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08/09/2012 10:13 AM

Lance and Pack - Post op care, Healing time, etc..

AoxoA
AoxoAPosts: 20
New Member

Hello-

I was diagnosed with HS this week by a GP. The lump was getting very painful and the Dr. lanced and packed it Wednesday. He wants to see me again on Friday to remove the packing and then replace it with less packing.

Now that i have done some research it seems lancing and packing is controversial. Too late now, its done. It is difficult to find answers to my questions on the web. I would like to hear from people in our HS community.

How do i care for this lance & pack wound? Do i need to wash it, put anything on it, etc.. How long does it take to heal? Should i let him pack it again?

My first time HS at day 7 (aprox.):

Aprox. size measurements:

Hour after lance & pack:

Dressing still moist next morning:

Post edited by: AoxoA, at: 08/16/2012 08:51 PM

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08/09/2012 12:31 PM
CanFizzle
CanFizzle  
Posts: 1470
Group Leader

Hello Aoxoa & welcome to our little family! I would love to hear more about you, if you have time to create an introduction. Laughing

In answer to your questions, I personally have never had a lesion packed. I have had them lanced open but now I feel that as counter-productive. There are ways to force the "alien" (as we like to call them before they are open) to self-rupture without sticking anything into it. Plus you should never use your fingers, as you could introduce a secondary bacteria that would require an antibotic. If you feel the need to clense the area, I prefer regular ole antibacterial soap (like a hand pump) to clense the area & to prevent bacteria. Plus Neosporin doesn't hurt either. Wink I would absolutely keep it covered when it's open (again, so that you do not introduce any bacteria) plus who wants blood/pus to get on their clothing/bedding? Unfortunately, there is no general healing time. All lesions have their own length of time to heal. Some may heal in a week, others could take much longer. I would personally recommend to keep it covered with a bandage as much as possible, but to also let it "breathe" and get some air possibly at night when you can rest your arm comfortably and not let anything near the wound. It's such a touchy area to discuss because so many people have their own treatment procedures... but these are just the ones that I find work best for me. At least in your armpit, you can lay down with your arm open & try to find a comfy position. I have HS on both sides of my groin & on my buttocks, so when I have an open lesion- it's nearly impossible to find a comfy position...ugh.

Anyway we are so glad that you have found us & please ask away with questions! We are not modest here. Tongue <3 Candace


08/09/2012 12:33 PM
CanFizzle
CanFizzle  
Posts: 1470
Group Leader

Also, change the bandage as often as you feel necessary. I found that if you keep the dressing "dry" (well, as dry as possible) of blood & pus, then it's less likey to become glued or stuck to the wound. OMG that is the worst- when you have to peel the bandage off...ugh. Ha! Just a tip I thought I would share. <3 Candace

08/09/2012 01:10 PM
gsantspree
gsantspreePosts: 1108
Group Leader

Aoxoa, hello and welcomed. I think Candace has giving you excellent suggestions. I might add just a couple more. Hibiclense wipes and tea tree oil. Like Candace I have never had mine packed and mine are in the groin, inner thights and bum. I have had some under my arms in the past before I knew they were hs but they have gone down and havn't flared in years just some small scaring and not like the big ones below Sad,

Please spend a few moments if you can and introduce yourself and tell us more about yourself. Also, there is a ton of info in the forum section under treatments. It takes some time to read through them to find what may work for you, but it is well worth it.

Gwenda


08/11/2012 08:42 AM
AoxoA
AoxoAPosts: 20
New Member

Thanks for the advice.

I visited the Doc again on Friday to get the packing removed and repacked.

How do I care for lance & pack wound?

    1. Dr. recommended lots of heat to help break down the lump under the surface and promote drainage. Do this with heating pads, heat packs, running hot water, etc.…as often as possible. I use heating pad while I have my bandaging on to prevent packing-stick (see below).

    2. Don't pull the packing out. The packing is there to keep the incision from healing shut. The idea is for the wound to heal from the inside out. Also, with the incision open, stuff can drain out. If the packing comes out and the hole closes Dr. said he would have to lance it again---which hurts like crazy and lancing has its own issues with the possibility of creating tunnels.

    The blood and gunk that slowly seeps down the packing can dry causing the packing stick to the skin or bandage so caution must be used to avoid pulling the packing out when removing the bandage, etc.... Dr. recommended Vaseline on the packing/wound/bandage to prevent sticking. I put Vaseline on the visible packing, etc…

Do I need to wash it, put anything on it?

    The Dr. said to could clean over the wound opening with hydrogen peroxide (optional). I wipe my armpit and the bump with witch Hazel---avoiding the opening where the packing material is coming out. (I may try the forum recommended tea tree oil to clean the area). Clean all the bits of dried blood/stuff off. I can rinse with water as the packing prevents water from entering the incision.

    I am covering it with bandages, band aids, etc.…and also letting it breath.

How long does it take to heal?

    I did not even ask the Doc because, from what I gather, nobody knows. I got lanced 3 days ago and it does not look like healing is in the cards. When the Doc removed the packing I felt a huge lump still under the surface of my skin. It was not painful like the alien that rose up but it was there. The Doc wants it to breakdown before we stop packing. Therefore, I'll be seeing him every 2-days to pull and repack (not fun). Based on my soiled bandages, this is going to take a long time. The stuff is not weeping out very fast.

Should I let him pack it again?

    I asked this question because of what I read,

    “In North America, after drainage, an abscess cavity is often packed. However, there is no evidence to support this practice and it may in fact delay healing.[3] To try to answer this question more definitely, a randomized double-blind study was started in September 2008 and was completed in March 2010.[4] Interim analysis of data from this study suggests that "wound packing may significantly increase the failure rates." [5] A small pilot study has found no benefit from packing of simple cutaneous abscesses” [edit to include source link http://en.wikipedia.org/wiki/Skin_Abscess]

    Well, I already let him repack it and will probably do so again.

Day 2 showing the packing pulled out some and the side view,

Hour after the first re-pack:

Post edited by: AoxoA, at: 08/11/2012 03:21 PM


08/11/2012 02:06 PM
oregonnative
oregonnative  
Posts: 5757
Group Leader

Hi AoxoA and welcome Smile Those are some of the best pics I've seen for showing what armpit surgery is like. I also had that done with the packing, but it was in 2000 and can't remember a lot of details. All I know is that I eventually had to have an infected cyst, plus the HS lesion and apocrine gland removed before it started tunneling in stage 2. It has not returned since, even though I have another cyst they missed.

I didn't keep mine covered unless it was with a telfa pad with neosporing on it to keep it from sticking. It was just too painful to keep pulling it loose and pulling the packing out a little. The second , more extensive surgery was not packed and it did much better, since there was nothing left to drain. I had taken Keflex for a month before the surgery to take the infection/abcess down.

I refuse to have any HS lesion lanced and drained. In my experience and humble opinion, it only makes the HS react and begin forming sinus tracts even worse nd sooner. Just take the dang apocrine glands and related follicles out and get it over with, is my mantra.

I wish my dr. agreed and that Medicare had sense enough to realize that abcesses and HS are two different issues. Germs in an open lesion cause abcesses....who knows what causes HS?

Thanks so much for posting the pics and showing those who haven't had that kind of surgery what it's like to have one lanced. Wide excision surgery or laser surgery looks much worse but at least it gets rid of the source, at least for some time if done correctly.

It looks like you are still in stage 1 with no tunneling (sinus tracts) so now is the time to stay on top of them and get rid of the offending glands if you get more.

Best of healing my friend,

Karen


08/11/2012 02:23 PM
gsantspree
gsantspreePosts: 1108
Group Leader

Aoxoa, Wow -- you have definately done some research. I love the way you have organized your posts -- very informative.

Since HS is a desease of the apocrine gland and not actually in infection (an infection can be a secondary problem) is it possible that the lump you are referring to is the swollen gland itself and may not go down? Not to discourage you, but this is why many of our hs friends have opted to have the whole gland (and if in stage 2 or 3 sinuses and surrounding area) removed. Hopefully this is not your case and you will not have this problem.

Heat packs are always good and does help to draw out the poison of an infection. From the pics -- it looks like it is a little less red and less swollen than the first pics. Sounds like you are taking care of it really well so please don't get discouraged by not seeing immediate results, if it is healing from the inside out it is going to take awhile. Thanks for keeping us posted and we are here for you.

Gwenda


08/14/2012 07:01 PM
ZippyJC
ZippyJCPosts: 20
New Member

Sorry you have to suffer with this. I have had one lanced and packed years ago, when there was only one. A surgeon did it and at the time I worked for another doctor and they took turns cleaning and packing it for weeks. It was painful but effective because the alien was so big. I haven't had that done again and since have gone through many trial and errors with my HS. Errors were definitley taking Accutane, but I have had 3 axillary surgeries to remove the glands and folicle under my arms, including a skin graft. I think lacning and packing on a small scale is a very effective idea.

TRy the tree tea oil sloution, it's wonderful. I also use Dial & hibiclense. I take tumeric, Zinc and Vit C twice a day and they a;; help suppress my outbreaks (but not eliminate).

Good lukc. This supoort group is a wonderful source of help & encouragement. Keep us posted.

Jenny


08/15/2012 04:09 PM
kycoz
kycoz  
Posts: 24
New Member

Thank you sooooo much for posting this sir! I was just diagnosed with HS today, and my doctor wants to lance and "dig out" the area. Not exactly sure what that entails, but he suggested that he could do it right in the office as opposed to going to the hospital.

I would love to hear what exactly happened when you doctor lanced and packed your lump. Did you have to go to the hospital or did he do it in the office? Sorry if you already mentioned it, I am a skim reader. Lol.

Best of healing to you sir!

Blessings,

Kylee


08/15/2012 08:28 PM
AoxoA
AoxoAPosts: 20
New Member

Glad this post helps others. I am glad we have a place like this.

I have not found a suitable bandage set up. It's a play between arm-down or extended. I like what they use at the doctor office and I will try to get the specifics next visit (this Friday). Fortunately I am not working and go most of the time with my shirt off. Sleep with my armpit open, etc..

It was repacked Friday and then on Monday. Next one is Friday.

What exactly happened when your doctor lanced and packed your lump?

    It's an in office procedure. Before the doctor visit, I shaved my under arm with an electric razor.

    First they gave me a heating pad and waited until the heat made the lump softer. During this part they shot an antibiotic in my butt-cheek. I also have been taking antibiotics by mouth a few days before this (and continue to do so).

    The Dr. supposedly numbed the area with a topical solution and used a scalpel (blade) to cut a slit in the lump. It was very painful, like a bunch of fire ants painful. It was so painful I did not think the numbing solution worked or he should have reapplied it as he was cutting. But, you can get through it……be strong.

    I am sure blood and pus oozed out on its own and he squeezed some out too.

    Then they get a long strip of “packing”. I can't remember if they squeeze some numbing agent into the wound at this point (but maybe). They use some tool to work the packing into the incision. This did not hurt as bad as the cutting. After that cutting business, this was a welcome discomfort. You just sit there and endure the packing. No problem, you can do it, especially after dealing with the cutting part.

    After it's done they put some goop on and bandage you up.

Getting a repack, what's that like?

    I complained about the topical numbing solution being weak or out of date for the original incision. Haha, so he decided to get a different kind. He brought in a long needle to inject the numbing agent. I said, “Man, you are kidding me?” The doctor said "ok, I'll take the needle part off." He put the plastic part (that the needle connects to) into the hole. It burned just a bit before numbing. Repacking was still uncomfortable but doable.

As you can see from the following pics, healing is going slow. The lump is still large (to me) 8 days after the lance (maybe due to the packing). I fear the future. This is the first time anything grew so large and painful. A few days before this one started, I had a small lump under the other armpit. I thought it was a boil and squeezed it so hard I felt it crush. It went away.

Post edited by: AoxoA, at: 08/16/2012 10:28 AM

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