question about wound undermining and tunneling

[fiffy]

My patient suffered from a wound tunnel of more than 6.5cm in length.

I have been treating him using mesalt for more than a month and there is no sign of the tunnel healing. In fact the condtion is much worst, it was less than 5cm one month ago.

The hospital have issued my patient with antibiotics but the medication does not seem to do anything. The doctor simply told him to wait for the flesh to granulate, but unfortunately it does not.

1. what other products should I use?

2. what other better treatment option is there?

3. should I advise my patient to go for MRI scan?

4. what are the chance that he would have to go to another operation?

I have been seeing this patient almost twice a week for more than 4 month, and everytime he is in pain, cant really bear the pain if he have to go to another ops.

5. is there anything that can help speed recovery?

I already recommend he get zinc + vitamin C tablets and he is also drinking at least 2 glass of milk a day.

6. Although unsure I think the tunnel may have reach bones, if so what should I advise the patient to do?

[XB9S, BSN, MSN, EdD, RN, APN]

I think with a wound of that depth, an MRI would be indicated, depending on where the wound is there may be an underlying cause of failure to heal and it would be good to exclude any oestiomyelitis.

As far as encouraging wound healing, nutrition is important so maybe some nutritional supplements depending on what your patients diet is like, a referral to a dietician wouldn't go amiss either. I'd also want to exclude infection, did the hospital swab before giving antibiotics it's worth ensuring that they are treating the right bug

Is it worth going back to the doctor and discussing your concerns, if you've got a non-healing wound that appears to be progressing then surgical intervention may be indicated.