My success, with sacral wounds has been to scrub the wound bed with Dove
soap and steral water. Apply solosite gel in wound bed once a day dress with dry drg. If there is slough in the wound I use same cleansing method,and apply Accuzyme in wound bed qd.

M.Friend LPN/Wound care nurse
 

-NEXT REPLY-They should just be putting the VAC sponge in the wound and no aquacel AG. If they want a silver dressing, the VAC sponge now comes with silver in it. IT sounds like the surroudnign skin is getting too wet from the moisture of the black VAC sponge; this can be avoided by using skin prep on the surrounding skin an bordering the wound with a barrier such as duoderm or stomahesive wafer. COrzolek RN BSN CWOCN

-NEXT REPLY-

I am not familiar with vacon, However, if you intended to write "Vac on" maybe I can help. Sounds to me you have a moisture and fungal problem. The KCI vac I am familiar with is great using the black sponge if the wound does not have tunnels or structure exposed. Otherwise, the white "versitile" foam in the deep areas and black foam on top is beneficial. Either way, you may have to hold the vac for a week and do frequent dressing changes using only plain aguacel or "DAMP", not wet saline dressing in the wound and dry on top. FREQUENT meaning 2-3 times a day if a moisture problem especially if she is incontinent or involuntary of stool. She may even benefit from having a urinary catheter for a short period if it is a problem. Diapers that entrap moisture is also a big no-no during this time. Fungus love the warm, moist areas on the body. Maybe her doctor could prescribe a good antifungal for the red intact skin around the wound, and maybe an oral Diflucan. A combination medication of Mycolog II and Silvadene (50:50) is a favorite of one of our wound care doctors. When the "Vac Vacation" of one to two weeks is over, and the redness is gone, I suggest when using the vac, not to use the Aquacel AG (bearing in mind I do not know what type vac machine you are using) and just use the sponges. Also might want to put the suction setting up higher. Sounds like the moisture is getting under the drape and not going to the canister. Don't forget to check mom's nutrition. Just because she may look "healthy", doesn't mean she still is not malnourished. People with underlying stresses such as illness, injury, burns and open wounds have a much higher nutritional need. Get her prealbumin checked.
Georgana Lapmarado RN
Case Manager
St. Joseph Wound Care.

Jennifer,

There are several options. Here are just a few, and hopefully you will get some suggestions from others as well. I am a certified wound specialist and work with wounds and skin conditions, but I am not an IV specialist. Maybe you will get some good advice from some of them as well.

Tegaderm and Duoderm you mentioned are long wear dressings meant to be left in place for up to 7 days on wounds. And they can be very irritating to the skin if changed more frequently than needed.

There are antimicrobial dressings on the market that can used on the site, and some are non-adhesive – Acticoat 3 is one example. Cut to fit and cover with a dry cover dressing – you can change it every 3 days. For the cover, you can use a telfa+tape border island dressing that is waterproof, like CovRSite Plus. If they must use transparent film dressings for the cover, then they need to use skin prep every time underneath (see below).

You can also use a plain waterproof cover dressing with a mild tape border (like CovRSite Plus) for a cover.

There are 7 day antimicrobial dressings on the market, some specifically for IV and catheter sites – Acticoat Site (for pin sites and IV sites), Acticoat Moisture Control (this is a cushiony foam antimicrobial dressing). The Acticoat Site may be too small for his catheter, but the Moisture Control comes in larger sizes and can be cut to fit. These have no adhesive, so must be secured with tape or a cover dressing.

A less irritating adhesive or tape would be Hypafix or other low allergy tape.

Skin Prep should be applied to the skin under any adhesive – it protects the skin. Since his skin is so irritated already, he would need the No Sting Skin Prep (the regular would burn). Apply to skin before any adhesive and let dry completely before applying dressing. Very important if they are going to continue the frequent changes (which they will need to do if they are not using an antimicrobial barrier dressing, and may be required to do regardless due to their protocol).

Depends on what protocols they are required to follow and what will fit in with that. Infection prevention is crucial however, and I would strongly consider a potent antimicrobial barrier dressing if they are able to fit into their protocol.

Good luck to you and your son – I hope he continues to progress well. I empathize with you.
Lee Ann

-NEXT REPLY-

Jennifer,
It appears that a skin protectant would be of value here. I prefer to use 3M no-sting as it allows the cover dressing to adhere, protects the skin, but allows the dressing to be removed without trauma. Another suggestion would be 3M Cavilon barrier cream, which also allows dressings to adhere.

Douglas Ross, ACHRN, CWCN

-NEXT REPLY-

Have you tried a protective film before applying dressing eg Cavilon film dressing? Smith and Nephew are the manufacturers and would be happy to advise.

unsigned

-NEXT REPLY-

first I would not touch the area where tegaderm was removed
allow that skin to rest and breathe

also purpose of th e duoderm is to avoid removing and irritating skin
so duoderm can remain for a few days to allow skin to rest

a & d ointment is effective to ensure healing of any irritated skin around site.

unsigned

-NEXT REPLY-

Your son seems to be developing a contact dermatatis from the transparent dressings. Try using a different manufacturer such as Opsite. You can also put down a good layer of a no sting skin prep and switch to a Prima Pore type of dressing (Smith & Nephew), which uses gauze and a hypafix type of tape, (cloth type of tape). Virginia Montez-Ochoa, RN, CRNI, WCC.

-NEXT REPLY-

The most gentle product I know is the molicka products. There is a tape called Mepitac that was originally designed for neonatal nasal tubes. There other dressings are made of the same silicone adhesive called "saf tac". Don't know what his needs are for a dressing but look at the Mepilex Border, Mepilex (foam) and Mepilex lite. If it is that painful then infection should be ruled out as it may already be a problem. Good luck. unsigned

-NEXT REPLY--

Jennifer,

I am sorry to hear of your son's status. I hope he finds comfort soon.
Have you tried 3M Cavilon No Sting Barrier and alternate with Xenaderm.
If I can imagine how the site appears, I think this may help quickly.
If you forward a picture of the site, I may have a better idea of what to do.
Good luck and I hope for your son's quick recovery.

Drew Griffin WCC

-NEXT REPLY-

Hi Jennifer,
There is a drsg known as mepilex that I feel would help your son soooooo much. This drsg has safetac technology. This drsg has a silicone backing and will not stick to fragile skin or even wounds. It will adhere but does not pull the skin when it is removed. There is only one company on the market at this time that has silicone base products and that is Molnlycke Health Care. They could use the mepilex foam/cut it to fit /use mefix tape by molnlycke which also has the nice silicone backing or metapore tape. You don't use skin preps or removers with these drsgs. I run a wound care clinic and for me the silicone drsgs are wounderful and address something so important that is PAIN. Any help needed in finding a rep or getting any information than please e-mail me tbjolly7@yahoo.com . Good luck and I know you will see a difference.
Tammy Jolly

-NEXT REPLY--

Is she using no sting skin prep on the skin before applying the dressing? C Orzolek RN BSN CWOCN

-NEXT REPLY-

Would a piece of non-adhesive allevyn sponge, cut like a tube gauze fit around the tube to absorb discharge? It can be taped on with a small piece of hypafix tape for sensitive skin. This way when removed there is not such a degree of cleansing nec. Also a product called 3 M is wonderful for cleansing. Good luck. BEE

-NEXT REPLY-

Jennifer,Maybe if the nurse would try applying skin protectant to the area after each dressing change,clean area first before applying the skin protectant.You can also try using opsite dressing instead of tape or bandaide.The company that puts out skin protectant product is Smith&Nephew.
Xenaderm is also good for irritated skin areas this can be applied under the opsite dressing.

M.Friend LPN/Skin&Wound Care Nurse

Gelfoam is an absorbable local haemostatic agent and is used in surgery to aid in the control of bleeding. At times it is also used to control blood-ooze following tangential excision or escharotomy in burns.
Kumkum

-NEXT REPLY-

Versiva XC (Convatec product) is a gelling foam. It is a new product and Convatec should be able to provide you with the information you need. We find it very useful. It is hard to believe that a "thin" dressing like this works magic by absorbing large amounts of exudate, trapping it and promoting healing as well as it does.
Good luck
Julie Miller
Podiatrist, Melbourne Australia

-NEXT REPLY-

Gelfoam is a water soluable topical hemastat.
Dennis Woytowicz Rn ICU

You should arrange a consultation with a plastic surgeon to discuss if surgical closure is right for you. You may be able to have a myocutaneous flap to cover the wound with muscle and skin taken for an adjacent area. This will give you the strongest closure and help prevent future breakdown (verses natural closure). Scar tissue will never regenerate the missing tissue and is only 80% full strength after 2 years of scar maturation. You may not be a good candidate but you should have the discussion. Good luck, Michelle, PT,CWS

-NEXT REPLY-

Alan,

You ask a complex question. It appears that there are many factors that still need to be addresses and asked.

1. Was it a failed flap?
2. Were you completely healed?
3. Did you follow the recommendations of the surgeon or Wound Care Professionals.
4. How do you transfer now?
5. Is there shearing involved?
5. How long do you remain Out of Bed in the chair?
6. How is your nutrition?

Thats to get started. If you are a paraplegic, with a rotator cuff injury, how do you transfer?
Who, if not you, transfers you?

Drew Griffin WCC

-NEXT REPLY-

I'm terribly sorry for your discomfort. I work for a Hospice in Cullman, Al. Our compounding pharmacy uses something called "Skin Healing Bandage". I have seen this product heal tunneling wounds down to the bone. They sometimes add an antibiotic for persistent wounds.Following is their information:

Specialty Pharmacy
Cullman, AL
256-734-1170

Good Luck!

Tammy

-NEXT REPLY--

Hi Alan,
You are in a tough situation. I don't know if they did a flap versus having the wound close on its own (secondary intention). If a plastic surgeon does a flap, the skin is a little stronger. There is a company called Huntleigh which bought Pegasus. Pegasus makes a low air loss alternating cushion that costs out of pocket about $4,000, but it does help. However, you need to make sure you continue to do pressure relief and offloading while sitting up. Pressure relief and offloading are key and your skins tensile strength will never be as strong as it was initially (only about 80% at max),  Another option is a High Profile Roho Cushion which is about $425, but again you have to continue doing offloading and gradually building up pressure and intensity of the damaged wounded skin. Best of luck. Lisa PT, CWS
-NEXT REPLY-My first question would be how well are you eating and are you taking any vitamin supplements? This is always a critical issue that has to be addressed first before any treatment can be successful.

The second issue is are you sleeping? This is when most of the healing takes place. Are you so stressed out that your body is reacting to the stress? All these things affect wound healing as much as using the right dressing and treatment and pressure relief.

Please read the story on the website under the Nutrition section. It may help answer your questions. Don't give up. There is hope to live wound free.

Yvonne Asay LPN

-NEXT REPLY-

Hi Alan, I am a former resident of Cocoa Beach so I am very happy to try to help you out. I believe that maggot therapy might be the answer for you. After all maggot therapy is used often with paraplegics for pressure ulcers. I am not a medical professional but a patient advocate for maggot therapy and on the board of directors for the BTERFoundation.org which educates, promotes and does research in bio-therapeutics. We also give grants to those who do not have medical insurance or cannot afford treatment. I am a former patient of maggot therapy and can tell you how great they worked. They healed up my diabetic stage lV ulcers and also the bone infection in both feet. Maggots are FDA approved and do three things at once. They eat JUST the dead infected tissue, excrete enzymes to promote healing and kill all the bacteria, all at the same time. Amazing! Please feel free to contact me for further information through our web site or my email Pamsmaggotinfo@aol.com

Thanks and Good luck,
Pam Mitchell
Patient Advocate
BTERFoundation.org

-NEXT REPLY-

Hello,
It sounds as if she is healing well. You should always follow-up with your appointments. I hope she is showering. Many do not realize how therapeutic water is when it comes to healing. The wound may not require packing but still needs to kept moist to continue the healing process with a hydrogel.

Harnitha V. Armstrong, RN,BSN,CWN,MA

--

Dont risk it - get it seen

unsigned

-NEXT REPLY-

Get some nugauze at the medical supply store and lightly pack it yourself.
Cover it with a dry gauze dressing and secure with medifix tape. This will work until your able to get back to the Dr. If redness to the surrounding skin, warmth and increased pain occur, then it is probably infected and she will definately need to be seen. Susan RN BSN Wound nurse

Stephanie,
Packing the wound would be appropriate to prevent closure, leaving a cavity. Your goal would be to heal the wound from the base up, and then allow closure. Sometimes, a wound can have a large amount of drainage due to a low level bacterial burden, and a period of antimicrobial dressings can get this into check and healing can resume. I would also ask if the area has been previously radiated due to your cancer, as radiated tissue is hard to heal without the benefits of Hyperbaric Medicine.

Douglas Ross, RN, ACHRN, CWCN

-NEXT REPLY-

Physicians usually drain seromas, though repeated aspiration is a risk factor for development of lymphedema.

Are you wearing any type of compression over the area to try to reduce the dead space available for fluid accumulation? Also, it is necessary to be aware that many bras can cause constriction and circulatory compromise that limit lymphatic drainage of an area and, especially after axillary node dissection and the impaired lymphatic transport that results, can exacerbate fluid accumulation in a seroma. The entire upper quadrant, not just the arm, can be affected. It would be a good idea to consult a lymphedema therapist who can evaluate your needs for compression, make recommendations on an appropriate trunk garment, and teach you a simplified version of manual lymphatic drainage and exercises to promote drainage of the area. Sara

-NEXT REPLY-

It does sounds right and it is certainly the right thing to do. You don't want to have abcess cavity (assumed infected or not) to collapse unto itself, . it would certainly then take longer to heal.

Ahmed

-NEXT REPLY-

Yes the area needs to heal from the bottom up - problems if it closes over the top of wound.

Helena

-NEXT REPLY-

Hello,
Any open space (that is considered dead space) needs to be packed. Depending on how deep and wide it is will determine what to use and how much drainage there is. An alginate will absorb the drainage and keep the wound moist for healing and a packing strip impregnated with a hydrogel can also be used.

Harnitha V. Armstrong, RN,BSN,CWN,MA

-NEXT REPLY-

in fact , you have infected wound and you must do wound cultur to be in the safe side

Mohammed

-NEXT REPLY-

Sounds like your Doctor is on the right track. By packing the wound it acts like a wick and actually sucks out the infection or drainage allowing for the wound to heal. Sounds like he is on the right track. It would be a good idea to have a culture taken of the drainage, which is done by swabbing the area with a special swabstick. that way they can check to see if there is infection there and what the infection is sensitive to as far as if it needs an antiboitic. Definitely see or talk to your Doctor about this if it continues or gets worse. Did they give you signs and symptoms of infection to look for?  reddened areas, swelling, temperature, discoloration of drainage or possible redness going in a line from the infection, .if that happens she needs to get in right away to be seen. Are you cleaning this every other day or everyday?  Good luck, wounds are not easy to deal with but with proper interventions eventually you will get better. Please always keep in touch with your doctor. Penny, RN, MIC (minor injury center) worked in wound clinic for 1 year. In the Minor Injury clinic we deal a lot with abscesses and they sometimes take a while to heal up. Keep it as clean as possible following your Drs instructions to the max. Best to you. Unsigned