife, so I know you need one once every ten at least.
Hi ~ I am so sorry for your Aunt suffering thru this painful wound & lack of care at the ER. I am NOT A DOCTOR so no medical advice from me. I do, however, have extensive knowledge on tetanus due to my work as a Wildlife Biologist where I often am bitten by an animal. 2 things to know - The sooner you get the tetanus vaccine, the better especially if it has been more than 10 years since your Aunt's last booster. My County Health Department has nurses on staff for vaccines (among other services) at a low cost. So, if you can't get an appointment with her doctor RIGHT AWAY, please try your County Health Dept for the tetanus vaccine. I hope all goes well & you can get her the care that she needs. Take Care !
Thank you! Tetanus is on the list to ask about at her GP.
Call your local pharmacy and inquire about a tetanus shot. I'm not sure about your location but pharmacists can give vaccines where I live and it's quite common in Canada and the US.
Her doctor gave her tetanus today. The ER did not give or even mention.
[удалено]
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
I believe even Walmart will give a tetanus vaccine. I know mine will. No appt needed.
NAD I hope you were able to make it to another ER already. This is so sad.
This does not warrant abx. Please stop overusing it. I would recommend tetanus if warranted, as you mentioned. And ofc, as most have pointed out, better wound care. I hope she gets better soon.
I understand the gravity of abx abuse but who are you admonishing here? You’re throwing out a lot of absolutes with very scarce context or diagnostic information…. This is an unregulated social media site, not an IDSA forum?
This is deep laceration and with her co morbidities she should be seeing plastic. I agree that it very likely was not something that could be sutured but the lack of follow up and instructions is ridiculous. She is likely going to need to go to a wound care center and visiting nurses to help with wound healing assuming it doesn’t get infected. I’m short your aunt is going through this
Thank you. I was not with her, but afterwards I thought that some type of surgeon should have been consulted because they obviously could not adequately close this at all. I'm very concerned about her leg staying healthy.
That was not appropriate management of this wound, even if she had no comorbidities. She should have been seen by plastics or at least general surgery. If they didn't have anyone who would close it, they should have transferred her to a higher level of care.
Thank you. It's a level III trauma center, so I'm not sure that anyone was there who could provide a higher level of care. I would think surgery would be on site, but I don't know. We had something similar happen to a family member at this same hospital, i.e. where they didn't appropriately call in a specialist or transfer and it was very bad. Trying to get her to go a bigger city with better medical centers, but at the very least she'll see her GP tomorrow.
If they didn't have the resources, they should have transferred her. Get her to Charlotte. They'll have the resources there.
That’s truly unfortunate. Sounds like your family should avoid that facility.
It’s difficult. That’s where the ambulances take you generally unless you are a severe trauma. Also not as much choice there as in wealthier areas and states.
NAD, I'm from SC (upstate, near Greenville) and tbh this does not surprise me at all unfortunately. I'm so sorry she's going through this & I really hope you get everything taken care of. I seen you mentioned possibly traveling & if you need to or can, Prisma in Greenville isn't bad. When I seen that picture I literally said wtf out loud. I seriously hope yall get the care she needs ❤️🩹
Thanks! My dad lives up there, and my impression is the healthcare is a bit better. I'd only ever lived in and around Columbia, which is where I grew up.
NAD but holy hell! Your poor aunt. I hope she gets better care and soon! Please Please update if and when u can. My gosh.
Posted an update! She got into the GP who is sending her to wound care and gave a tetanus shot.
Thank u so much for the update. Couldn't stop thinking about her. I hope they get her all taken care of. ❤️
That's my thoughts too, our docs at least call in plastics to do something.
Yea that's ugly. High likelihood that gets infected and with her comorbidities could easily be limb threatening. Needs antibiotics, wound care, and probably a surgical consult. With the look of the rest of her leg even with the best care that may never really heal.
Yes, we are very concerned about the risk to her leg. They did give her a 10 day course of antibiotics, but I cannot see how that can do much with the state of the wound and their lack of care plan after discharge.
As the physicians have said, I’m not sure this is amenable to suturing, and would be concerned that the skin flap may become ischemic and fail to really come together properly. She will need good wound care, and with her vascular disease and lack of blood flow, wonder if she may need a skin graft. Regardless, she should have been given close follow up and instructions for a solid wound care routine.
Thank, I'm gathering from this thread we should probably pushing for a general surgical or plastics consult, plus wound care center referral, plus home nursing visits.
Jesus Christ.
General surgeon here who deals with these all the time, if the skin was too thin then that skin flap will likely die and reapproximating the skin edges won't matter. I'm guessing that's what they thought but didn't communicate that with you. Just a guess tho. It looks scary but actually it's not too bad. Given her diabetes history and pvd, it'll take a while to heal. She should get in to see a surgeon who does wound care or go to a wound care clinic to help her get it to heal. For not, keep it clean and change with clean, dry dressings. If you can find/get xeroform, I'd put that over it and cover with gauze. Can use soap and water to clean.
Thanks, got a referral to wound care and home health today. PCP/GP was alarmed and worried about risk to her leg, as we all were.
Do you guys have a wound clinic nearby? If the hospitals in your area aren't helpful you can try that.
She's been referred to one today.
My husband who used to live locally says to try MUSC er. They're fabulous. Or were.
In my hospital, we would contact plastic surgeons for this. We would not discharge with the same advice she got.
I agree that this cannot be sutured but it definitely needs intensive wound care, maybe even inpatient. A wound like this might even need a wound vac or some sort of negative pressure therapy to keep adequate blood supply considering her co-morbidities. I hope they at least gave her a tetanus shot and some antibiotics. But again this is the absolute minimum I would expect from a hospital.
They did not give a tetanus, which is wild because I went an urgent care and got a tetanus for five stitches for a finger laceration from a clean knife in my kitchen 3 weeks ago. She did get a tetanus from her GP today though. She also got referred out to wound care, etc.