Following the surgery (my third), Dr. Carbonell was very happy.  He said that we had caught the new infection very early and that they suspected that the bacteria we were still dealing with the gram-negative rod bacteria.  He packed the wound with a fabric made of silver that resists bacteria and keeps the wound dry.  He said that much of the skin around the sutures had died during the time from my discharge the night before and my return to the hospital the next day (yikes!).  Therefore, they were going to allow the skin to die away on its own, cut it off, and eventually skin graft new skin to cover the open wound.  In the mean time, the wound would remain open (can you see the hardware that was screwed in during the second surgery under the dying skin??). 

He let us know that the wound not only needed to drain, but that they needed to encourage tissue growth from inside the foot.  Therefore, within the next few days, a “vac” would be attached to my wound.  Basically, they would cut a sponge in the shape of the open wound, seal off the entire wound with a sheet of adhesive, and then insert a small tube into the sponge.  The tube would be attached to a “vac” that would provide constant suction to the wound.  Not only would drainage be sucked out, but the negative pressure would also encourage blood flow and tissue growth around the site.  The vac will actually encourage tissue to grow from the inside of the wound and grow in and around the hardware installed earlier.  When new tissue has filled in the entire wound and the drainage has stopped, they will skin graft on the new skin.

He assured us that he would not discharge me from the hospital until the infectious disease doctors and he were convinced that the infection was under control.