This afternoon I had my second appointment at the wound clinic.  It was supposed to be with Dr. Lannigan, the doctor covering for Dr. Livingston while Dr. Livingston is on vacation.  Instead, the PA, Charles Thomas, showed up.  He didn't talk much.  He took a look, and said there was still too much dead tissue in the bottom of the wound.  He said that I can't use a VAC device as long as that dead tissue is in there.  It wouldn't work, just as suturing won't work.
 
He debrided it again, pulling little chunks of me out.  That hurt, a surprising amount.  It's very strange, the constant contrast in that region between pain and numbness.  I suspect most of my pain must be coming from the lower wall, where the skin wasn't separated from the fascia and nerves weren't cut.  But a lot of what he did today was above that line, and I had a lot of discomfort.
 
When he was finished, he said there was still a "shelf" of dead tissue on one side.  I think he was talking about the little tunnel I've seen that appears to be following the vertical incision line.  He said (to the nurse, more than to me) that he would have to use anesthesia to get it all out because it was hurting me too much.  (Nice of him.)  So instead, he turned to a chemical debriding agent, an enzymatic ointment called Accuzyme.  The enzymatic debriders work sort of like hydrogen peroxide, dissolving tissue, but I think they are a little more selective in not killing off healthy tissue like the hydrogen peroxide does.
 
The new dressing also includes a new material called AccuGel.  This is pretty cool stuff.  It looks like a little thin square of fiberfill or fiberglass, all fuzzy.  But when it gets wet, it turns into this gelatinous goop.  It just barely holds together enough to be pulled out for dressing changes, but it also provides this very moist, fairly airtight environment for healing to take place.  So for the new dressing, instead of packing with cotton gauze soaked in saline, I pack with AccuGel smeared with some Accuzyme.
 
I go back next Monday to see if this is doing any good.  Right now, I just hope I make it that long.  It was sore when I left the clinic.  Of course, it hurts more and more with every single visit.  But at this point, I have to say it hurts as much as it did when I had the original surgery.  Driving home after dinner, it hurt just to move my foot from the gas to the brake.  I got a script for Tylenol 3 today, so I'm using that instead of the Vicodin tonight.  Ouch.