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This would be called a Kennedy Terminal Ulcer. It is shaped like a pear with a yellow appearance usually within 2 wks. of death. There is a website you can look at. www.kennedyterminalulcer.com
Cheryl

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The wound is called a "Kennedy Terminal Ulcer" and is pearshaped - ir has irregular borders and sudden onset - it is usually on the sacrum - they start out larger than other pressure ulcers and rapidly progress -

Best Regards,

Hilary Tobin, ARNP

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This particular wound is called a Kennedy ulcer.
Elsy Stiebel ANP New York

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The ulcer that you are referring to is called the Kennedy Terminal Ulcer. It is described as pear-shaped. It was described by Karen Lou Kennedy. It is on the sacrum, coccyx or ischium with sudden onset and it is stated that death usually occurs within 2 weeks unless delayed by IV fluids or other means. There is a pictorial guide by Gaymar titled "Gaymar Pictorial Guide to Pressure Ulcer Assessment". You may be able to order through www.gaymar.com

There is a lot of discussion whether or not all pressure ulcers are preventable. Regardless, everyone agrees that to even have a remote chance of proving that a pressure ulcer is development you must document your risk assessment and preventative measures. If the preventative measures (such as frequent turning or assuring adequate nutrition) are not consistent with end of life goals such as pain control, then the likely outcome of pressure ulcer development must be discussed with the patient and family and documented.

I hope that this helps.

Thanks. April Kuhlman RN CWOCN

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What you are referring to is a kennedy terminal ulcer and it can be shaped like a pear and is usually on the sacrum. It can include the colors red, yellow, black. The borders of the ulcer are usually irregular. This ulcer has a sudden onset and most patients die within 8-24 hours of onset. For reference see "wound, ostomy, continence secrets" by Milne, Corbett, and Dubuc.

Sherrilyn Shannon RN, Clinical Nurse Manager in LTC

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Many more people sent answers to this question with similar responses. Thank you. You taught me something !

Dr. Allan Freedline
 

(Laundry)

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have you had clients with MRSA? If not, don't worry about it. If you have, perhaps their laundry can be stored and cleaned separately then wash their clothing with a 10% bleach solution (won't work for colors) or increase water temp for their clothes only.
Chris Berke RN CWOCN

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Arlene,
I would suggest a silver dressing. Sometimes with chronic wounds bacteria can keep it from healing without it becoming infected. The silver dressing will decrease the bacteria load by killing over 150 different bugs. so with his skull exposed he for sure need infection control. There are several types out there and over the counter. If I can suggest a dressing it would be would be Arglaes - made by Medline, its a sticky thin film, if you can trim his hair around the wound then apply the arglaes, It can be changes every 7 day or if leaking.

I hope this helps
Sherri Merrill, RN WCC

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aloe vera may help
kumkum
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 Liz Willson-Chandler RN, Wound Healing Specialist, RSA

The wounds on your husband’s skull may take a very long time to heal since radiation destroys the capillary bed and deeper tissue for the remainder of his life. This tissue is very difficult to grow.

Some points to consider:

1. Ask a Reconstructive surgeon for his opinion on a free flap (best option), skin grafts are not strong enough to survive radiation.

2. Ask a therapist to debride the senescent cells off the margins of the wound.

3. Lazer treatment may aid in healing

4. Keep ALL pressure off the area, do not allow pressure on the area even when your husband is sleeping. This can be achieved by tying tennis balls into his T shirts whilst he sleeps. Simply place the tennis ball in the location of the T shirt which would cover the area that you don’t want the patient to lay on, secure the tennis ball in the T shirt with an elastic band. Ie. If the wound is on the back of the head, the patient should not lay on his back, therefore place the tennis ball in the centre of the back of the T shirt and secure with an elastic band.

5. Prevent the wound from becoming too wet, if the margins become white, the wound is too wet. Drier wounds heal better than wet wounds, however moist wounds heal fastest. The margins should always be pink.

Hope you win this one!

Liz, RSA
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Hi Arlene:

These wounds are difficult to heal because the tissue has been damaged by the cancer and the radiation. I would have to see this wound to make any specific recommendations. I do know that Biafine gel is a very good dressing for radiation wounds ---it is very soothing. If bone is exposed –it needs to be kept moist. What you are currently using appears appropriate. Consider nutrition for overall health support. After the body goes through such an inury one needs to help the body to do the best to repair itself. Have you spoken to the surgeon about short and long term goals? I would recommend this.

Jamie Pinnock RN CWCN

Cheryl

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Susan,
Suggest you look into if he is bladder incontinent, hygiene practices (can he effectively use a urinal); also I've seen this also in some patients who were
obese and the scrotum is irritated by the fat pads with the legs rubbing against the scrotum. Do they look
anything else but red, or do they look yeasty? Management depends on what other areas you need
to look at to consider as contributors.
Maria Carunungan, DPT, CWS

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You might try Xenaderm, an ointment from Healthpoint pharmaceuticals. It works nicely on inflamed or scored skin, with no dressing needed.

Vicki, MSPT, CWS
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I prefer to use a barrier ointment such as zinc oxide or a product containing peruvian balsam on this type of problem.
Debby RN/WCC

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You really don't provide enough information. I assume the pt is incontinent of urine and stool. what is the mom using for absorbency and is it a product that wicks the moisture away from the skin? Is she changing the product when it is wet (I often see staff/families try to change briefs only every two hours but change should be determined by need - have you had mom complete a voiding diary to determine if there is any pattern to the pt's elimination). Finally, is mom using an appropriate skin cleanser with each change and then following up with a good skin protectant with dimethicone or petrolatum?
chris Berke RN CWOCN

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You might try Xenaderm. It is perfect for these type of problems.
Cheryl Treatment Nurse
Leah

(Gluteal Folds)

You are correct, you need to keep the wound open and allow it to heal from the inside out. There are a lot of impregnated gauzes on the market that can be cut to fit in the wound, I personally would look at DermaGran impregnated gauze, it comes in a 2x2 and the type of material used doesn't fray went cut.
Tina (L.V.N./wound care nurse)

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Hi Dona. I am not a health care professional but I had similar story to yours. I am a 42 year diabetic and I had two ulcers on my feet. They were treated with "everything" IV antibiotics, creams, Oasis, surgical debridements, etc., etc. Nothing worked after 2 years. I turned to Maggot Therapy and healed them both up and my osteomyelitis, in a few months. Sounds gross, yes, but it works and whatever it takes. These a sterile maggots, raised just for this purpose. They also have been FDA approved. Please check out our website for more information. Good luck.

Pam Mitchell
Board of Directors BTER Foundation

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Donna,
I suggest you contact a wound care specialist who can coordinate your care with your rheumatologist.
You are probably immunosuppressed with the RA meds which can happen. This would delay healing,
but, delay may also be due to other causes. Where is the legs are the wounds? Do you have edema and are your legs discolored? You need a
CWS to identify what kind of wounds you have (whether venous, arterial, diabetic, neuropathic?, etc). Management is different for each type and immunosuppression is only one factor to consider. Other factors are
nutritional status, other meds (some steroids can actually delay healing and are given help from some nutritional supplements to counter effects), stress (which is common in RA), your activity level, etc.
Best combination to look into your wounds- rheumatologist and wound care specialist in your case.
Good luck,
Maria Carunungan, DPT, CWS

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Has the wound been biopsied? Have you ruled out CA and pyoderma gangrenosum?
Debby RN/WCC

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Have you tried hydrofera blue?

unsigned

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My name is John Davis and I too have a stasis ulcer on the interior of my left calf. It has been the same size for the last 3+ years.
I have been to 3 vascular surgeons; 12 months of wound care at Hoag hospital in Newpor Beach; and have tried all the debrieding compounds on the market with NO success.

I am hoping to find a physician who will prescribe microcyn as a new method of debrieding. I have read remarkable results using this solution. It was approved by the FDA this month.

It is truly a shame that modern medicine cannot offer a cure for an open wound.

Good luck