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Why is my wound not healing?

Answered by: Dr. Suneet Sood
Consultant Surgeon,
Metro Multispecialty Hospital,
NOIDA, UP

Q. I am 35 years old. There is a sinus track found in my left leg, left lower limb. It was operated and sent for biopsy and the report shows: granulomatous inflammation consistent with tuberculosis. The doctor prescribed AKT4, Benadon, Esoz 40 and Glynase. My wound is not healing. The doctor says the wound must be kept open but I have pain. There is fluid coming out from the wound. Please suggest.

A.  Biopsy reports are nearly always reliable, and therefore you must presume you have a tuberculosis infection, or a tuberculosis-like infection. The biopsy can usually not differentiate between TB and TB-like. With AKT4 and dressings you should have become better in about 6 weeks. Remember that TB heals much more slowly than other wounds. The doctor is right: the wound must stay open and heal from below. If he sutures it too early, the sutures will probably break down, or, worse, they will heal and the sinus will recur. Are you sure that the wound is not healing? My suggestion:
  1. Wait for another four weeks. Keep your wound clean: I believe that dressings should be done at least once a day.
  2. If you are convinced after another month that there is no healing, consider
    • Resistant TB (more likely) or
    • TB-like infection (less likely).
Get samples from your wound for resistant TB and TB-like infection. The technical term for TB-like infection is atypical mycobacteria, so ask your doctor to send samples to the laboratory for a. resistant TB and b. atypical mycobacteria. I am not sure where you stay, but major laboratories like Auroprobe, Lals Path Labs, Specialty Ranbaxy have facilities for these tests. Very few hospitals will be able to do these tests. Ganga Ram Hospital in Delhi can definitely help you with atypical mycobacteria. After you get the reports from these tests, you will need to modify your medications. The wound cannot heal till the TB goes away.

A.  Biopsy reports are nearly always reliable, and therefore you must presume you have a tuberculosis infection, or a tuberculosis-like infection. The biopsy can usually not differentiate between TB and TB-like. With AKT4 and dressings you should have become better in about 6 weeks. Remember that TB heals much more slowly than other wounds. The doctor is right: the wound must stay open and heal from below. If he sutures it too early, the sutures will probably break down, or, worse, they will heal and the sinus will recur. Are you sure that the wound is not healing? My suggestion:
  1. Wait for another four weeks. Keep your wound clean: I believe that dressings should be done at least once a day.
  2. If you are convinced after another month that there is no healing, consider
    • Resistant TB (more likely) or
    • TB-like infection (less likely).
Get samples from your wound for resistant TB and TB-like infection. The technical term for TB-like infection is atypical mycobacteria, so ask your doctor to send samples to the laboratory for a. resistant TB and b. atypical mycobacteria. I am not sure where you stay, but major laboratories like Auroprobe, Lals Path Labs, Specialty Ranbaxy have facilities for these tests. Very few hospitals will be able to do these tests. Ganga Ram Hospital in Delhi can definitely help you with atypical mycobacteria. After you get the reports from these tests, you will need to modify your medications. The wound cannot heal till the TB goes away.

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