First Aid/infection


Marcus,          I am a 43 year old male with hypothyroidism and fibromyalgia. I have slightly open wounds below my knee medial to the tibia tuberosity. I have knee pain and I have applied Voltaren gel and EMLA creme to ease the pain. Unfortunately, I believe the creme somehow got into these cuts which did make them feel better since EMLA is a general anesthetic but it is not meant to be applied on open wounds. The wound began to close up and heal with the creme stuck under the skin. This created a cyst which i lanced, sterilized and drained the best I could. It opened up again last night and i decided to measure how deep the one was. I used a sterile 23 gauge hypo and measured 9.5 mm deep, yet it doesn't bleed. Only clear fluid came out. I disinfected the wounds with crystal violet. Today the area all around the wounds have pitted edema. I pushed the fluid towards the wounds yet nothing seems to come out of them. My question is, how can i wound be that deep yet neither bleed nor allow subcutaneous fluid in such close proximity to drain? Do infections somehow cut themselves off from the circulatory and lymphatic systems?

Hello Rick,

It sounds like you may have created a dry pocket with the various treatments you have preformed. you mentioned a 23GA needle (diabetic?). If you are diabetic I would highly recommend seeing a doctor about this wound so it can heal properly. At this point it sounds like it has become a pocket for a future infection to grow which could become very serious.

Get well quick, stay healthy.


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Marcus LaBarbera


I am available to answer most questions related to: first aid, pre- hospital medicine, EMT and Paramedic questions, medical transport, critical care transport, ICU/CCU care, sedation, and medicine in general.


I have worked as a NYS Paramedic since 1993 for both community based ambulance companies and large commercial agencies. I Have experience as bike team commander, and shift supervisor for a commercial ambulance. As a member of the Disaster team I was deployed to Louisiana for 20 days following hurricane Katrina. I worked along side the county Haz-Mat team as a "Tox-Medic" with advanced training in treating injuries from chemical agents. Besides my experience on the on the ambulance I have worked in a number of hospital based offices including dialysis and a sleep lab.

I started my EMS career as a NYS CFR (Certified First Responder)in 1989, an EMT in 1991, a Paramedic since 1993, and a CCU transport paramedic since 2005. I currently hold certification as a: NYS Paramedic, Critical Care Transport Paramedic, ACLS/CPR/PALS certified. Advanced Haz-Mat Life Support certified (AHLS). In the past I have taught CPR and ACLS to my coworkers and the local community.

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