non-healing surgical wound following hip replacement surgery

sem posted on Thu, Sep 17 2009 3:54 AM

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September 16, 2009

My father has Type One Diabetes, though it did not emerge until he was past 50. He is now 71. Though he says his diabetes is well controlled, his endocrinologist describes his diabetes as "brittle". Two years ago he received a prosthetic hip and has since had eight more operations. The basic problems are necrotic tissue around the surgical site and a surgical wound from May, 2009 that has not yet healed. He was also recently diagnosed with a staph infection in the surgical site.

In May, 2009, his surgeons "revised", as they say, his prosthesis. In a Hip Revision, the prosthesis is removed, the hip joint is cleaned up and the prosthesis is reinstalled. In this operation, as in prior operations, a significant amount of dead tissue was removed. If I am counting correctly, the May operation was the third revision of his original surgery.

In August, 2009, 13 weeks after the May operation, fluid starting leaking from the site of the incision for the May surgery. The incision itself had healed, but the tissue below the incision had not. He was operated on in mid-August. The surgeons drained a significant pool of clear fluid, removed some dead tissue and sewed him up. That incision also healed.

On Labor Day, fluid leaked from the site of the August incision. His surgeons again drained some clear fluid, removed more dead tissue and closed the incision. This time, they also found a staph infection in the surgical site. Currently, he is in the hospital being treated for the staph infection with IV antibiotics, though he will soon be moved to a rehab facility.

His doctors are baffled. They say they have never encountered a problem quite like this. They do not know why tissue is dying in the surgical site. They do not know where the fluid collecting behind the incision is coming from. And they do not know why the wound will not heal.

His chief surgeon is quite pessimistic, and says the leg will probably have to be amputated.

During his several hospital stays, my father's blood sugar has tended to be high. When I observed how the staff measured and controlled his blood sugar, it seemed to fit the description of what is called the "sliding-scale" method. From what I read, this is an obsolete method, though still widely practiced.

Has anybody seen a problem similar to this? If so, where would you go to get it resolved?

We are trying to get a second opinion, but we do not know if he should see an orthopedic surgeon, a vascular surgeon (The surgeons report that some of the tissue around the hip is "dry" though vascular imaging studies indicate that the blood supply to that area is adequate.), a wound healing specialist, a pathologist, a tissue specialist or some other medical specialist.

These kinds of problems are more common in patients with Type One Diabetes, so we assume he needs some sort of Diabetes specialist to look at this,  or treatment at a center that specializes in Diabetes.

Any suggestions? My father lives in Northern New Jersey.

Thanks.