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Mike,

I like the Clinical Guide Wound Care by Cathy Thomas Hess by Springhouse. It is like a nursing drug handbook but for wound care supplies. It includes the brand name (like Duoderm), the generic name (like hydrocolloid), how it's supplied, and the dressing's action, indications, contraindications, applications and removal.

I hope this has been helpful.

Laura Urias, RN, CWS

unsigned

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I am a nurse practitioner and all I do is work with chronic wounds. It sounds like you have done all of the right things with your husband at the beginning and mid-levels of wound care. Now it is time to go up to the next level. All of the treatments he has used are designed to encourage his own body's healing capabilities. Those treatments were designed to create the most optimal healing environment possible. If he was going to heal on his own, he most likely would have done so in 9 months. There is facinating work being done now for where you husband is with his wound. It is now possible to add growth factors right to the wound instead of waiting for his body to supply it's own. It also is now even possible to go further than that and add the cells directly to the wound that the growth factors are trying to produce. He also has an advantage to being diabetic because he will qualify for insurance coverage with some of these products where other people will not. From what you have written, I don't see any reason why he won't heal with a little extra help. You need to find a medical person that specializes in wounds because chronic wound care is a speciality all to itself. Good luck.

unsigned

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Hi Angelia, I am not a medical specialist by no means but I have a lot of experience and success with diabetic ulcers and wounds. I myself have used Maggot Therapy to debride and heal my NON-Healing ulcers on my feet. When the docs wanted to amputate I talked them into trying this up and coming treatment that has JUST been approved by the FDA! It worked when nothing else would. Please check out this website for more info.(how to order, how they work, etc.)

Dr. Sherman's Maggot Information

Pam Mitchell
Board of Directors
BETER Foundation
Patient Advocate
(Trying to help diabetics know their options)

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I'd make sure the offloading is achieved and debridement is performed as needed. Then PACK the ulcer with Aquacel, cover with a piece of Aquacel and DuoDerm, q 4-7 days. If the wound bed is clean, I'd put Hyalofill before packing. At the same time, a long course of Doxycycline would help too. JL, DPM, CWS
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Xenaderm is a good product. It has 3 healing properties. The three main ingredients, Balsam Peru which acts as a vasodilator which increases blood flow to the tissues, Trypsin which acts as a antimicrobal and Castor Oil which stimulates epithelialization. The Aluminum Magnesium Hydroxide Stearate works as a fluid repellent. Without knowing the depth of the wound it would be hard to tell how benificial this product would be. We have had great success on superficial wounds and preventative therapy on stage I areas but have never used this product on wounds that have moderate to substancial depth. Hope this information is helpful. ....Jan, LPN Wound Care Coordinator.
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Hello,
I have had some luck with Xenaderm before. If it doesnt help, another dressing I would recommend is Aquacel Ag if he isnt allergic to silver (evidently not if he used silvadene), as it sounds as if he has some drainage. The silver, of course, will help with any bacterial colonization.

Good luck,
Vicki, MSPT, CWS

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It sounds like he's tried lots of things. You didn't mention off-loading. That is, keeping off his foot. If he hasn't done that yet, I recommend that he use crutches or a walker to keep non-weightbearing.
Renee C, MSPT, MPH, CWS

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Hi Angelia,

There are many reasons why a wound from a diabetic patient my not heal, all of these reasons are well known by most specialists. When you treat a wound, you must have a holistic vision of the patient; many times complex lesions are due to simple systemic problems, and at times, a simple wound is due to a complex systemic problem. You should analyze how all influencing factors are interacting with each other, draw a map of all factors that may be contributing to the slow-down of the healing process, also write all the factors that should be in place to achieve healing. Find out what could be missing from both sets of factors, then systematically act. Remember to consider the patient as a global system. I do this with all of my patients. Start from the basic requirements for healing, and move on to the most complex ones. Your husband has a diagnoses that imposes the need to have a special understanding of all interfering factors. Look also, at the superficial peripheral circulation, is the skin temperature adequate? is the temperature at the surface of the wound adequate to promote healing?. What is his renal condition?. Many antibiotics slowdown the healing process, is this happening? Check the interaction between his many medications, are the vitamins being taken at the wrong time, or the wrong vitamins? Why is he on Penicillin and Levaquin intermittently for so long, ( prophylaxis). Are you introducing any organisms to the surface of the wound during dressing changes? Is the wound suffering from mechanical trauma, wrong ph or variation in temperatures by too many or too little dressing changes, what is his blood protein level?. Does he have any kind of renal compromise. Is he maintaining pressure off the wound surface? What is the quality of the regenerative tissues present at the wound? Is there too many devitalized tissue present that may be impeding healing and harboring "tenant bacteria" (bacteria that lives on dead tissue, escaping the direct action of systemic antibiotics, but continue to release harmful toxins into the wound surface ).

"Remember, the body gives us, the so called wound specialists, the privilege of getting the glory of having healed a wound, but the truth is that we are only, simple assistants to the real specialist; the human body. If you find out what is keeping the body from doing is job, and eliminate these barriers, it , most of the time, will heal itself, and gracefully let us take all glory......

E.O.Leme,RNC
Brazil

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There is a skin substitue indicated for the treatment of diabetic foot wounds and Venous Leg ulcers that have not responded to conventional treatments, called Apligraf. It reports efficacy rates at 56% for diabetic
foot wounds. In the mean time make sure the wound has proper offloading to allow for healing.

Kellye King OTR

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Angelia,

You have not said how old is your Husband. That
matters a lot in deciding treatment options.
Have you heard of maggot debridement therapy (MDT)? It is the use of live medicinal larvae (maggots) to cleanse necrotic, non-healing ulcers. It is not new
and has been used since 1935, introduced early in the US by William Baer to treat chronic osteomyelitis and other wounds successfully. Maggot cleanse wound by first secreting enzymes that biochemically attached and specifically degrade dead (necrotic) tissue. This has superior advantage to human sense of seeing in targeting damaged tissue. What may look like damage tissue to the human eye during surgical debridement may actually be healthy tissue and what looks like healthy tissue may actually be dead tissue.  Dr Ronald Sherman of the Department of Patholgy, University of California Irvine and Dr steve Thomas of the Princes of Wales Hospital Uk have been successfully running clinical trials. Agreed, not everybody can subscribe to having maggots on their wounds not even as part of treatment of seemingly hopeless situation.

But understanding this as natures way of cleaning the
environment and recycling energy coupled with the
enormous benefits and advantages of this form of
treatment, acceptability can and will be improved.
I have just concluded work (thesis ) at masters degree level on Maggot debridement therapy: the extraction and characterization of maggot factor that can pave way for production of maggot factor that can be use alone without necessarily using maggots, thereby deriving MDT benefit without maggots in the future.

Visit Maggot therapy homepage for more information at www.mdtproject.com . This can help you and your
Husband to consider this treatnment option.

Dr Ahmed Mohammed Sabo (MBBS, Msc)
Lecturer-II (two)
Department of Human physiology,
Faculty of Medical sciences ,
University of Jos
PMB 2084.
Plateau state .
Nigeria.
 

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Total contact cast; he probably needs to offload it.

Barry

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Glennys,

It is hard to advise you from more than 8 thousand miles away. The correct thing to do, if you have questions about the healing process, is to get a second opinion. Many things could be causing the wound to continue to release exudates. Normally the regenerative tissue is red, moist, and you can visualize small red dots that represent very small blood vessels being formed. It is important to make certain that the exudates coming out of the wound is not from a fistula that has formed after surgery. Also, that the amount of exudates, is not abnormal or is harming peripheral healthy tissue. My advise is for you to look for a specialist to monitor your wound closely. If you are in US, look for a Home Care Agency near you, as periodical visits from a wound specialist could help you.

E.O.Leme, RNC.
Brazil