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I had three surgeries this summer, the last surgery was 11 weeks ago. The incision is small, about 2 inches, and started to heal fine at one end. The other end rejected 3 stitches which were pulled and drained for 3-4 weeks. Since, the wound has been healing very slowly (it is still bleeding slowly and is open). The surgeon has said that it is progressing the entire time, but progress has been very slow. They recommended me to a wound care office.

Yesterday at the wound care office they treated the unhealed part with Silver Nitrate and prescribed a silver based ointment to put under their bandage.

When I pressed the doctor on what was happening that slowed the healing process and required the nitrate treatment, she wouldn’t give any specifics. She only said “the wound has healed too much, and now it can’t heal anymore without knocking it back first.” I asked for more details and got a similar response back.

Can anyone give me some clarification as to the biological process going on and what the nitrate treatment is supposed to accomplish?

Thanks

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“the wound has healed too much, and now it can’t heal anymore without knocking it back first.” I asked for more details and got a similar response back.

Talking to patients is an art. This doctor lacks that art to some extent.

Wounds left to heal on their own - without stitches - heal by secondary intention, that is, the wound fills in with a temporary tissue called granulation tissue. The best outcome is that enough granulation tissue is laid down to cover the wound, then, within the tissue, the normal components of skin, such as epithelial tissue and blood vessels grow.

Epithelialization and neovascularization result from the increase in cellular activity. Stromal elements in the form of extracellular matrix materials are secreted and organized. This new tissue, called granulation tissue, depends on specific growth factors for further organization to occur in the completion of the healing process. This physiologic process occurs over several weeks to months in a healthy individual.

However, this is somewhat of a "dance" dependent on how much of what kinds of signals the injured tissue sends out, and sometimes the granulation tissue grows too much, and actually impedes the process of epithelialization. In that case, the excess granulation tissue (or even all of it) needs to be removed so the process can start over (the process is dependent on the right amount of the right signals (e.g. growth factors).

This is what was meant by the doctor.

As to why silver nitrate was used, it destroys granulation tissue, but so does just picking it off and other methods.

Your wound specialist really should have this talk down pat enough to give the answer in under a minute. But patients ask questions, and time is getting shorter and shorted for doctors to spend with patients (blame insurance companies for that.) So one way to save time is to avoid answering questions. You'll heal just as well without the information, but it doesn't engender much trust in the doctor.

Wound Closure Technique

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    At my second visit to the wound specialist, I asked them specifically about granulation tissue being the problem. The PA was kind enough to confirm what you're saying here, especially about the excess tissue being the removal target. I think @langlangc was after the same idea with hypergranulation, but your explanation of the "dance" is a more helpful answer to my question about the biologic process. Thanks! – voxobscuro Sep 21 '17 at 18:36
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What is reported here about the "wound care specialist" sounds like being either badly phrased by the doctor or misunderstood, misremembered or phrased rather unluckily by the OP (no offence, just speculation).

Whatever the reason for this unsatisfactory status of explanation: This treatment is likely not focused on the nitrate part of the formulation alone.

Silver nitrate is likely employed to help with the healing process. Quotes from the links:

[#] Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues.

[#] Whether it is used as a topical ingredient or a dressing ingredient, the use of silver in treating wounds has been around for quite some time. Silver has an array of beneficial effects in promoting healing.

[#] The use of silver nitrate application reduce dramatically the size of large wounds, which eventually healed, avoiding the patients to undergone surgery.

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    No offense taken. Thanks for the links, I’m assuming that hypergranulation tissue is what they’re treating. This at least gives me a starting place for understanding what is going on in my body. – voxobscuro Sep 13 '17 at 22:28
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    @voxobscuro Just fyi if you're having delayed healing, make sure you get checked for diabetes etc and stop smoking, those are 2 major causes for delayed wound healing. – DoctorWhom Sep 14 '17 at 3:36
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    @LangLangC great answer, but OP is also asking about the delayed healing. Perhaps add a bit on that. Welcome btw, thrilled to have you here, great answers so far! – DoctorWhom Sep 14 '17 at 3:39
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    @DoctorWhom thanks, I think that’s good advice. I’m not a smoker (of any kind) and I believe I was checked for diabetes this summer along with a bunch of other endocrine and immune system tests. I’ll verify that though. – voxobscuro Sep 14 '17 at 4:18

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