I would like to know from you the following:
1. The place of phenytoin (anticonvulsant) in wound
management.
2. The use of pure honey also in wound management.
Thanks.

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Hi: I am not sure about Phenytoin. i have not heard much about this. I am interested to know what others have to say. Honey has been used for thousands of years as a remedy for skin ailments and wounds. The benefit is largely because of it's antibacterial properties. I do not know of any recent studies done on the effectiveness of pure honey in wound management. This may be an area of research for some of the wound companies to explore. I can only imagine the use of honey being cost effective if the could synthesize the properties that make it effective. very interesting what will happen in the future with honey in wound management. There is a web site http://www.worldwidewounds.com  excellent website-- totally awesome wound care information. Highly recommend to all. There is an article on the use of honey in wound management:

Hope you have fun reading the info from this site there is a wealth of info.

Best Regards,

Jamie B. Pinnock, RN

Mississippi

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Hi:
Wound Expert is a pretty good program for wound care documentation. Web: www.woundexpert.com. In addition to wound assessment notes. The program allows for multiple reports etc. An excellent wound management tool.

Best Regards,

Jamie B. Pinnock, RN

unsigned

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Hi,
Use of Accuzyme (or any papain-urea topical) can irritate healthy tissues. Try to keep it only on the non-viable tissue. I use it carefully, and stop it when I feel that the rest of the debridement can be accomplished by autolytic means.

Vicki, MSPT, CWS

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Hi:

According to Healthpoint, Accuzyme is tissue specific so therefore it only works on devitalized tissue. You may want to visit Healthpoint's web site
ans check out the product info or contact the company directly.

Best Regards,

Jamie B. Pinnock, RN

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Accuzyme is a potent digestant of nonviable protein matter but is harmless to viable tissue. It's one of my favorites. Donna Cameron RN WCC

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Accuzyme, or any enzymatic debrider, is pretty specific to necrotic tissue. However, it can macerate periwound skin if it gets on it. For an authoritative source to end the argument, look at the package insert.

Renee C,, MSPT, MPH, CWS

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Accuzyme does not harm healthy tissue, but should be used only on necrotic wounds. If the wounds are healing with little necrotic tissue, I may use Panafil which facillitates wound healing and has some papain urea as well (main ingredient in accuzyme). Hope this helps.

Lisa MPT, CWS

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Accuzyme, if properly applied to necrotic tissue should not harm healthy tissue, however I have seen it put on wrong and had a wound grow from 2x2 cm to 3x4 cm over night. If you are truly worried about it being put on healthy tissue you might want to look at Panafil (same company makes it) it has the same debrider but has copper (strengthens and decreases odor) and other components that "feed" healthy tissue. I have used both and see the same debriding results from both.
P.S. Both are coming out in a spray soon to prevent over application.

Tina (wound care nurse/ L.V.N.)

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As I understand it, Accuzyme is for placement on necrotic tissue only. Once the wound is debrided, you can change to Panafil which is a combination granulation stimulant and debrider. This information I once received from a distributor of Panafil & Accuzyme.

Lisa H. LVN
Lancaster, CA
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The sales reps will tell you it does not damaage healthy tissue. Clinic use will tell you otherwise at times. I have seen it irritate periwound intact skin. I have not seen it hurt new granulation tissue in the wound bed, however. Just be sure to protect the periwound skin properly and make sure the patient or caregiver is aware of proper application.

PS - sales reps will also tell you the burning is transient - lasting only 10-15 minutes. That doesn't happen all the time either. Varies from patient to patient and some simply cannot tolerate it. Good product when it can be tolerated. Becky, PT
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Hi there,

Accuzyme should not be use on granulation tissue.
Accuzyme works well on slough or necrotic tissue but should be discontinued once desirable granulation tissue appeared, prolong use will cause burning and inflamation sensation, the pt. will definitely let you know when it started to feel burn! Hope this help.

Telina, RN

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accuzyme is motly used for wounds with necrotic tissue....but if theres presence of some granulating tissue...u may use panofil......there are chances of damaging the healthy tissue if you continue using accuzyme--- unsigned

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Leg ulcers can have a myriad of causes, underlying etiologies. A vascular assessment would be a good place to start: ie;venous stasis vs arterial or mixed dz. Hydrogen peroxide could even inhibit healing. If a vascular assessment reveals ABI's -wnl's, compression therapy may be in order. There are many products that would be applicable to use for local wound care@site of lesions, with a compression component. The increase in edema, while ambulatory is a telltale sign! (just to mention there "ulcer care" compression hose/stockings). The wounds should be also considered for bacterial burden, although they may not be truly clinically infected. As a holistic approach, other aspects of wellness must be considered, such as diabetes control, weight reduction, nutrition, exercise-some times lower extremity edema is the result of dependent positioning (sitting,standing) as opposed to walking or elevation of extremity. The key here is knowledge of underlying etiology, selection of appropriate wound care products, and especially participation of patient in the healing process. It may take some trial and error, or changing method of care to progress these wounds to healing thus limb preservation.
Wayne Best,LPN,W.C.C
U.S.D.V.A

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In my experience, peroxide is very intrusive to good tissue killing the tissues ability to reproduce. It sounds to me that a combination of compression and wound protection is the key. You should clean the wound gently with saline or sterile water. He needs to wear stockings at a minimum to reduce the edema. Some local DME providers should carry or be able to order some stockings with a zipper to make them easier to get on and off without damaging the already fragile skin. Edema is very detrimental to healing tissues, it makes it extremely difficult for good blood to get in and bad metabolites to get out creating a great environment for bacteria. Is the wound red or yellow? If its yellow, you need some type of enzymatic agent such as Collangenase or Accuzyme to break it down and progress to red. Be sure to use a combination dressing due to the increased exudate (wound fluid). If they are red or pink, controlling the swelling is the first step to healing. If there's any odor, controlling the bacterial burden will help the healing process. A good topical agent is silver. It is not invasive to good tissue but is a little expensive but should be paid for by insurance. Silvasorb, Acticoat are a couple of those dressings. They can be left on the wound be for up to 7 days. You could try a combination of the Silver and alginate to address the extra drainage. The key to any wound healing is blood supply, which edema reduces dramatically and wound environment. If you can control those 2, you should see a steady healing process. Sometimes, also, a wound needs to be jump started with debridement but I think discontinuing the peroxide will do wonders for the wounds appearance and healing potential. If your husband is still working, a wound center is unlikely going to fit into his schedule. A consistent, at home treatment is an excellent substitution.

Pam Craft

 I am a registered physical therapist with 12 years of wound care experience.

Pam

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Harriet, I don't want this answer to sound mean because it is not intended to be - it is intended to be an honest, objective answer to your question. Your husband needs to lose weight - period, the end. He is the best answer to his own health problems. He needs to take care of himself or he will be looking at an amputation in the not so distant future. He may have a combination of arterial and venous disease and everything goes against healing when you are overwieght - especially when you are diabetic. You will be further ahead washing the wounds daily with a mild soap (i.e. unscented Dove) and water and applying antibiotic ointment, dry dressing (no tape on the skin). You will need to have a complete assessment of the arterial and venous status at a reputable wound center. Call your area hospital and ask to speak to their ET nurse - he or she should be aware of the best wound care in your area. Again, I cannot emphasize enough how important it is to your husband's overall health that he lose weight. His primary care doctor should be able to refer him to a good weight loss program if you don't think you can do it on your own. I wish you the very best. Becky, PT

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You need to see a specialist for this problem. He should have vascular studies done to see what kind of circulation he has in his legs. If he has artery problems, he will be treated differently than if he has vein problems. A specialist is needed to decide what to do because usually people in your husband's situation have both artery and vein problems, making healing difficult. Your primary physician is not going to be able to help you very much, so find a wound center near you. J McDaniel RN CWOCN

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Harriet,

I would recomend that your husband see a vascular doctor and have some ankle pressures measured. It sounds like he has a problem with venous insufficiency. If this is the case, he may need something like a pressure stocking or uni boots or profore dressings to heal his wound. With venous insufficiency the compression will help the leg to heal better.

RachRN

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I would first get non invasive vascular studies including an ABI (Ankle Brachial index) to find out blood flow. He may however need a toe pressure study if his arteries are incompressible. I might also recommend a venous reflux and doppler to rule out a DVT and see if venous insufficiency is another culprit. If he has palpable pulses, feels better when legs elevated it may be venous insufficiency which is treated with compression therapy. I would recommend seeing a vascular physician or somone who can point you in the right direction. If you go on the website www.aawm.org
you should be able to find a wound specialist in your area. Meanwhile, I personally would not use hydrogen peroxide, but certainly saline is a great choice. Good luck to you.

Lisa PT, CWS

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If your husband has had vascular studies to see if he can tolerate compression and the answer is yes, he needs to be wearing compression stockings to reduce the edema. Peroxide is not recommended for wound cleansing. Normal Saline is a better choice. There are better products for venous stasis ulcers such as xeroform gauzeor panafil ointment to aid in wound healing. Eliminating the lower extremity swelling is the key to healing these ulcers. Seeing a vascular specialist should be your first move and go from there. When I worked with a wound care center these are some of the choices that were offered.
Jean Barnes, LPN

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1- CALL THE NEAREST NEW YORK HOSPITAL AND ASK THEM FOR THE NEAREST WOUNDCARE CENTER.
2- STOP THE PEROXIDE, IT HINDERS THE HEALING PROCESS. IF ANYTHING REPLACE THE NEOSPORIN WITH A HYDROGEL LIKE "INTRASITE GEL" BY SMITH & NEPHEW OR SOLOSITE GEL BY MEDLINE INDUSTRIES. BUT THERE IS GOING TO BE A DELAY (OR MAYBE EVEN A NON-HEALING) OF THE WOUND IF THERE'S EDEMA, SO TRY AND GET THE LEGS EVALUATED FOR THE POSSIBILITY HE MAY NEED COMPRESSION. AND ELEVATE LEGS HIGHER THAN THE HEART LEVEL.
GOOD LUCK,
AMY PASTOR RN CWS.

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Hi,
It sounds like your husband pobably has insufficiency ulcers and needs to see a wound specialist who can decide how to best proceed. Without seeing the wounds, I would guess that they are venous insufficiency, and might benefit from some sort of compression therapy (ie wrapping, compression stockings, or sequential compression via a pump and sleeve). However, you need to make sure you get the correct diagnosis. The wounds could be arterial insufficiency ulcers, or even something else entirely, and compression could be contraindicated. Make sure he has his arterial blood flow assessed before someone just starts tightly wrapping his legs (I have seen this happen over and over).

If he has purplish pigment to his leg skin, that's a hint that his wounds may be venous insufficiency. Those wounds usually are irregular shaped and drain a lot of fluid, and need the compression to heal. Arterial insufficiency wounds can be healthy-looking, but just refuse to heal over, and sometimes people have to have surgical intervention to improve the blood flow to the limb.

Find a wound specialist who will talk to you, answer your questions, and explain things to your satisfaction. Clinicians who know wounds should be happily willing to answer your questions.

Vicki, MSPT, CWS

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Go to www.aawm.org or www.wocn.org to find a certified specialist in your area. There are lots of wound specialists in NYC. It's hard to tell what needs to be done based on this brief post, but he likely needs some more advanced care than what he's been doing so far.

Renee C., MSPT, MPH, CWS
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Hello

Your husbands wounds need a holistic approach to help them heal. Firstly is his diet good and are his blood sugars well controlled? Having appropriate blood sugar is absolutely essential in the healing process! Wounds in diabetics are notoriously difficult to heal! Does he see a dietician? - he may need some extra protein supplements to help him out! Does the wound appear infected, has it been swabbed recently? Do you have any tissue viability nurses or wound care clinics locally?

Here we advocate a minimal cleansing policy - if you are doing the dressings at home just warm tap water in a bucket for a soak is fine. If the surrounding skin is very dry then add an emolliant to the water. Is the area around the wound boggy use a barrier cream like cavilon which will protect the healthy skin from maceration. Last of all the dressing - we tend to use iodine based dressings such as iodoflex (smith and nephew) or inadine (johnson and johnson) for diabetics change every 3 - 7 days depending on the wound. Obviously you'll need a secondary dressing to secure this - something like a simple adhesive foam like allevyn should be fine!

Hope this helps - Fiona Hill community nurse Uk
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Dear Harriet, I am sure you have heard all this before, but your husband is at risk for many other problems in addition to the leg ulcers. His weight reflects poor eating habits, as does his increased cholesterol. His hypertension and diabetes combined with high cholesterol and insulin injections are a heart attack waiting to happen. He MUST find a way to lower his weight, blood pressure and cholesterol. This will also reduce his need for insulin. An insulin dependent diabetic is at great risk for leg and foot ulcers, possible amputation due to the non-healing sores, retinal problems, and cardio-vascular problems. The problem is not the leg ulcer, but the underlying diabetes. Diet and exercise are going to help him immensely. If he is on his feet a lot in sales, surely he can find a few minutes several times a day to sit down and elevate his legs. He should ask his physician about compression stockings that will help the return of blood to the heart. He needs to plan his food, and take it with him if possible. I know all these things are very hard, but it is his life at stake here! Please encourage him to see a diabetic educator, and a endocrinologist physician. Maybe you could plan meals together, and go for walks on the week-end. My son in law got off insulin, lowered his weight by 30lbs, and lowered his cholesterol just by changing his eating habits, and slightly increasing his physical activity. He no longer buys food at work, and my daughter has lost weight too, by cooking differently for her husband, and walking with him! Maybe it can work for you. Wishing you well,

terrigene schmidt RN,BA
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Beloved Harriet Arthurton,
I would advise at first to make a vascular appraisal of the inferior limbs (Echo Color Doppler), subsequently instrumental all'indagine will be able to
be taken in consideration the elasticizzate possibility to carry out a handwraps for elastic jam by means of bende or through stocking jam specific.

Cordialità
Frank Dr. Ovidi
ITALY

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STOP USING PEROXIDE!!!!! this can damage the newly developing tissue. are you seeing a wound care specialist? neosporin is an antibacterial are the
wounds infected? ( red, pus or yellow drainage, hot swollen ect) ? you need a professional to guide you in your decisions for treating these wounds.
god bless,
Marie S. RN

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I have many insulin dependant pts, we have the most problems with elevated blood sugars if your husband can keep his below 160 or so he may have more sucess healing. You may want to consider sliding scale insulin dosage until the wounds have closed. We also are using compression stockings that have zippers, these can be helpful in keeping a dressing in place and are worn more consistantly by the diabetic's because of ease of application. Good Luck with your spouse. Nick WCC Wisc. Veterans Home