Wound Care Information Network
January 4, 2004
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New questions sent by readers. Please e-mail your answers. See previous questions and answers below.
| If you know of any patients who are interested in being part of advanced wound care clinical trials, please visit this new offering by a non-profit organization. It's a free service that can potentially connect patients to appropriate clinical trials. Click here for more information. | |
| Congratulations to all the winners from the recent online survey. We know it was a long 30 questions, but for those of you who completed it, the payoff was hopefully worthwhile ! A few grand prize winners won $ 200 certificates while 50 others won $ 20 gift certificates each. Winners were randomly selected from those who completed the survey. Look out for future opportunities to share your thoughts and win some prizes ! | |
| I'M RUNNING DESPERATE CONCERNING MY HUSBANDS ULCERATED FOOT (2YRS) HE IS A DIABETIC WITH RECENT TRIPLE BYPASS AND AMPUTATED TOE ON THE OTHER FOOT. I WOULD LIKE ANY INFO AND INSTRUCTIONS REGARDING THE USE OF HYALOFILL, HIS ULCER ON THE BOTTOM OF HIS FOOT IS ABOUIT 5CM AROUND AND IS NOW SHOWING BEIGE STRINGY MATTER >>> WHICH I,M NOT SURE IF THAT IS A GOOD THING OR NOT. I WAS USING REGRANEX BUT DO TO HIS SHOES IT STARTED WORKING THEN HE RAN INTO MORE PROBLEMS. I HAVE JUST RECENTLY ORDERED CUSTOM MOLDED SHOES , AND A DIABETIC BOOT HOWEVER HE DOES,NT CARE TO WEAR IT ANY INFO I WOULD BE THRILLED TO HEAR FROM ANYONE WHO CARE TO RESPOND TY,DIANNE | Archives messages can't be replied to. |
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Hi, My dad has got an ulcer half way between his knee & ankle. He has bad circulation as he had a blood clot 5 years ago, we are just wondering if you can recommend any web sites or any treatments which will help reduce the size of the ulcer. It is about the 5cent piece size. It gets a crusty scab and causes a lot of pain. Your help will be much appreciated Many thanks Jessica |
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I am a community nurse, I have a client with
venous ulcer, over-granulation is present recently. I would like to know how
to manage the over-granulation. Is hydrocolloid works? Flora |
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Hello, I am not sure if this the correct name. I am a wound nurse at the naval medical center in San Diego. A plastic surgeon insists that this solution will heal a wound. Are you aware of a solution by this name? Do you know where I could look for more information? Your assistance in this matter would be appreciated. Dawn, CWOCN |
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I have found your website very helpful in
developing an education program for nurses working at the large aged care
facility where I work in Sydney. I am interested in innovative education
tools/techniques that enhances nurses understanding of how to prevent
pressure ulcer development. Do you have any resources/contacts? Thank you |
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Congratulations to Thomas
Sharon, R.N. on the publication of his new book. Thomas is a long time
viewer and active participant on the Wound Care Information Network.
PRACTICAL LIFE-SAVING ADVICE ON AVOIDING |
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Submit your new question to the group right now: wounds@medicaledu.com
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Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.
| We are
having a discussion about decubitus ulcers?
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Pam, I have done research and presented on this topic. According to the NPUAP and the AHCPR, pressure ulcers cannot be staged until all of the necrotic tissue is debrided away. This can be found in the Clinical Practice Guidelines for the Treatment of Pressure Ulcers put out by the US Dept of Health and Human Services. I hope that helps. Jen Jennifer Anne Cavallaro, PT --- If a wound cannot be seen due to slough, we call it an "unstageable"
until the wound bed is clearly visible and an appropriate determination can
be made. --- YES, USUALLY, IF A WOUND HAS SLOUGH, YOU WOULD STAGE IT AT LEAST A 3. IF
THE WOUND HAD ESCHAR, YOU WOULD NOT BE ABLE TO STAGE IT UNTIL ESCHAR IS
DEBRIDED BECAUSE YOU CANNOT EVALUATE THE WOUND BED. --- Think of it like this--how can you tell what is inside a box without
taking off the lid? How can you stage a pressure ulcer without removing the
necrotic tissue? You may have an idea of the stage of the wound, but without
being able to visualize the wound base, you have no idea. There have been
sometimes that I have been surprised at the actual stage of the wound after
debridement. --- Pam, ---
If the wound bed is completely covered with
slough then you cannot stage the wound. However if only a portion of the bed
is covered with slough and you feel that an adequate portion of the bed is
exposed to make a staging assessment do so. |
| Hi, My name is Amba, a student of physiotherapy studying in India. As per my course requirements, I am to submit a project work on the topic of my choice. The topic I have selected is "Recent advances in wound care with electrotherapy". I would like to know what are the various electortherapy modalities available in the treatment of wounds and also would be greatful if someone could give me links to websites carrying relevant subject material. I have searched for HVPGS, but haven't found any describing the exact procedure of treatment. Thank you, Amba. |
The most commonly
used e-stim type is HVPC. But, now the thinking is that the key thing is the
total dose, no matter what form it takes. For searches, try the names Kloth
or McCullough. They are the leading researcher in this field. Go to
www.pubmed.gov to search the literature. -- Renee C., MSPT, MPH, CWS |
| My
doctor says I would be a candidate for Dermagraft, however, my insurance
company will not cover the cost as I am not a diabetic and they say it is
still in testing stage. I have two trauma ulcers, one on each leg, that will
not heal. Has anyone used Dermagraft and has it worked to close this type of
wound. Gary |
Dear Gary: First you need to find out the reason why your wounds are not healing. If it is an arterial blockage, you need the services of a vascular surgeon. If it is some form of peripheral vascular disease, the question of whether or not you have diabetes is moot. Once you have done this you can ask your doctor to write a letter of medical necessity explaining why Dermagraft should work with your condition. Health insurance companies always deny payment for new types of treatments calling them "experimental". You need to contact your state's Insurance Department to find out how to file an appeal to overturn the denial. These appeals are usually successful when there is a clear and concise letter from the treating physician explaining why the denied treatment should be covered. Good Luck Thomas A. Sharon, R.N., M.P.H. |
| Could
you please help settle a debate? Is tincture of iodine better for wound care
than triple antibiotic cream? Thank you Philip |
Iodine in that form
is cytotoxic to healthy cells in addition to the bacteria. Therefore, the
antibiotic ointment is better since it does not damage the healthy tissue.
However, there are so many other things available to help with wound
healing, even for infection management, such as silver dressings and
cadexomer iodine (a special form that doesn't damage healthy tissue). Renee C., MSPT, MPH, CWS --- I don't mind using an anti-infective such as Betadine when an acute
injury has occurred and the wound is dirty, but after the initial cleansing
I would use moist wound care such as wound gel and use the antibiotic cream
for infected wounds. No sense developing drug resistant bacteria. We have
enough of a problem with that as it is. --- No, iodine isn't better. It is cytotoxic. Remeber the old phrase...never
put anything in a wound that you wouldn't put in your eye. --- Iodine is no longer recommended for wound care because the iodine dries
out Edna Hawkes RN |
| Has
anyone had any experience with a product called CircAide T-3 boot and sleeve
for compression of LE venous insuffiency. Does this product increase patient
compliance? Does it seem to be an effective alternative to multilayer
compression wraps to remove edema? I have a patient who is currently having
a difficult time transferring from multilayer compression wraps (Profore)
that I put on to being independent with her compression garments. Each time
we get set to go Independent, something seems to happen where she is unable
to get her compression stockings on at home...more edema...more
wounds...back to Profore. Is the CircAide boot and stocking a viable
transition alternative? Thank You Carl, PT |
The CircAid can be
helpful if the person has ankle movement, and
moves their foot. If not, it is not very compressive. It is often easier to don than stockings. Have you tried the various donning systems (slippees or frames) to help with the stockings? Renee C., MSPT, MPH, CWS --- Dear Carl: |
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I was wondering, what are some of the alginate
dressings or other dressings that are absorbable if left in the wound bed
(most likely accidently)? Someone told me that all alginates work this way, but I don't believe them. Chris |
Fibricol by J & J is a
collagen dressing. I think it absorbs a little bit of drainage, but it is
absorbed. Alginates have to be flushed or rinsed off; they are not absorbed. Nancy B. RN, CWCN |
| Hi, I'm a PT that has been practicing wound care at a major hospital for 4 years. I had a question about iodoform packing strips. I know certain levels of iodine are indescriminately cytotoxic. Doctors in the hospital always seem to order iodoform packing strips (which I most often am able to change to a more healing-friendly dressing). But if you were to use this dressing, is the level of iodine in these gauze dressings still cytotoxic to all tissues?? Is there any research that shows what levels of iodine would be "appropriate" (I use this word very loosely) ? Thanks for your time. Chris, PT |
I'll sometimes use
cytotoxic materials for a few days to take down the bioburden, to allow
healing to begin. Then, I'll stop, and go to something else. Look at the
MSDS for Iodoform. It's scary. Renee C., MSPT, MPH, CWS --- There is no problem with iodosorb packing depending on the wound bed/
cavity. Cytotoxicity is a non issue. |
| I have
a long-term bed the patient, the buttocks and the left hip have a pressure
sore, NaCl wet packing for 4 months, because the wound heals slowly, changes
by the seaweed rubber surgical dressing, but healed is still slow, asked,
what method I possibly did use to improve it? (Has picture)
Taiwan
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First of all you
might need to address nutritional needs for healing. Increased protein,
Vitamin E & C and Zinc Sulfate. Because it takes 3 days for new skin cells
to form and adhere them selves you might consider converting to a dressing
that is changed less frequently . I would suggest using a hydrogel with
fibrin or collagen, covered by a hydrogel wafer that you change every 72
hours. This provide the optimal environment for healing with moisture and
the essentials for cell generation and adherence. Good Luck……. Jan, LPN Wound care Coordinator |
| Hi,
I am interested in finding out about any type of exercises presecribed for people with vascular insufficiency. I have two diagramed exercise protocol from dow hickman(simple exercises to improve circulation) and Lower extremity exercises for people w/ diabetees from Novo Nordisk Daibetees Care. bindhu t.a. |
sorry, no replies |
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