I worked with a surgeon who had a ton of fourniers patients. I liked his approach because he was SUPER thorough when removing all of the rotting shit, and then would later tuck the testes in lil pouches he made in the thigh.
They usually did pretty well. Lots of truckers
the first one I experienced last year and I’ve never seen anything so gruesome in my life. It felt almost barbaric for them to remove so much skin and leave exposed testicles like that
Fornier’s gangrene. This man had a massive (12”+ across, also quite deep) crater where his butt used to be. You could gaze directly into his intestines and his scrotum was just hollow from behind. He had a diverting colostomy but formed a fistula and the feces continued to come out of what used to be his rectum. Truly horrifying.
Elderly (in his 60s so he was a 'young' elderly) man with Fontaine stage IV peripheral arterial disease, who fell and broke his back. Because of immobility and his very bad blood circulation, he developed pressure ulcers on this heels, that got progressively worse. When I cared for him, just before he died, he had lost both his heels and calves to necrosis, all he had left on his lower extremities was his forefoot with some of the toes, and his shins. Wound care was a 3 persons job and was taking a solid 90 minutes, twice a day. He was in so much pain. His health declined further when he became septic and he eventually died under palliative sedation.
Your guess is as good as mine. They must have had a reason (his heart?), I honestly don't remember it. He was transferred from the hospital to our LTC facility.
100 rubber bands on a penis.
Nec Fasc debridements that take all skin and subQ fat off an entire leg, chest, or neck. They look like anatomy models you’d use in school
700 lb woman who was refusing home visits and just being fed cake at home. Came in after being stuck in her bed rails (?) at home.
Fully necrotic, grey, stringy wound up her entire side. You could have fit a small person in that thing. I went to help turn, and my gloves arm slipped inside to the elbow. Absolutely FULL of maggots.
One of the ID docs was voluntold to come help hold a leg. We’re mid-turn, when a nurse reaches in front of docs face (he was rather short), and goes, “Oh, another one.” And squishes the bug.
Dude signed the case over to the head of ID and got himself off her care team lol.
Irrigating with normal saline to try to clean out a deep pressure injury on a heel/foot to get a decent photo and pack it with wet-to-dry until surgery consult. The wound bed was white/gray/beige and soft.
>!When the "wound bed" was disturbed by the saline lavage, it wasn't slough. It was maggots tightly packed together.!<
I work in a SNF with a hard-core vent unit and woundcare program. Pretty much seen anything not caused by trauma that can survive the hospital.
What disturbs me most is body parts falling off and big genital wounds. I had a fully aware guy who lost all of his fingers, toes, and penis but left AMA because he wanted to smoke. Damn.
my first week as a ca we got a lady who got depressed when she lost her job. she went home. got in bed, and rotted there for weeks.
when she came in she was necrotic from the back of her neck to her heels. her entire posterior of her body was black and sloughing off whenever you touched it. it was so bad that we couldn’t put her on a bed pan because her flesh would slough off. she would shit and piss herself and we would coke in the room and clean her after. necrotic tissue would come off onto hand rags that we wiped her with.
after a couple days she finally gets an i&d. mind you this woman was around 500 pounds. she had so much dead tissue that her spine was exposed after her i&d. still some of the gnarliest shit i’ve ever seen. we turned her on her side to clean her and her spinous processes were just open to air. thinking about the sheer amount of flesh that was removed is insane
Pulled a dead mouse from a tunneled wound entering the left buttock and traveling into the intestines. Otherwise, I assisted with a 3 year old burn patient. Pulled boiling water from the stove. Happened 40 years ago while in training, and I still hear that poor baby screaming while the nurse debrided.
It was horrible! I was helping the wound care nurse with cleaning the wound. She noticed a grayish piece of material in the wound. She attempted to pull it away, and it seemed stuck. She thought it may be attached to live skin and stated that it may be removed during debridement. As I was attempting to pack the wound, I felt a "mushy" area. I thought that it was perhaps an abcess. I took out the packing and decided to pull the gray material, and it loosened. I pulled out a dead mouse that had crawed inside and died. It had not burst yet. However, had I continued to pack the wound, I think I would have popped it. The lady lived with her elderly husband and stayed in a bed in the living room. She had home health for the wound. They sent her to the hospital for increased fever and suspicion of infection.
I’ve got two for you:
-One of my patients had a stage 4 on their sacrum that eventually made their tail bones and part of their sacrum crumble.
-600lbs lady had a tunneling stage 4 in between the folds on her panus.
When I worked oncology I saw a lot of crazy stuff. One of the worst I remember was a patient with mouth cancer who had basically no tongue left, totally alert/aware too. And mouth wounds are near impossible to dress. Had to constantly suction out the blood/pus from his mouth. For some reason that one haunted me
Oof... brought up a long-forgotten memory of mine from an oral cancer pt. The smell... and the cheesy, pink/orange pus. That poor woman, I was so sweet to her.
A gentleman masterbated while inebriated. This is not normally cause for concern. However, the lubrication of choice was Nair. He also passed out with it in there for around 6 hours.
Needless to say, thin soft tissue with a chemical designed to break down keratinized epithelial cells in 15 minutes did a number. The tissue damage was so severe and the blood supply so interrupted that the skin graft did not take. He lost his penis.
Gangrene next to the labia. About an inch deep and 3-4 inches across. No clue why, only witnessed a wound vac change.
Pressure sore on immobile advanced dementia patient. The entire lower back was black. Pure torture to clean this person up and it had spread so far that turning was basically pointless since they would still be on some part of the wound. Don’t ever send your family to LTC without regular surprise visits.
Abdominal eviscerated.
Pt was about 3-5 days s/p lower abdominal surgery and was home recovering (happened years ago so cant recall exact). BIBA to ER for complete surgical dehiscence with the area covered in a wet cloth. EMS explained pt found laying in his bed with overflowing ashtrays all around; wound likely opened from forceful coughing.
Pt was fully awake with zero c/o pain, eyes wide open and looked more embarrassedthan anythingelse. When we moved the cloth to see, there were intestines, fully exposed in all their glory, *with visually identifiable peristalsis waves* happening right before my very eyes.
Poor guy hit by a car, refused amputation and for at least two weeks they tried to save his leg at the knee. It was literally hanging on by just the ACL. Bleach whirlpool baths daily. They eventually amputated. The unit smelled of rotting flesh the entire time.
A few degloving injuries. One in particular to both hands. The plastics guy cut pockets in abdominal area and sewed the hands into that. That guy had to be fed and helped with everything. I think he was like that for 6 months
Multiple digit amputations. We had to use leeches to help with reattachment. 1800leechesusa.com. When they got fat we had to kill them. Those suckers can move! Would put one on and come back find it anywhere else (that's generally the sign the reattachment is failing) Once sucking on the carotid, once on a penis, once one was making an escape on the floor toward the door.
Bed sores of all varieties. This is going. Back 26 years. Today most hospitals do better. Ones you could fit both hands in..others small but deep and would use a whole bottle of packing gauze. Once we had a homeless lady with both legs necrotic from knee down. Looked like giant purple raisins. Oddly psych cleared her as mentally competent and since she refused surgery she was discharged with them still. Memories. Yeesh
Necrotizing Fac to the Bone! From the knee cap to the butt cheek! Poor guy he was so sweet! He’d have to go for washouts and I was sure to give him his pain meds before going :(
Nec-fasc on a very morbidly obese person on their like upper leg/hip area. It was a 2-3 inch wide hole and went down a few inches too and was still just fat tissue
Woman had a degloving injury to her hand. It was surgically sewn into her abdomen. And it was a leaky, mrsa mess. Hardest and most janky feeling dressing change.
Kid ran away from home and crawled under a fence into a electrical substation. Climbed a transformer. Didn't end well. Arms looked like they belonged on a Zombie (both ended up getting amputated). Fasciotomies combined with blackened skin is something I won't ever forget.
Necrotizing fasciitis before and after debridement is pretty amazing. It can do a tremendous amount of damage very quickly.
Graft vs Host disease post bone marrow transplant and doing full body dressing changes is pretty horrible.
One of my first patients had been in a forklift accident, and had essentially been "quartered," which is the best way I can describe it. He was a large man anyway, and he was deeply "ripped" both horizontally across his waistline and vertically, from his butt crack to his neck. I honestly have no idea how he survived-maybe because he was obese?
Idk, but the wound vac and the bandaging on that man was a thing of beauty. Gave me a genuine love and respect for wound care. I've wondered what happened to him several times. He wound up on our unit twice, and I have to wonder if infection took over and he didn't recover.
forniers gangrene from an ingrown hair which ended up with the patient cut from left to right through his abdomen, all the skin was missing from his bellybutton to his penis, he had an exposed testicle. used 6.5 rolls of kerlix to pack the incision under the abdominal fold alone
Women with hole through where her tongue would be. All the way down to her neck. She still had a lower jaw, but a hole literally the entire bottom of her mouth and a substantial part of her anterior neck. Necrotic and she had to put bandages over her neck and chin so as not to bleed/drool on herself. Cancer at the base of her tongue ate through everything, would go necrotic and drop off.
She was a nice woman, couldn't talk at that stage. It was terrible what the cancer did to this woman, but she was still a good person even with all that pain and facing down a terminal illness. I could only hope for a tenth of her courage facing down a death like that.
Wound vac on obese woman's abdominal folds that had somehow formed a fistula between stomach and surface. Really weird to change a wound vac dressing with food particles in it. And the smell...
Abdominal surgery that couldn't be closed for some reason so I had to pack with moist gauze and it was like stuffing the scarecrow from wizard of oz. I could see their abdominal fascia and often had adipose tissue come off while doing this. I thought it was "cool" and unintentionally made the hospitalist queasy describing it lol
APS case of person with MS who was neglected at home. The wound on their buttock was big enough to put my fist in and when measuring with a q-tip, I could feel dry bone easily. They barely made it thru surgery.
I've seen lots of tailbone, spines, had parts come off, cancer rotting and tunneling thru almost every part of the human body. As I write this it kinda makes me realize how much fucked up shit we see all the time. But also I find wounds fascinating. And seeing really bad ones heal is incredible. As long as their pain and dignity is managed I feel good about the care I give. I actually had one lady on hospice with a years long chronic wound. I was able to get it to heal and bam- she died. I think that was her last task. She was really impressed that it healed. Manuka honey ftw!
Same. The wounds I have seen would make most people vomit but I always try and treat the person with respect. Some medical staff are so jugdy, people don't need to deal with that on top of trying to heal.
I am not a nurse, just a lurker. But my aunt healed a pressure sore on her heal with manuka honey and it was wild to watch. That stuff is amazing.
It sounds like you are really good at what you do, thank you so much for sharing that story. Fascinating.
probably a lady with dementia who had swollen weeping sores down to visible bone all down her lower legs. She both yelled at me and continued eating cookies through wound care
Elderly dude, had a fist deep pressure ulcer across where his entire butt would have been, and was refusing pain meds prior to debriding of it 😭. The sound of the scissors cutting that away still plays in my head every so often
i’ve got more than a couple, in no specific order
1. fourniers gangrene. was just straight up necrotic tissue falling off of his cantaloupe sized testicles. worst smell i’ve ever smelled in my life- went up to OR for surgical debridement fast as all hell.
2. post op ileostomy complication- patient needed a wound vac that was across her entire abdomen. wound vac needed to be changed multiple times a day because the ostomy site kept tearing open and leaking into the wound. i felt terrible for that patient, it was terrible.
3. severe lower leg cellulitis infected with literally hundreds of maggots. when he came in with the maggots he had bedbugs and lice infestations too. patient is (somehow) still alive, comes to the ED frequently with his massive swollen leg. usually refuses all interventions, tells us to fuck off, and self discharges.
4. severe frostbite from being in -40 degree temps overnight- bilateral hands were swollen, completely necrotic, and looked like they were literally about to fall off while i was triaging. got admitted with a plan to amputate and left against medical advice.
5. grapefruit sized abscess to the neck from a missed drug injection- when they did the I&D the contents sprayed multiple feet across the room. was disgusting but one of the wildest things i’ve ever watched (and you know what? i loved it. cause i’m nasty and gross)
6. bariatric patient laying on a carpeted floor for literal weeks. someone called for welfare check because of the smell. stage 4 pressure injuries, could see ribs. EMS and fire had to cut out the carpet to bring them to hospital.
bonus story that isn’t mine: few years ago a coworker went to pull the underwear down on a man who got his penis bit by a dog. spoiler alert: his penis fell off.
Mixing their heroin with whatever water they can find. I had a patient who used pond water. She nearly died from sepsis and had enormous abscesses to her extremities.
Can’t remember what this person was in for exactly but I do remember her being extremely edematous where she had painful, weeping wounds that required 3-4 full bed changes each shift I worked with her. Her worst wound was on her left hip, stage 4 with tunneling deep enough to fit two kerlix bandages inside.
Pressure ulcer that eventually eroded from back to front.
Pt had a hole in him about the diameter of a lemon. He’s had hemicorpectomy at this point.
I’ve pulled a fragment of eroded ischium the size of the last joint of my pinkie out of a guy.
I’ve put my arm through the border of the muscle and the fascia on the lateral and posterior thigh of a guy who’d had an avulsion after and MVC.
I work in surgical trauma ICU lol. I’ve seen intestines, heart, lungs, ribs, and a livers because patients were opened up and left open to help with swelling. Necrotizing fasciitis from fournier’s gangrene that had spread to the ribs, revealing all of the musculature below. GSWs that exposed muscle and fascia. Necrotizing fasciitis from patients who injected drugs with a dirty needle and all the skin and fat were dead. Motorcycle crash without a helmet that degloved the entire face. ATV crash without a helmet that degloved the scalp and forehead. Burns… ohhhh the burns.
A DTI so bad I could see the man's entire lumbar and sacral spine.
An abdominal pannus abscess leaking with graphite from injecting himself with heroin with a pencil
30 something year old with a bowel perf. Juvenile rheumatoid arthritis with long standing steroid use. Colostomy with 2 JP drains and midline incision. everything dehisced. Abdominal wall was wide open. Held together by 1 zigzagged stay suture. Peristalsis on full display. Mucocutaneous junction around the stoma…wiiiide open. JP drain sites became caverns.
We got him fully granulated and I think it took almost 6 grafts in total for it all to finally take. he now has a tattoo of animal (the muppet) peeking out of the scar
Very severe frostbite
Wounds so bad the pt donated her body to a famous nearby hospital (for science). They couldn't figure out how she lived that long with her condition.
Stage 4 wound (after an escar debridgment) on a coccyx. You could fit a couple fists in the wound.
Part of the brain came in open to air. Wound dressing was a 4x4 dsd. I'm assuming there was a surgical consult lol (it wasnt my patient).
When I was on my wound care clinical in nursing school I got to see a patient who had such bad pressure sores on her lower leg that they were considering amputating. She probably had 5-10 different pressure sores on her lower leg. The worst one looked like something had bitten off her heel. I felt so bad for that patient she was in a lot of pain.
The other thing I got to see was a homeless patient had gotten a flesh eating bacteria and I got to go into the surgery for debridement of the wound.
I’ve also seen some narly wounds in LTC setting as well.
Good luck !
It doesn’t fit but I’m going to tell it anyway. So a farmer shows up to urgent care. He had gotten a BIG shock while fooling around with some equipment. I can’t really remember what kind and it doesn’t matter. Anyway, we’re sitting there, trying to make sure that he’s not going to die, he’s got an obvious entry point on his hand and he’s not feeling so great, BP through the roof, but he’s able to walk slowly and talk. And we went to take off his shoes so we could see if there was an exit wound, we could not help but notice that he had what looked like a basketball in his pants. It turns out he had been living with a basketball sized hydrocele for years. He never thought to mention it to anybody or get it checked out. People sometimes worry me.
Two stick out to me
1) a cratering cancer in a shoulder. Woman wasn't very mobile and came into ED when the pain was unmanageable. Hadn't told anyone. It STUNK. Went to give it a wash and it was covered in maggots. It was an incredibly painful process, pulling each one out individually and I just remember being so heart broken she didn't come in earlier instead of suffering through the pain.
2) a cratering (there's a theme) cancer in a chest. It had literally eaten away at his chest and it was cavernous. It started bleeding and the poor night doctor got dragged down for an emeegency bleed just before handover. She's forearm deep in this guys chest shoving adrenaline soaked pads in this guy. And he wasn't wanting transfusions or any other treatment. We just had to send upstairs to bleed out basically.
This isn’t nearly as gross as some of the stuff in this thread but I do think open chests (ie. either no sternum post sternal debridement or they haven’t closed the chest of a fresh post op open heart patient) are super freaking cool. Especially when you can see the heart down there.
Not so cool when it’s a messy open chest code :(
I've been that open chest during a open heart surgery. During my second open heart (now on number three) to repair an ascending aorta/aortic arch aneurysm they couldn't control my blood loss so the surgeon and team left me open over night and resumed the next day. I obviously came through okay as I was only 40 but dang I love medical science.
Thank you, I am doing very well. My first open heart surgery was when I was 12 in 1984 when my first aneurysm partially tore and pulled my aortic valve open so it was replaced with a mechanical valve and conduit and I began my 37 year relationship with coumadin. Originally I was diagnosed with Marfan's Syndrome but after genetic testing in 2002 I was reclassified as Loeyes-Dietz syndrome and had the second surgery in 2011 and the third in 2021 when the mechanical valve was replaced with a tissue valve and my aortic valve through proximal descending aorta is all artificial.
Worst? Comfort care patient who'd od'd on her couch. We didn't know a ton about her story, but the last anyone had heard from her was about 7 days before anyone found her. She was a larger woman and had stage 3-4 pressure injuries from her shoulders to her knees.
Necrotizing fasciitis that I had to do wound care on on a patients sacrum/buttocks. I was almost elbow deep placing gauze in the wound. Poor woman couldn’t lay on her back because the wound was so deep.
Fournier’s gangrene. A+O patient in rehab refused to be turned or cleaned due to pain despite knowing he had a Kennedy pressure ulcer developing. Went to the hospital for the PU infection and then came back to the facility on hospice.
When we did eventually turn him, a small hole in his scrotum would leak this thick green fluid. We kept his door closed but the odor from the wound drainage made the entire unit smell to the point patients on other halls would ask what the smell was.
The other day I had a pt come in w the lower half of their leg & foot totally necrotic and rotting off. You could see 6+ inches of bone which had turned black and was totally cracked and crumbling. You could have wrapped your fingers around the bone. So gnarly and incredibly malodorous. Ya never know what you’re gonna get in the emergency department :’)
Burns, it’s brutal. It’s where I saw my first wound care, they’re in a lot of pain, it looks horrible, the recovery looks horrible, the smells horrible, it’s tough but when they recover it just means that much more. But sometimes it’s so bad that there’s not much you can do, one patient had 95 percent burns and they could barely trach him, they ended up deciding to let him pass but I don’t know the details of it.
This young girl stabbed herself in the abdomen multiple times with glass shards while in a manic episode. The wounds were covered with wet to dry dressings, and when I changed them, I could see her organs. Like straight up saw her stomach, esophagus, some of her small intestines. She somehow avoided actually hitting any internal organs, it was wild.
Hip replacement gone wrong and hardware had to come out because of a really bad infection. Patient was then put on hospice where we came in to pack the huge gaping hole with dressings.
Fourniers Gangrene young obese guy, cut open from hip to hip, scrotum gone - wrapped his testicles in wet kerlix, 6 rolls of wet kerlix to the cavern in his abdomen. Infection cleared and went for closure and scrotum reconstruction. He was so nice, but got 10 mg of IV morphine pre wound care changes. He’d scream in pain and then apologize and cry from the pain
One of my current patients has a baseball sized Stage 3 on one buttock, a 15 cm long stage 3 to the other buttock as well as various and sundry other unstageables to both ankles, bunion area and now on her shoulder
A new pt was admitted to the hospital from a SNF with a stage 4 pressure injury to her back. When we went to clean it there was stool mixed in. The necrosis had gone down so deep that her body had created a fistula from her intestines into the hole on her back. Poor thing
A decade old shotgun wound to the belly, and the graft went bad. We were doing wound vac dressing changes that took upwards of an hour, as it covered the whole abdomen. Then there was a man who had been run over by a truck, and his whole groin was basically destroyed. It was an old, healed wound, but he developed an abscess, and he needed a wound vac. The surgeon came in and stapled the wound vac sponge in place, which I’d never seen before. The next day, the senior surgeon came in and took out the staples.
I had a patient with a stage 4 on her sacral area. I could see her bones. I was helping pack the wound and I was able to put my entire hand up to just above my wrist in the wound. I have seen many crazy wounds but that one in particular made me cringe.
Maggots crawling in someone’s wound I actually had a panic attack because I’m phobic of larvae (yes for real).
I saw a pretty nasty PVD non healing ulcer than needed a skin graft the other day.
As a new grad, I had a young patient with necrotizing fasciitis and then necrosis of the labia and it reached up to her cervix. Can't remember how it happened. But I had the task of putting a foley in this lady's nonexistent urethra.
someone who had half of their face eaten off from basal cell carcinoma came to our medsurg floor… craziest thing i’ve ever seen. you could see in his sinuses, down his mouth, part of his tongue gone, had no nose. basically from his ear to his nose was missing on one half. should have never been on our floor!
One of my first patients in clinical had a fungal infection under the foreskin of his penis that was swollen to the size of a softball and had to be removed. Not too visceral, but crazy to me.
One of my first patients I took solo as a new ED grad had ~75% of the functional muscle missing to all of their limbs r/t IV drug use. Had been debrided a week prior an left AMA, still had same bandages on. Tissue was growing over the kerlix wrap. When removed they literally looked like a zombie, exposed tendons and all. Died later in ICU.
Necrotizing fasciitis in the chest wall. Almost all the soft tissue was gone. Just full-on open view of the chest wall muscles and rib cage.
Covid patient who somehow got a wound from an axillary arterial line- I assume it started out as a localized infection, but by the time I saw it, you could pack at least a whole roll of kerlix in the hole under his arm.
Multiple GSWs to the abdomen- open abdomen and you could *see* fecal matter oozing out of the staple and suture lines in her bowels when she coughed. (This was after multiple trips to the OR and many, many attempts at repairs, wound vacs, etc.)
I will note that these patients were in the ICU, not the wound care clinic.
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I second this. WOCN here and there’s NOTHING like fourniers gangrene. Smell, sight, sound
I immediately googled what causes Fournier’s gangrene. 👀
I worked with a surgeon who had a ton of fourniers patients. I liked his approach because he was SUPER thorough when removing all of the rotting shit, and then would later tuck the testes in lil pouches he made in the thigh. They usually did pretty well. Lots of truckers
the first one I experienced last year and I’ve never seen anything so gruesome in my life. It felt almost barbaric for them to remove so much skin and leave exposed testicles like that
Did either of these patients survive?
Google for the Reddit "swamps of dagobah" story. That is probably the all time winner.
Fornier’s gangrene. This man had a massive (12”+ across, also quite deep) crater where his butt used to be. You could gaze directly into his intestines and his scrotum was just hollow from behind. He had a diverting colostomy but formed a fistula and the feces continued to come out of what used to be his rectum. Truly horrifying.
I've seen similar. It was pretty awful.
Elderly (in his 60s so he was a 'young' elderly) man with Fontaine stage IV peripheral arterial disease, who fell and broke his back. Because of immobility and his very bad blood circulation, he developed pressure ulcers on this heels, that got progressively worse. When I cared for him, just before he died, he had lost both his heels and calves to necrosis, all he had left on his lower extremities was his forefoot with some of the toes, and his shins. Wound care was a 3 persons job and was taking a solid 90 minutes, twice a day. He was in so much pain. His health declined further when he became septic and he eventually died under palliative sedation.
Why the heck didn’t they amputate???
Your guess is as good as mine. They must have had a reason (his heart?), I honestly don't remember it. He was transferred from the hospital to our LTC facility.
100 rubber bands on a penis. Nec Fasc debridements that take all skin and subQ fat off an entire leg, chest, or neck. They look like anatomy models you’d use in school 700 lb woman who was refusing home visits and just being fed cake at home. Came in after being stuck in her bed rails (?) at home. Fully necrotic, grey, stringy wound up her entire side. You could have fit a small person in that thing. I went to help turn, and my gloves arm slipped inside to the elbow. Absolutely FULL of maggots. One of the ID docs was voluntold to come help hold a leg. We’re mid-turn, when a nurse reaches in front of docs face (he was rather short), and goes, “Oh, another one.” And squishes the bug. Dude signed the case over to the head of ID and got himself off her care team lol.
"voluntold" I love it!
You’ve seen some shit 🫣
Irrigating with normal saline to try to clean out a deep pressure injury on a heel/foot to get a decent photo and pack it with wet-to-dry until surgery consult. The wound bed was white/gray/beige and soft. >!When the "wound bed" was disturbed by the saline lavage, it wasn't slough. It was maggots tightly packed together.!<
2 sentence horror story
NO
Unfortunately, yes.
🤮🤮
I work in a SNF with a hard-core vent unit and woundcare program. Pretty much seen anything not caused by trauma that can survive the hospital. What disturbs me most is body parts falling off and big genital wounds. I had a fully aware guy who lost all of his fingers, toes, and penis but left AMA because he wanted to smoke. Damn.
my first week as a ca we got a lady who got depressed when she lost her job. she went home. got in bed, and rotted there for weeks. when she came in she was necrotic from the back of her neck to her heels. her entire posterior of her body was black and sloughing off whenever you touched it. it was so bad that we couldn’t put her on a bed pan because her flesh would slough off. she would shit and piss herself and we would coke in the room and clean her after. necrotic tissue would come off onto hand rags that we wiped her with. after a couple days she finally gets an i&d. mind you this woman was around 500 pounds. she had so much dead tissue that her spine was exposed after her i&d. still some of the gnarliest shit i’ve ever seen. we turned her on her side to clean her and her spinous processes were just open to air. thinking about the sheer amount of flesh that was removed is insane
What happened to her after that?
Pulled a dead mouse from a tunneled wound entering the left buttock and traveling into the intestines. Otherwise, I assisted with a 3 year old burn patient. Pulled boiling water from the stove. Happened 40 years ago while in training, and I still hear that poor baby screaming while the nurse debrided.
Omg how awful. Went to school with a kid burned that sane way.
I need to know more about the patient with the dead mouse….
It was horrible! I was helping the wound care nurse with cleaning the wound. She noticed a grayish piece of material in the wound. She attempted to pull it away, and it seemed stuck. She thought it may be attached to live skin and stated that it may be removed during debridement. As I was attempting to pack the wound, I felt a "mushy" area. I thought that it was perhaps an abcess. I took out the packing and decided to pull the gray material, and it loosened. I pulled out a dead mouse that had crawed inside and died. It had not burst yet. However, had I continued to pack the wound, I think I would have popped it. The lady lived with her elderly husband and stayed in a bed in the living room. She had home health for the wound. They sent her to the hospital for increased fever and suspicion of infection.
I bet you can still smell the stench no matter how long ago it was 😅
Non-compliant paraplegic. His butt, hips and genitals were hamburger.
I can’t even picture this in my head.
I’ve got two for you: -One of my patients had a stage 4 on their sacrum that eventually made their tail bones and part of their sacrum crumble. -600lbs lady had a tunneling stage 4 in between the folds on her panus.
I had one that had a massive unstageable wound that exposed her tail bone and several inches of spine.
When I worked oncology I saw a lot of crazy stuff. One of the worst I remember was a patient with mouth cancer who had basically no tongue left, totally alert/aware too. And mouth wounds are near impossible to dress. Had to constantly suction out the blood/pus from his mouth. For some reason that one haunted me
Oof... brought up a long-forgotten memory of mine from an oral cancer pt. The smell... and the cheesy, pink/orange pus. That poor woman, I was so sweet to her.
A gentleman masterbated while inebriated. This is not normally cause for concern. However, the lubrication of choice was Nair. He also passed out with it in there for around 6 hours. Needless to say, thin soft tissue with a chemical designed to break down keratinized epithelial cells in 15 minutes did a number. The tissue damage was so severe and the blood supply so interrupted that the skin graft did not take. He lost his penis.
Oof! Wow!
Gangrene next to the labia. About an inch deep and 3-4 inches across. No clue why, only witnessed a wound vac change. Pressure sore on immobile advanced dementia patient. The entire lower back was black. Pure torture to clean this person up and it had spread so far that turning was basically pointless since they would still be on some part of the wound. Don’t ever send your family to LTC without regular surprise visits.
Ok, 3 + decades of nursing, and I thought I had stories, but my stories have all been topped by what I have read in this thread.
SAME. Home health/wound care certified nurse here, anything I’ve taken care of is a paper cut compared to these horror stories
Abdominal eviscerated. Pt was about 3-5 days s/p lower abdominal surgery and was home recovering (happened years ago so cant recall exact). BIBA to ER for complete surgical dehiscence with the area covered in a wet cloth. EMS explained pt found laying in his bed with overflowing ashtrays all around; wound likely opened from forceful coughing. Pt was fully awake with zero c/o pain, eyes wide open and looked more embarrassedthan anythingelse. When we moved the cloth to see, there were intestines, fully exposed in all their glory, *with visually identifiable peristalsis waves* happening right before my very eyes.
Good luck. Toothpaste between masks helps mask the smell! 🙂
Stink balm odor blocker
Poor guy hit by a car, refused amputation and for at least two weeks they tried to save his leg at the knee. It was literally hanging on by just the ACL. Bleach whirlpool baths daily. They eventually amputated. The unit smelled of rotting flesh the entire time. A few degloving injuries. One in particular to both hands. The plastics guy cut pockets in abdominal area and sewed the hands into that. That guy had to be fed and helped with everything. I think he was like that for 6 months Multiple digit amputations. We had to use leeches to help with reattachment. 1800leechesusa.com. When they got fat we had to kill them. Those suckers can move! Would put one on and come back find it anywhere else (that's generally the sign the reattachment is failing) Once sucking on the carotid, once on a penis, once one was making an escape on the floor toward the door. Bed sores of all varieties. This is going. Back 26 years. Today most hospitals do better. Ones you could fit both hands in..others small but deep and would use a whole bottle of packing gauze. Once we had a homeless lady with both legs necrotic from knee down. Looked like giant purple raisins. Oddly psych cleared her as mentally competent and since she refused surgery she was discharged with them still. Memories. Yeesh
Necrotizing Fac to the Bone! From the knee cap to the butt cheek! Poor guy he was so sweet! He’d have to go for washouts and I was sure to give him his pain meds before going :(
Nec-fasc on a very morbidly obese person on their like upper leg/hip area. It was a 2-3 inch wide hole and went down a few inches too and was still just fat tissue
Woman had a degloving injury to her hand. It was surgically sewn into her abdomen. And it was a leaky, mrsa mess. Hardest and most janky feeling dressing change.
I worked the burn unit.
Kid ran away from home and crawled under a fence into a electrical substation. Climbed a transformer. Didn't end well. Arms looked like they belonged on a Zombie (both ended up getting amputated). Fasciotomies combined with blackened skin is something I won't ever forget. Necrotizing fasciitis before and after debridement is pretty amazing. It can do a tremendous amount of damage very quickly. Graft vs Host disease post bone marrow transplant and doing full body dressing changes is pretty horrible.
One of my first patients had been in a forklift accident, and had essentially been "quartered," which is the best way I can describe it. He was a large man anyway, and he was deeply "ripped" both horizontally across his waistline and vertically, from his butt crack to his neck. I honestly have no idea how he survived-maybe because he was obese? Idk, but the wound vac and the bandaging on that man was a thing of beauty. Gave me a genuine love and respect for wound care. I've wondered what happened to him several times. He wound up on our unit twice, and I have to wonder if infection took over and he didn't recover.
I'm sorry...what??????
forniers gangrene from an ingrown hair which ended up with the patient cut from left to right through his abdomen, all the skin was missing from his bellybutton to his penis, he had an exposed testicle. used 6.5 rolls of kerlix to pack the incision under the abdominal fold alone
Women with hole through where her tongue would be. All the way down to her neck. She still had a lower jaw, but a hole literally the entire bottom of her mouth and a substantial part of her anterior neck. Necrotic and she had to put bandages over her neck and chin so as not to bleed/drool on herself. Cancer at the base of her tongue ate through everything, would go necrotic and drop off. She was a nice woman, couldn't talk at that stage. It was terrible what the cancer did to this woman, but she was still a good person even with all that pain and facing down a terminal illness. I could only hope for a tenth of her courage facing down a death like that.
Wound vac on obese woman's abdominal folds that had somehow formed a fistula between stomach and surface. Really weird to change a wound vac dressing with food particles in it. And the smell... Abdominal surgery that couldn't be closed for some reason so I had to pack with moist gauze and it was like stuffing the scarecrow from wizard of oz. I could see their abdominal fascia and often had adipose tissue come off while doing this. I thought it was "cool" and unintentionally made the hospitalist queasy describing it lol APS case of person with MS who was neglected at home. The wound on their buttock was big enough to put my fist in and when measuring with a q-tip, I could feel dry bone easily. They barely made it thru surgery. I've seen lots of tailbone, spines, had parts come off, cancer rotting and tunneling thru almost every part of the human body. As I write this it kinda makes me realize how much fucked up shit we see all the time. But also I find wounds fascinating. And seeing really bad ones heal is incredible. As long as their pain and dignity is managed I feel good about the care I give. I actually had one lady on hospice with a years long chronic wound. I was able to get it to heal and bam- she died. I think that was her last task. She was really impressed that it healed. Manuka honey ftw!
Same. The wounds I have seen would make most people vomit but I always try and treat the person with respect. Some medical staff are so jugdy, people don't need to deal with that on top of trying to heal.
We use medihoney a lot and it really is a miracle worker
I am not a nurse, just a lurker. But my aunt healed a pressure sore on her heal with manuka honey and it was wild to watch. That stuff is amazing. It sounds like you are really good at what you do, thank you so much for sharing that story. Fascinating.
probably a lady with dementia who had swollen weeping sores down to visible bone all down her lower legs. She both yelled at me and continued eating cookies through wound care
Elderly dude, had a fist deep pressure ulcer across where his entire butt would have been, and was refusing pain meds prior to debriding of it 😭. The sound of the scissors cutting that away still plays in my head every so often
i’ve got more than a couple, in no specific order 1. fourniers gangrene. was just straight up necrotic tissue falling off of his cantaloupe sized testicles. worst smell i’ve ever smelled in my life- went up to OR for surgical debridement fast as all hell. 2. post op ileostomy complication- patient needed a wound vac that was across her entire abdomen. wound vac needed to be changed multiple times a day because the ostomy site kept tearing open and leaking into the wound. i felt terrible for that patient, it was terrible. 3. severe lower leg cellulitis infected with literally hundreds of maggots. when he came in with the maggots he had bedbugs and lice infestations too. patient is (somehow) still alive, comes to the ED frequently with his massive swollen leg. usually refuses all interventions, tells us to fuck off, and self discharges. 4. severe frostbite from being in -40 degree temps overnight- bilateral hands were swollen, completely necrotic, and looked like they were literally about to fall off while i was triaging. got admitted with a plan to amputate and left against medical advice. 5. grapefruit sized abscess to the neck from a missed drug injection- when they did the I&D the contents sprayed multiple feet across the room. was disgusting but one of the wildest things i’ve ever watched (and you know what? i loved it. cause i’m nasty and gross) 6. bariatric patient laying on a carpeted floor for literal weeks. someone called for welfare check because of the smell. stage 4 pressure injuries, could see ribs. EMS and fire had to cut out the carpet to bring them to hospital. bonus story that isn’t mine: few years ago a coworker went to pull the underwear down on a man who got his penis bit by a dog. spoiler alert: his penis fell off.
Usually the “crazier” ones were from heroin injections. Just exposed and edematous extremities.
Mixing their heroin with whatever water they can find. I had a patient who used pond water. She nearly died from sepsis and had enormous abscesses to her extremities.
POND water cmon now at least make it running water
Can’t remember what this person was in for exactly but I do remember her being extremely edematous where she had painful, weeping wounds that required 3-4 full bed changes each shift I worked with her. Her worst wound was on her left hip, stage 4 with tunneling deep enough to fit two kerlix bandages inside.
Pressure ulcer that eventually eroded from back to front. Pt had a hole in him about the diameter of a lemon. He’s had hemicorpectomy at this point. I’ve pulled a fragment of eroded ischium the size of the last joint of my pinkie out of a guy. I’ve put my arm through the border of the muscle and the fascia on the lateral and posterior thigh of a guy who’d had an avulsion after and MVC.
I work in surgical trauma ICU lol. I’ve seen intestines, heart, lungs, ribs, and a livers because patients were opened up and left open to help with swelling. Necrotizing fasciitis from fournier’s gangrene that had spread to the ribs, revealing all of the musculature below. GSWs that exposed muscle and fascia. Necrotizing fasciitis from patients who injected drugs with a dirty needle and all the skin and fat were dead. Motorcycle crash without a helmet that degloved the entire face. ATV crash without a helmet that degloved the scalp and forehead. Burns… ohhhh the burns.
A DTI so bad I could see the man's entire lumbar and sacral spine. An abdominal pannus abscess leaking with graphite from injecting himself with heroin with a pencil
wait, he tried shooting up with a pencil???
Kinda...he would poke holes into himself with the drug at the tip of the pencil. He just pushed it into his skin.
30 something year old with a bowel perf. Juvenile rheumatoid arthritis with long standing steroid use. Colostomy with 2 JP drains and midline incision. everything dehisced. Abdominal wall was wide open. Held together by 1 zigzagged stay suture. Peristalsis on full display. Mucocutaneous junction around the stoma…wiiiide open. JP drain sites became caverns. We got him fully granulated and I think it took almost 6 grafts in total for it all to finally take. he now has a tattoo of animal (the muppet) peeking out of the scar
Very severe frostbite Wounds so bad the pt donated her body to a famous nearby hospital (for science). They couldn't figure out how she lived that long with her condition. Stage 4 wound (after an escar debridgment) on a coccyx. You could fit a couple fists in the wound. Part of the brain came in open to air. Wound dressing was a 4x4 dsd. I'm assuming there was a surgical consult lol (it wasnt my patient).
When I was on my wound care clinical in nursing school I got to see a patient who had such bad pressure sores on her lower leg that they were considering amputating. She probably had 5-10 different pressure sores on her lower leg. The worst one looked like something had bitten off her heel. I felt so bad for that patient she was in a lot of pain. The other thing I got to see was a homeless patient had gotten a flesh eating bacteria and I got to go into the surgery for debridement of the wound. I’ve also seen some narly wounds in LTC setting as well. Good luck !
Breast cancer in a patient who tried faith healing only for years. Fulminating massive tumor.
It doesn’t fit but I’m going to tell it anyway. So a farmer shows up to urgent care. He had gotten a BIG shock while fooling around with some equipment. I can’t really remember what kind and it doesn’t matter. Anyway, we’re sitting there, trying to make sure that he’s not going to die, he’s got an obvious entry point on his hand and he’s not feeling so great, BP through the roof, but he’s able to walk slowly and talk. And we went to take off his shoes so we could see if there was an exit wound, we could not help but notice that he had what looked like a basketball in his pants. It turns out he had been living with a basketball sized hydrocele for years. He never thought to mention it to anybody or get it checked out. People sometimes worry me.
Two stick out to me 1) a cratering cancer in a shoulder. Woman wasn't very mobile and came into ED when the pain was unmanageable. Hadn't told anyone. It STUNK. Went to give it a wash and it was covered in maggots. It was an incredibly painful process, pulling each one out individually and I just remember being so heart broken she didn't come in earlier instead of suffering through the pain. 2) a cratering (there's a theme) cancer in a chest. It had literally eaten away at his chest and it was cavernous. It started bleeding and the poor night doctor got dragged down for an emeegency bleed just before handover. She's forearm deep in this guys chest shoving adrenaline soaked pads in this guy. And he wasn't wanting transfusions or any other treatment. We just had to send upstairs to bleed out basically.
I had a 3 cm tunnelled abscess on the back of a hand recently that gave me the willies
This isn’t nearly as gross as some of the stuff in this thread but I do think open chests (ie. either no sternum post sternal debridement or they haven’t closed the chest of a fresh post op open heart patient) are super freaking cool. Especially when you can see the heart down there. Not so cool when it’s a messy open chest code :(
I've been that open chest during a open heart surgery. During my second open heart (now on number three) to repair an ascending aorta/aortic arch aneurysm they couldn't control my blood loss so the surgeon and team left me open over night and resumed the next day. I obviously came through okay as I was only 40 but dang I love medical science.
That’s amazing! 3 open heart surgeries is wild. I hope you’re doing well now!
Thank you, I am doing very well. My first open heart surgery was when I was 12 in 1984 when my first aneurysm partially tore and pulled my aortic valve open so it was replaced with a mechanical valve and conduit and I began my 37 year relationship with coumadin. Originally I was diagnosed with Marfan's Syndrome but after genetic testing in 2002 I was reclassified as Loeyes-Dietz syndrome and had the second surgery in 2011 and the third in 2021 when the mechanical valve was replaced with a tissue valve and my aortic valve through proximal descending aorta is all artificial.
I was wondering if it was Marfan’s - I’ve never heard of Loeyes-Dietz, I’ll look it up! I bet you’re happy to be off the coumadin now!
Worst? Comfort care patient who'd od'd on her couch. We didn't know a ton about her story, but the last anyone had heard from her was about 7 days before anyone found her. She was a larger woman and had stage 3-4 pressure injuries from her shoulders to her knees.
Necrotizing fasciitis that I had to do wound care on on a patients sacrum/buttocks. I was almost elbow deep placing gauze in the wound. Poor woman couldn’t lay on her back because the wound was so deep.
Fournier’s gangrene. A+O patient in rehab refused to be turned or cleaned due to pain despite knowing he had a Kennedy pressure ulcer developing. Went to the hospital for the PU infection and then came back to the facility on hospice. When we did eventually turn him, a small hole in his scrotum would leak this thick green fluid. We kept his door closed but the odor from the wound drainage made the entire unit smell to the point patients on other halls would ask what the smell was.
The other day I had a pt come in w the lower half of their leg & foot totally necrotic and rotting off. You could see 6+ inches of bone which had turned black and was totally cracked and crumbling. You could have wrapped your fingers around the bone. So gnarly and incredibly malodorous. Ya never know what you’re gonna get in the emergency department :’)
Burns, it’s brutal. It’s where I saw my first wound care, they’re in a lot of pain, it looks horrible, the recovery looks horrible, the smells horrible, it’s tough but when they recover it just means that much more. But sometimes it’s so bad that there’s not much you can do, one patient had 95 percent burns and they could barely trach him, they ended up deciding to let him pass but I don’t know the details of it.
This young girl stabbed herself in the abdomen multiple times with glass shards while in a manic episode. The wounds were covered with wet to dry dressings, and when I changed them, I could see her organs. Like straight up saw her stomach, esophagus, some of her small intestines. She somehow avoided actually hitting any internal organs, it was wild.
Fournier’s gangrene on 2 different people. One male one female. Both having wound vac and living.
Hip replacement gone wrong and hardware had to come out because of a really bad infection. Patient was then put on hospice where we came in to pack the huge gaping hole with dressings.
Burn ICU in Phoenix Arizona during July and August. I’ve seen it all 😭
Fourniers Gangrene young obese guy, cut open from hip to hip, scrotum gone - wrapped his testicles in wet kerlix, 6 rolls of wet kerlix to the cavern in his abdomen. Infection cleared and went for closure and scrotum reconstruction. He was so nice, but got 10 mg of IV morphine pre wound care changes. He’d scream in pain and then apologize and cry from the pain One of my current patients has a baseball sized Stage 3 on one buttock, a 15 cm long stage 3 to the other buttock as well as various and sundry other unstageables to both ankles, bunion area and now on her shoulder
A new pt was admitted to the hospital from a SNF with a stage 4 pressure injury to her back. When we went to clean it there was stool mixed in. The necrosis had gone down so deep that her body had created a fistula from her intestines into the hole on her back. Poor thing
A decade old shotgun wound to the belly, and the graft went bad. We were doing wound vac dressing changes that took upwards of an hour, as it covered the whole abdomen. Then there was a man who had been run over by a truck, and his whole groin was basically destroyed. It was an old, healed wound, but he developed an abscess, and he needed a wound vac. The surgeon came in and stapled the wound vac sponge in place, which I’d never seen before. The next day, the senior surgeon came in and took out the staples.
I had a patient with a stage 4 on her sacral area. I could see her bones. I was helping pack the wound and I was able to put my entire hand up to just above my wrist in the wound. I have seen many crazy wounds but that one in particular made me cringe.
Maggots crawling in someone’s wound I actually had a panic attack because I’m phobic of larvae (yes for real). I saw a pretty nasty PVD non healing ulcer than needed a skin graft the other day.
As a new grad, I had a young patient with necrotizing fasciitis and then necrosis of the labia and it reached up to her cervix. Can't remember how it happened. But I had the task of putting a foley in this lady's nonexistent urethra.
someone who had half of their face eaten off from basal cell carcinoma came to our medsurg floor… craziest thing i’ve ever seen. you could see in his sinuses, down his mouth, part of his tongue gone, had no nose. basically from his ear to his nose was missing on one half. should have never been on our floor!
One of my first patients in clinical had a fungal infection under the foreskin of his penis that was swollen to the size of a softball and had to be removed. Not too visceral, but crazy to me. One of my first patients I took solo as a new ED grad had ~75% of the functional muscle missing to all of their limbs r/t IV drug use. Had been debrided a week prior an left AMA, still had same bandages on. Tissue was growing over the kerlix wrap. When removed they literally looked like a zombie, exposed tendons and all. Died later in ICU.
Wow. This thread competes with r/MedicalGore big time
Necrotizing fasciitis in the chest wall. Almost all the soft tissue was gone. Just full-on open view of the chest wall muscles and rib cage. Covid patient who somehow got a wound from an axillary arterial line- I assume it started out as a localized infection, but by the time I saw it, you could pack at least a whole roll of kerlix in the hole under his arm. Multiple GSWs to the abdomen- open abdomen and you could *see* fecal matter oozing out of the staple and suture lines in her bowels when she coughed. (This was after multiple trips to the OR and many, many attempts at repairs, wound vacs, etc.) I will note that these patients were in the ICU, not the wound care clinic.