Sharon Rowe

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unsigned

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Lisa-
Try Xenaderm - it's an ointment that you don't have to cover and can be applied several times a day (after incont. of stool). Check out the web site healthpoint.com
Tina (LVN, wound care nurse)

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I think that a very good product for a sacral ulcer that is not necrotic, has small amount of drainage, and no evidence of infection would be duoderm, a hydorcolloid dressing that can be changes every 3 days, and prn. This type of dressing will prevent stool and urine from contaminating the wound, and provides a moist wound healing environment.
Donna Gardner, FNP-WOCN
New York

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Hello,

I've seen curasol soaked nuguaze strips cut very thin and parked very lightly into the wound (very lightly) work pretty well for the type of wound you mentioned.

V/R,

Chuck DiTullio R.N.

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I would use a hydrogel with a cover dressing. The hydrogel with hydrate the wound bed and a cover dressing to assist with keeping any bowel of the wound. It is important to make sure that the skin is dry to the dressing with adhere well. Jennifer, PTA

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Try a stomal therapy pad to protect the ulcer. This creates a barrier at the wound edges and then simply put a light dressing over the top.
Julie Miller
Podiatrist, Melbourne
Julie

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With a sacral wound so small and the patient is incontinent I would suggest to use a barrier OINTMENT It would keep the dry wound area moist allowing granulation/epithelization and easy to clean off after each bout of incontinence. To reapply barrier ointment {suggestion-Calmaseptine ung It will stay in place with just using a 2x2 to cover it Very cost effective with good results Using tape is not a good idea when the pt is incontinent,it could actually cause further damage

Janet RN/ET CWCN/COCN

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Hi, if the patient has full care then as she is being checked regularly, this ulcer should not need a dressing, but to be thoroughly cleaned when
soiled. If you have to put anything on it I would use a film dressing such as Onsite, this is very kind to skin on removal.
M Keeling S/Nurse

I recommend d/c'ing the wpl. If the bone is white and healthy, it can granulate under the right conditions. Use a moist dressing. VAC can help the granulation tissue form. If the bone is yellow/gray and dessicated, it's dead, and the surgeon will need to go further.

Renee Cordrey, MSPT, MPH, CWS

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Becky.....if the wound is clean, a whirlpool is contraindicated and preventing any hope of area closing....depending on how much bone is exposed, the patient sounds like a candidate for some kind of graft.....if the edges are somewhat approximated and not totally healed over, you may get some epithelialization encouraged with a moist wound bed environment (hydrogel) covered with a dressing for protection.....maybe a referral to a wound clinic is in order. mao, PT

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Might be a possible solution, I recently assisted healing over an exposed bone by sprinkling comfrey root powder, obtained from a health food store, over the entire area. There was about 3 1/2 to 4 inches of bone showing and within 1 month this has filled in with muscle tissue and the skin is following over it. The area needs to be moist so the powder will adhere.

S.L.Willis, Arroyo Grande

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hi in regards to your post my husband had a wound that the bone was showing through and 2 yrs i spent trying to get it closed although everyone is differant he ended up at a wonderful surgical podiatrist that operated and it has been closed evr since if it was ,nt for him my husband would of lost his foot hope this helps, Dee

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I am a patient of a PT in Pullman WA. The treatment I am receiving that is working for me after having an open wound for 5 years is low impulse electical therapy.
I have poor circulation and my immune system has been compromised but this treatment is working and I am nearly healed after only 10 weeks of 1/2 hour of therapy 3X's per week.
Sincerely,
Judy Benson

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I am not big on wp once the wound is clean. There are products out there that will assist with the granulation of tissue. Are you doing the wp daily? This may also decrease the healing process. Wound beds must stay moist but not wet. Jennifer PTA

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My first reaction would be to D/C the wp secondary to having the extremity in a dependant position which may compromise an already poor blood supply. The wp may be too harmful to the granulating tissue. I would choose a less force full choice of water irrigation such as pulselavage. Please see a Zimmer sales rep.

Keep the exposed bone moist with a suggested xerophorm petroleum dressing. Check for osteo.

Tim Biggs P.T.A.

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I am Australian Podiatrist and deal a lot with amputated bits of feet. I am curious for more information about the whirpool therapy. For exposed bone areas I would look at Dermagraft (Human dermal tissue replacement) Contact a Podiatrist (DPM) in your area.
regards,
Julie

I don't like them. I don't like the mess they create on removal, the smell or the appearance of all that exudate mixed with dressing breakdown. My patients think its puss. I'm thinking about using a foam dressing as my first line treatment on most wounds.

Can you offer thoughts on why I should or should not get rid of hydrocolloids?

Alfred, MD

I have been a Registered Nurse for 18 years and NEVER saw improvement with Hydrocolloids. They are in my opinion only good for palative care, covering up a wound to keep it from sight! As for you comment about using foam as a first line, I would hope you
evaluate every wound individually, determining the stage of healing, presence of infection and management of exudate. Some wounds need an Alginate (for absorption on wound drainage) others may need a moist dressing such as wound gel to keep the wound bed moist and promote healing. If you are not comfortable with individualizing the treatments maybe a referral to a local wound care center would be a better choice.
Marie RN

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Those are problems with hydrocolloids. But, if you educate your patient before using it that it will look like pus, but it is the bandage doing what it's supposed to do, they're usually fine with it. I use hydrocolloids inpatient, but usually don't in outpatient. I've come to love the thin foams, such as Allevyn Thin (S&N), Flexan (Bertek), and Mitraflex. They don't macerate like the hydrocolloids, and are great with autolysis.
Renee C, PT, MSPT, MPH, CWS

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Hydrocolloids are moisture retentive dressings and therefore great for softening dry necrotic tissue.
Foam dressings only manage exudate and keeping a moist wound environment, they do not aid with autolytic debridement.A good system to use is the CDE colour, depth and exudate
-Pink wounds need protection
-Red wounds need exudate management
-Yellow wounds need debridement
-Geen wounds need antibiotics and safe topical antiseptics
-Black wounds need debridement if the circulation is good and not a malignant wound
So deciding what a dressing must do for the wound first, will aid in deciding which dressing to use.
Exudate management is very important especially in chronic wounds, moist wound healing does not mean a pool of exudate, only that we stop the wound
from developing a scab so that epithelialisation can occur quicker.www.worldwidewounds.com have some good papers on dressing products

Helma Riddell

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I sorry, to have to disagree with you on hydrocolloid dressings. This type of dressing is indicated for certain wounds. The wound must not be infected, not a full thickness wound, and a wound that has minimal drainage. It does take some education on the appearance of the dressing, i.e. the drainage that sometimes develops under the dressing, but that is the very reason that wounds heal well with this type of dressing. It creates the moist environment that decreases healing time. I cannot tell you the number of sacral wounds I healed with this dressing, it kept the urine and feces out, and allowed the wound to heal, at minimal cost.
Donna L. Gardner FNP-WOCN.
New York
 

Nerve Decompression surgery is a procedure that has been utilized for many years. Most of the studies concerning its use have centered around the treatment of Tarsal Tunnel Syndrome, a painful condition in which there is physical compression of the Posterior Tibial nerve where it passes through a narrowing in the channel in which the nerve lies. Multiple studies have been performed over the years verifying its efficacy in the treatment of this problem; thus, this particular procedure is neither new, nor experimental. Rather, it is the standard  of care for certain nerve problems.

What is in question, relative to your inquiry, is the use of this  procedure for diabetic neuropathy. This is new, and large scale studies have yet to be performed. Early investigations have been rewarding, and because of the lack of definitive treatment options for painful neuropathy, a decompression procedure seems like a technique worth considering. Primary complications consist of infection (as with all surgical methods), delayed healing, and those associated with trauma to one of the many nerves branching off the Posterior Tibial. This can lead to a painful neuroma (when a nerve is cut and heals with excessive scar tissue) and/or numbness. Except for this latter possibility, none of these are considered terribly common when a fair degree of surgical expertise is utilized.

Dr. Conway T. McLean, DABPS, DABPO
Director, Dept of Podiatry, Home Physicians, Inc

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I have use Anodyne treatment with neuropathy and seems to be successful. It is an infared modality. I believe if you research under "Anodyne" there should be info on where you can find clinics with this modality. Jennifer PTA

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Sterile enough? There is no such thing!
An item is either sterile (the bottle's contents until opened) or it's not! If you open the bottle it is considered clean unless contaminated and should not be used for more that 3 days, assuming that it is used with aseptic technique. This means the cap is removed only long enough to pour the liquid into a receptacle for use and recapped immediately, and that nothing is dipped into or held against the lip of the container. Clean washed hands only touch the container.
Marie RN

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There's nothing I know of out there in the journals. There was a poster at a conference showing that they could culture out microbes
after 24 hours at room temp, and 1 week if refrigerated. Those are kind of standards, though there's little evidence support for it.

Renee C., PT, MSPT, MPH, CWS

I'd suggest you find a wound specialist to help your husband. www.aawm.org or www.wocn.org can help you locate someone near you.

As far as getting your experience, you have a few options. You can look into a CWOCN program. Many are distance or partial distance now. www.wocn.org for a list of accredited schools. Also, you can switch from a traveller position to a permanent one in a place where you can do some wound care under the mentorship of an experienced wound  clinician. Lastly, keep going to that con ed.
www.woundcaresymposium.com and www.symposiumonwoundcare.com are two
good ones. The www.aawm.org site has a list of con ed.

Renee C, PT, MSPT, MPH, CWS

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Hi Gerri,
I am a Podiatrist and I would recommend spending some time (even a day or two) in a Podiatry clinic or "High Risk Foot" type clinic that deals alot with Diabetic foot complications and amputations. You will learn alot in a short time and feel more confident to manage your husbands stump and foot. Look up your state Podiatry Association for possible clinics.
Regards,
Julie