Husband leg infection being almost ignored (disgusting pics included)

[NOTSUREWHATIMDOINHERE]

Hello

So been at nurse 3 weeks in row. Had leg infection for 2 weeks antibiotics not working and it's now worse. Smells. Pain so severe he cant walk so will be off work now! Nurse just dressing it and sending him away after asking gp to prescribe 2nd set of different antibiotics after 1st set that was supposed to be the right ones for that infection did absolutely nothing to help him.

What would you do ? We are worried, he can't get about its horrible. He had a venous ulcer but this was due to that part of the leg getting bumped and all of sudden this infection gets worse , he was hiding it from me !

Thanks. Yes its 2 nurofen express alongside 2 paracetamol currently.

I’m not so sure it desperately needs IVABX as everyone seems to think.

It’s now an ulcer secondary to the initial trauma of the bang to the leg. The wound bed looks like clean, pink epithelial and granulating tissue. It looks as though it’s healing. But it’s going to take a very long time due to the vascular problems going on in the leg.

He needs to see a tissue viability nurse in the first instance and get a lower limb assessment including Doppler. He then needs that wound cleansed and debrided and an anti microbial dressing placed in the wound. He needs compression to help the underlying venous disease otherwise it will never heal. He can also request a dressing with ibuprofen within it which can help with the pain.
If you get no joy, you can order dressings yourself and self care.

This issue is classed as "harmful" he is not getting guideline care so I would kick up a fuss and ensure you get a referral to tissue viability and use words like harm and complain.

I work in wound care and loads of people are in this situation ands it avoidable which is a real shame.

Best of luck

Also when you get back in touch with GP ask for a prescription of codeine for the pain in his leg. The more elevated it is kept will reduce swelling but if he has dopplers and it is deemed compression bandaging is needed, this can also help keep the wound more comfortable- although it sounds counterintuitive. The wound needs a full review by a GP and/or specialist nurse and a treatment plan put in place, including analgesia.

Hope he can get some actual care soon, I know services are overstretched but this is dreadful that noone (apart from you) seems to be even making an effort to get this sorted.

Thanks looks like this now. What do you think ? Extremely painful but I'm wondering of infection gone...@

That looks a lot better. A lot calmer. He needs to get it bandaged properly now and elevate it as much as possible. Can he take time off work?

Thanks ! Yes he is taking time off, the whole week.

Another vote for tissue viability and dopplers. Also, is he known to be diabetic? If not, would be worth checking that too.

That's good! Get those legs up as high as possible for as long as possible.

Is it as grey as it looks in the photo OP?

Yes and the ulcer part is a little less red than the pic.

I still don’t like the look of this, especially with the amount of pain…. I’d be back to A&E and refusing to leave (ex-nurse).

I’ve got no medical background but it doesn’t seem healthy to be that grey colour. Hopefully a doctor or nurse on here can comment on that?

Yes hopefully one of the ones that was commenting earlier will come back and see updated pic and give some advice. It looks worrying to me but I also have no medical background.

Hi OP, I’ve just read through this thread. That grey area around the wound appears to have come on suddenly and I’m very sorry to say looks akin to necrotising fasciitis so I would want that ruled out. He needs to go back to A&E tonight

The discolouration is "normal" in the context of him having venous insufficiency.

That's a relief! Why wasn't it that colour the other day tho? And why is he in so much pain?

Not this level of discolouration with such rapid onset

Wound healing can be an absolute bastard
I had an incision and drainage in my armpit and ended up with an open wound for 9 months. They tried everything including honey and also silver nitrate which I couldn't tolerate

Month 10 I cried at the doctors because my skin was so sore from dressings, I felt like I smelt as I couldn't wear antiperspirant, everything rubbed under my armpit
Ended up having a skin flap done

But I get the frustration, the dressing clinics were on when I was working, I wasn't told I had to buy my own dressings, rules seemed to change weekly... even organising it in the first place

Do you have a medical background @Evergreen90?

He needs regular paracetamol 1 g 4 x daily plus regular codeine 60mg ( 4 times daily ) plus oramorph when required eg for dressing changes and prob every 4 hours .
His doctors are being very mean with pain relief!

Venous ulcers are incredibly painful!

Nothing helpful to add but my goodness, your poor DH. What a state the NHS is in if we're having to figure it out in here rather than your DH getting any suitable care.

Hope he's much better very soon.

The grey purple discolouration represents skin changes or chronic venous insufficiency . It is not ischaemia/ necrosis or anything acute / worrying. The ulcer bed looks really clean and from this picture this does NOT look infected or sloughy. There is no cellulitis.
He does not need debridement etc and I wouldn’t be doing dressing changes more than every 2 days as it will be painful and unnecessary.

He need high elevation and full compression and enough pain relief to allow him to get the leg up. The reason it is so painful is that it is superficial and there are many nerve endings in this layer of skin.

He will need 3 weeks off work minimum and then need a phased return with his leg up for much of the time. If he doesn’t get the leg right up it will continue to deteriorate.

I am a vascular consultant and see complex leg ulcers frequently. Feel free to ignore ! I am only posting as I could see so much wrong advice being given in this thread.

I would call the practice manager tomorrow and kick up a massive stink about the lack of nursing care today , inadequate pain relief prescribed and the fact you were told to stop compression which was absolute the wrong advice and has caused the further deterioration.

Absolutely agree with this assessment.

Thanks this is great advice, really appreciate this.