poor healing wound

I am a wound specialist and I have a patient with a wound on his top of his foot. To me the tissue looks poorly oxygenated. He had a test done in his home in the past the showed him not breathing during the night but has not had the full apnea study. Anybody have any problems with healing.

Sleep apnea can cause all sorts of problems. It wouldn't surprise me in the least if it cause wounds not to heal properly.

I am struggling to treat my sleep apnea. I have several areas where the skin is rough and hard and has even become infected. The dermatologist doesn't know what they are for sure and the medications I've used including a steroid have not helped. These are definitely improving as I get more sleep on the machine.

Hi woundnut68,

It is quite a common condition for some folks to not breath at night. Did anyone check to see if he was breathing during the day? This is actually a little less common but but equally important.

As a wound specialist you are no doubt aware that cessation of breathing in almost all cases leads to poor oxygenization of cellular infarctions paticularly of the radical variety associated with massive intrusions involving epidermal or musculature tissue within and surrounding the upper hoof area.

An analysis should quickly be made of the cardiovascular tissue to see if there is sufficient activity to transfer oxygenated red blood cells through the lower vascular system to stimulate the auto-immune anatomical defences to polarize the antibodies in sufficient strength to provide theraputive value.

Overall, the prognosis does not look good in this case due to the wound being in the lower body extremities and the patient having not breathed throughout the night.

You are probably correct to order a full Apnea study in this case especially in conjunction with a high pressure setting of at least 80 cm and a humidity level of no less than 300 kp. Any local DME can probably provide the patient with an interface between the actual Apnea unit and the facial configuration needed to completely exhaust him.

Good luck!

Dr Bob F, ME

woundnut, I don't know if this applies, but a woman who is a nurse and posts on another message board wrote of how any bruise she got lasted an unusually long time.

Later, after being diagnosed with OSA and getting on cpap treatment, she noticed passingly (wasn't even thinking about it or looking for it) that her lingering bruises cleared up, and any new bruise lasts a "regular" amount of time instead of staying discolored so long.

I am sure that this person has been tested for diabetes. wounds, cuts, whatever, are very slow to heal. I know from personal experience. I am not noticing any faster healing with 3 mos. of apap.
each person's healing, is differing...etc.

But, on the flip side, my #'s daily/glucose/monitoring are lower. Not as low as I'd love, but lower, thus proving, that the apap treatment is helping my metabolic imbalances. Slowly but surely.

Might take me forever, but the alternative of acute apnea events, and now my daily apnea "watch" has brought my episodes down to less than 10 for the night. so overall, I'd say adding apap/cpap treatment has helped me.

I do not know if your patient is a diabetic, these are just my own personal experiences and observations. IMHO of course.

woundnut68 wrote:I am a wound specialist and I have a patient with a wound on his top of his foot. To me the tissue looks poorly oxygenated. He had a test done in his home in the past the showed him not breathing during the night but has not had the full apnea study. Anybody have any problems with healing.

Its not just the lack of oxygen- not getting restorative sleep delays healing too. Any sleep problem can cause it & should be treated ASAP.

I been diagnosed with Reiter's Syndrome. This weird arthritis causes my fingers and toes to swell like sausages. I disagree with my rheumatologist though because it only happens if my apnea has been out of control for awhile. So for me, it is pretty evident that peripheral circulation is affected.

Vicki[/url]

I have an open wound on the back of my leg just above 3 inches the left heel. I have a small wound on the front of right shin a little above the ankle. My legs are red and have been very dark at times. With the cpap therapy I am on my legs have gotten a little less red.

I think non-healing wounds or other problems of the lower extremities should be checked out for both diabetes and Sleep Apnea. My wounds have been with me for 3-4 months.

My sleep study had a ahi of 59-62 side/back. Max apnea was 48 seconds, max hypopnea was 37 seconds. My O2 saturation baseline was about 93%, with minimal saturation of 54% at the worst, below 90% for 18% of the time.

I think I have had sleep apnea for a few years as my legs have been progressively getting more red over the past 2-3 years. I had cellulitus years ago.

I hope this helps with information about people with wound problems.

Snoozer,
Your red legs could be the beginning of venous stasis. Check it out with your doctor. Surgical (compression) stockings and elevated legs (whenever possible) helps to delay progression.
Not sure if cpap use has also slowed progression for me.

I plan to get it checked out as fast as possible, preferrably by a specialist. When I talk to my regular doctor or my sleep specialist, they don't show much concern, but thanks for letting me know. Now I can do some research and get better attention from my doctor when I go to see him.

Thanks again.
Lost Snoozer, still finding himself.

Poor healing wounds can also be caused by high blood sugar or liver disorders

Uncle Bob,.....the "upper HOOF??????" [/quote]

unclebob wrote:Hi woundnut68,

......
As a wound specialist you are no doubt aware that cessation of breathing in almost all cases leads to poor oxygenization of cellular infarctions paticularly of the radical variety associated with massive intrusions involving epidermal or musculature tissue within and surrounding the upper hoof area.

This is what I was talking about.....

Hi Janelle,

OK, you got me! I blew it!! Should have used the word "paw". Some judges leave no room for error. I should have known that un Greatful Dane was a dog and not a horse but the damn droppings were of the same volume. Believe me, thats the last time I feed Silver kibbles no matter what Tonto says!

Hey, it's the weekend and no one is watching me. I can circulate all the air I want and who gives a smell!

I suspect I must apologize to the "Guest" who started this thread. I originally responded because I thought it was a prank and thought I'd have some fun. My post was off the wall and intended to provide some humor as well as insinuate acknowledgement that the poster was trying to pull our leg. Between the lines - "poorly oxygenated....test done in his home....not breathing during the night....problem with healing - putting all this together I concluded a "wound expert" would not be consulting this forum for advice in his own speciality.

I figured, a "wound expert" must be a doctor so would read up on this in volume ' Wo', # 843 sec 1786, sub sec 412, para 24 in the Authoritative American Handbook of Physicians, Surgeons and Wound Experts which clearly identifies proper procedures in this circumstance including stringent use of iodine, gauze, cauterization, needles and fishing line. Or just asking a colleague in his field of expertise.

The only other thought I had was if this guy was not a doctor or a prankster but just simply a clumsy sheriff from the Lone Star State practicing his fast draw - maybe he needed to gallop into town and get real medical treatment. Or he did accidentally shoot his horse in the foot and the word hoof was indeed correct, but then he may need a DVE - do they have those in Texas? Oops!!

Sorry if I offended anyone, pain and suffering is not fun, healing is often a challenge. Hope I didn't scare off "Guest" as valid information from all sources is useful and important for each of us.

Bob F

I goofed,

In my previous thread I was referring to "woundnut68" not any "Guest".

Bob F