On September 15, 2012, I slipped and fell, cutting an area of skin on my shin which was already affected by a weird degenerative skin condition called Necrobiosis Lipoidica.  WARNING: The photos on this page are graphic.  

If you have NL (necrobiosis lipoidica) or NLD (necrobiosis lipoidica diabeticorum) and have a wound that doesn’t seem to want to heal, this page may be interesting to you.  The short version of this story consists of two facts:

  1. Nothing will heal properly as long as the area is infected.  
  2. In the end, specialized dressings and Silvasorb ointment were what worked for me

It took a long time and a lot of pain and heartache to learn those facts.

PART TWO | PART THREE

Care plan recommended by urgent care clinic: cover with antibacterial ointment (Neosporin) and a non-stick (Telfa) pad, then wrap with a bandage.  I did this for 60 days without any healing whatsoever.

For the next 7 days I left it open to the air.  Bad idea.  This photo was taken at the doctor’s office while I waited for him to help get rid of the infection that developed.  Apparently wounds are a tricky thing, and leaving them open to the air to “scab over” so they can heal is folly.

infected-wound-with-necrobiosis-lipoidica

it got wicked infected, smelled bad, and was intolerably painful.  I went to the doctor’s office and was given a cocktail of antibiotics and a referral to the local wound care center.

The wound care doctor “debrided” (“dee-BREE-ded”) by first applying numbing cream to the surface of the wound and then scraping off the “slough” (“sluff” – which is dead material upon which bacterial will feed) with forceps. The photo above shows my second visit to the doctor where a chemical agent was used to prevent the skin from forming a “ledge” which would have inhibited further skin growth. This was quite painful but it looked promising.  I was encouraged.

Unfortunately an infection was causing the wound to deteriorate.  The following pictures show week-to-week progress as the infection destroyed the skin.  Throughout this process the doctor continued wrapping the leg in an “UNNA boot,” in which a bandage is placed directly on the wound, followed of a strip of calamine-based wrapping around the entire foot and affected area (in my case from the knee down), and finally wrapped with a compression bandage to physically limit any swelling of the tissue.

unsuccessful-wound-care-on-necrobiosis-lipoidica

Hang in there.  There’s a happy ending to this story but it gets worse before it gets better…

necrobiosis-wound-getting-worse

 

Next up: December 20, 2012:

december 20 2012

 

December 27, 2012: In the next shot you can really see the deterioration taking off.  The top layer of skin has what looks like the dishpan-hands effect and spent white blood cells are collecting in the pools.  We kept fighting it with the same approach so it got worse from here.

decrobiosis-lipoidica-wound-getting-worse-after-treatment

 

January 3, 2013:  This photo is epic.  It’s one of my favorites.  The body language in the photo is unmistakable.  The nurse’s hand shows that the mind is elsewhere.  To me it clearly speaks the message “wow this is not looking good.  I don’t envy your doctor.”  This should have been a turning point for me.  I should have paid attention to this one, because it was clear on this day that our approach wasn’t working, something was terribly wrong, and we needed a change of strategy.

necrobiosis-lipoidica-deteriorating-after-wound-care

 

January 8, 2012.  Instead we just kept on doing the same stuff…

 

necrobiosis-lipoidica-wound-debriting-infected

 

I’m told that the condition was cellulitis caused by a bacteria called psuedomonas

necrobiosis-wound-infected-cellulitis

Friends and family started praying for me.  

Up to this point I had kept the situation quiet and those close to me knew things weren’t getting better and asked if they could have their churches start praying for things to get better.  The next part of this process was NOT fun, but there was a definite turning point that occurred at this time.

My normal doctor sent me home with a product called Santyl to apply to the wound and cover with gauze wrap as needed.  After enduring the agony of dressing the wound myself twice, I called to see if there were any other options. It happened that another doctor at the same wound care center was able to take a look.  He identified the infection by its odor and recommended that I be admitted to the hospital for continuous care to get rid of the infection.  this (below) was at the height of the infection.  about an hour later on Jan 21, 2013 I was admitted to the hospital.

necrobiosis-lipoidica-wound-cellulitis-psudomonas

Like many stories this one hits rock bottom before the happy ending.

READ ON TO PART TWO OF THIS SERIES ON HEALING A WOUND TO NECROBIOSIS LIPOIDICA.