Advice for non-healing perianal abscess after 4 weeksM

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My friend's elderly mom is a diabetic who had a perianal abscess drained about 4 -5 weeks ago in another state. It was packed and changed daily for a while but is not healing well. The poor lady sometimes refuses to get out of bed and walk, and is becoming withdrawn, even had a few instances of stool incontinence due to this. This makes her not want to eat. The main problem from her perspective is pain. I was concerned about the length of time and its still not healed, might lead to a fistula. We feel she is going to lie down and die because of this!

Any wisdom for us? I have a critical care background so they ask me lots of questions, but honestly, I'm a bit out of date on these issues now. I feel the healing should be managed more rapidly and aggressively due to the impact on her daily life.

1. Can't she be given topical or local pain control instead of pills that make her mind foggy?

2. Can more be done to heal the wound? Can it be closed with surgery? Fibrin? Is negative pressure possible or helpful? I know there is much more to be done now than in my day. I hear about growth factor, is that a new treatment?

3. I feel (from what I hear second hand) that her care is fragmented. Has anyone heard of hiring a case manager to oversee all the different home health people?

Would appreciate wisdom from the wound care nurses.

Thanks,

Hummy.

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Anyone out there? Guess I will take my question to the general forum.

Hummy.

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Specializes in ED, MS, CC.

I think we need more information is she diabetic? able to walk? whats her medical history? I work in a long term acute care hospital we get patients like this every day, they stay an average of 21 days, and get b.i.d dressing changes, with iv antibiotics consulted with infectious disease so usually its 2 different antibiotics 1 iv 1 po , we also have rehab that sees the pt usually 3 times weekly, so without her history its hard to determine, perianal abscesses are the longest healing wounds sometimes taking up to 12 weeks to heal and smelling like forgive me but-god awful, they require

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Specializes in Advanced Practice, surgery.

Unfortunately without actually assessing the wound and underlying medical conditions it would be very difficult to give advice. I think the best advise would be to discuss your concerns and suggestions with the health care provider.

Because it's against the terms of service at allnurses to give medical advise I am going to close this thread

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