JW

----

Dear JW:

Taking a shower will most probably not cause infection. However, it will retard your healing because the wound bed has growth hormone and other healing factors produced by the body and the water from the shower washes all of that away. The best way to handle such a wound is as follows:

1. keep the wound moist with sterile hydrogel;
2. change the dressing everyday;
3. do not wash or rinse the wound and remove the old dressing carefully. If the bandage is stuck moisten it with a lot of saline until it comes off easily.
4. check for signs of infection like, redness, odor, purulent discharge - if you see any of those go to your doctor immediately.

Remember that the wound needs to be left undisturbed to allow it to heal naturally.

You did not say if you have diabetes or any other problems with your circulation. In any event, make certain your blood sugar is at a normal level and be sure to drink enough water and eat adequate amounts of protein and vegetables. Fish is the best source of what you need. Also make sure you have enough vitamin intake. Good nutrition is vital for healing.

If you do have any circulation problems, you need to make certain that you are receiving medical care for that.

Sincerely,

Thomas A. Sharon, R.N., M.P.H.

----

Any open wound is subject to bacteria contamination. I have found that wounds in general heal in a moist environment. All necrotic tissue should be debridement by chemical of sharp method. I have found that a good product to use on all stages of wounds is Amerigel with a moist saline dressing cover. The package insert offers specific and easy to follow instructions. I have successfully used this product on all stages of wounds.

Dan Klein, DPM,CWS

---

I would seek a second opinion. Bactroban & wet-to dry are not even similar dressings. Wet-to-dry should only be used to mechanically debride. I can't recommend a dressing without seeing the wound, but it sounds like you may benefit from being seen at a wound clinic MD or by a WOC nurse if there is one available.Beth, RN, BSN, WOCN

---

1st wet to dry is no longer the standard of care for wounds. You may have a low level of bacterial contamination in the wound and a product with silver might be beneficial to use on the wound. it is antimicrobial and kills any kind of fungal and bacterial growth including msra within a 2 week period. you wan to keep the wound moist and warm to promote healing. there are multiple factors that can affect wound healing. you should be seen by a wound care specialist. unsigned

---

Wound care to the area depends on how the wound bed looks, how much drainage there is and if it is infected or just colonized. Usually hydro-gel dressing are the way to go if the wound is clean and non infected. If there is slough tissue, then you can use a topical debridement agent such as Accuzyme and/or sharp debridement. The collagen matrix dressings such as Promogran and/or Prisma (silver
added) are a great alternative and if the wound is not draining much, can be used over the course of the week until it saturated (based on individual basis) There are a multitude of dressings to use, but if you are paying out of pocket, plain old hydrogel/gauze is a good choice. Panafil is a good agent to use if the wound is mostly free of slough, it is promoted as a healing gel. Bactroban is also a good wound dressing, honestly, if you wound is not infected and regressing, pressure relief, and any one of many wound dressings will heal it. Showering is fine as long as you wash the area as the last part of the shower, pat dry and apply your dressing of choice. Good luck. Virginia Montez-Ochoa, RN, WCC

---

Wet to dry NS is pretty much outdated, and if your home health nurse was Wound Care Certified she should have brought that to the MD's attention. For pressure ulcers I use polymem, it only needs to be changed every 5 days or when 70% saturated. Get an MD order and have your Home Health Nurse bring it to you. If she doesn't know what it is tell her to read the insert, and she shouldn't be doing home health care if she doesn't care enough about her profession to stay current.
I haven't used wet to dry NS in years.

Patricia Seemann RN BSN WCC

---

In response to your question. From your posting it sounds as if some work still needs to be done.
The risk of infection is always a concern. If you a showering and cleaning the surrounding tissue I wouldn't be too concerned. Without being able to assess the wound, I would suggest being cautious with any form of scrubbing of the wound. Additionally, I would avoid most cleansers such as soap etc.
Can you describe more specifically, the location of the wound, (near the inside ankle or outside ankle)?

Additionally: ( not to pry)

- your age
- how long you have had this wound
- do you have a history of lower extremity wounds
- any other pertinent medical history
- history of smoking
- diabetes
- anemia
- how was this caused? Do you have a shoe, or boot that was too tight, or other irritating factors?
- more specific treatment history of this wound?
- can you describe the wound more specifically by % of colors ( red, pink, yellow, green, black)
- how wound you describe the edges of the wound? (punched out and round or even / uneven, flat )
- is the wound draining? how much (none, minimal, moderate, copious)
- did you have any studies done? (blood tests, circulation tests ie, ABI or vascular doppler studies)


I wouldn't be concerned with getting it wet if you wanted to take a shower.

Drew Griffin WCC

Pam

Peggy

----

No panafil is not harmful to healthy tissue, it actually promotes new tissue and blood vessel growth.

Katy Langness RN WCC
---

Panafil is an enzymatic debridement agent that works on necrotic tissue only not the good tissue.

Dan Klein, DPM, CWS

Andrea

---

Yes, Hyperbaric oxygen treatment.
I have heard it is excellent for healing wounds of this kind.
Julie Miller
Podiatrist.
Melbourne Australia

---

I love polywic for all my packings unless the wound is draining large amounts. It will clean up a wound and stimulate tissue faster than anything. Patricia Seemann RN BSN WCC

---

I would recommend going back to the surgeon for surgical removal of the hematoma. It is important to start the chemotherapy as soon as possible, and I am surprised the surgeon is not being more aggressive. Once the hematoma is removed an appropriate wound care protocol can be started. Hope this helps.
R DeLaney LPN, CWS, FCCWS

---

Hi Helene, Yes, I have a great suggestion. I am not a professional health care provider but I am on the board of directors for the BTER Foundation. I strongly suggest "maggot therapy" Maggots do not work on live tissue(cancer) but it does work after the cancer has been removed to help the wound heal up. I have spoken to a lady recently who used maggot therapy after a tumor was removed. Her doctors were amazed how clean and healthy the tissue was after treaments.The maggots have three actions. They eat just the dead infected tissue, they excrete enzymes to promote healing and they kill all the bacteria. They work and they are cost effective. Please do the research to learn about these amazing little guys. Gross yes BUT they do work and they are disinfected and sold just for medicinal purposes. Please feel free to contact me through our web site for any further information or help.
Pam Mitchell
Patient Advocate
BTERFoundation.org

Mohammed

----

Wow...did he have radiation to that area? Culture it...may just be a bioburden impairing the healing...I would need to see a picture of it it those don't help you. Patricia Seemann RN BSN WCC

---

There are many viable options, but one I would choose is a calcium alginate with silver (calcium alginate can absorb 20 x its weight and the silver is a broadspectrum antimicrobial).

Deborah Harris, BSN, JD, RN, CWCN, WOCN