Wound Care Information Network

 

 

December 15, 2003

Automated removal instructions are at the bottom.

Home Page

 

 

Sponsor's message:
"Change your life in one week"...Wound Management Certification Seminar

Test your knowledge...
What is a healing ridge?
.(answer)

 

Wound Care Education Institute presents
Wound Care Certification Course
One week seminar, CEU's, and exam
for "WCC" Wound Care Certified Credentials.

click here for details

"...One of the best educational experiences I have ever had"
Carol K. RN, Aurora, IL

 


 

 New questions sent by readers. Please e-mail your answers. See previous questions and answers below.

If you know of any patients who are interested in being part of advanced wound care clinical trials, please visit this new offering by a non-profit organization. It's a free service that can potentially connect patients to appropriate clinical trials.  Click here for more information. No replies to archived emails.
We are having a discussion about decubitus ulcers?
Can a decubitus with slough be staged?
Some think yes a 3 or 4,,,,,others say no because you can't see the wound bed.
Pam
 
Hi,

My name is Amba, a student of physiotherapy studying in India.

As per my course requirements, I am to submit a project work on the topic of my choice. The topic I have selected is "Recent advances in wound care with electrotherapy". I would like to know what are the various electortherapy modalities available in the treatment of wounds and also would be greatful if someone could give me links to websites carrying relevant subject material. I have searched for HVPGS, but haven't found any describing the exact procedure of treatment.

Thank you,

Amba.
 
My doctor says I would be a candidate for Dermagraft, however, my insurance company will not cover the cost as I am not a diabetic and they say it is still in testing stage. I have two trauma ulcers, one on each leg, that will not heal. Has anyone used Dermagraft and has it worked to close this type of wound.

Gary
 
Could you please help settle a debate? Is tincture of iodine better for wound care than triple antibiotic cream?

Thank you

Philip
 
Has anyone had any experience with a product called CircAide T-3 boot and sleeve for compression of LE venous insuffiency. Does this product increase patient compliance? Does it seem to be an effective alternative to multilayer compression wraps to remove edema? I have a patient who is currently having a difficult time transferring from multilayer compression wraps (Profore) that I put on to being independent with her compression garments. Each time we get set to go Independent, something seems to happen where she is unable to get her compression stockings on at home...more edema...more wounds...back to Profore. Is the CircAide boot and stocking a viable transition alternative?
Thank You
Carl, PT
 
I was wondering, what are some of the alginate dressings or other dressings that are absorbable if left in the wound bed (most likely accidently)?
Someone told me that all alginates work this way, but I don't believe them.
Chris
 
Hi,
I'm a PT that has been practicing wound care at a major hospital for 4 years. I had a question about iodoform packing strips. I know certain levels of iodine are indescriminately cytotoxic. Doctors in the hospital always seem to order iodoform packing strips (which I most often am able to change to a more heaing-friendly dressing). But if you were to use this dressing,
is the level of iodine in these gauze dressings still cytotoxic to all tissues?? Is there any research that shows what levels of iodine would be "appropriate" (I use this word very loosely) ?
Thanks for your time.
Chris, PT
 
I have a long-term bed the patient, the buttocks and the left hip have a pressure sore, NaCl wet packing for 4 months, because the wound heals slowly, changes by the seaweed rubber surgical dressing, but healed is still slow, asked, what method I possibly did use to improve it? (Has picture)

Taiwan

 
Hi,

I am interested in finding out about any type of exercises presecribed for people with vascular insufficiency. I have two diagramed exercise protocol from dow hickman(simple exercises to improve circulation) and Lower extremity exercises for people w/ diabetees from Novo Nordisk Daibetees Care.

bindhu t.a.
 

Submit your new question to the group right now: wounds@medicaledu.com
Sign up with our Email Service to see replies.


 Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.

What type of dressing or product is available that can help to control odor caused by hard to heal wounds?
Brenda
First of all, you have to control infection, because the bad odour is a result of microorganisms destruction, if you destroy the bacteria, there will be no odour.
Did you ever try Curasalt by Kendall - it is very potent dressing for wound infection control, it is 20% NaCl impregnated gauze and it really doesn't matter what kind of bacteria is involved - nothing can survive in 20%!!!

You should use it carefully - put vaseline around the wound and never put it on healthy tissue!!!
unsigned
----

Brenda,

I found Actisorb very good to help control odors. It has charcoal in it and it helps in the wound healing also. It's a good product. Good luck. Maryanne, R.N.

---

This is hard to answer since you didn't post a description of the ulcer. However, you can use Panafil by Healthpoint, its a debrider/ deodorizing ointment that is really great in controlling odor and healing wounds.
unsigned
-----

Actisorb by J&J has silver and charcoal together so has an antimicrobial effect and charcoal for odor. Smith & Nephew has Acticoat and Acticoat absorbent where in theory if you have antimicrobial effect should decrease bacteria and therefore odor. Again all silver dressings from different companies are antimicrobial, but J&J's product has the added charcoal for odor. Iodosorb by Healthpoint in another option-antimicrobial with iodine. I would contact your local sales representatives to get the research, samples and then you can make your choice.

Lisa, MPT, CWS

---

Depending on why you have an odor. You need to determine what the odor is caused from and the goal of your tx and dressing.
If there is necrotic tissue it has to be debrided.
If it is a fungating type of tumor you have several options. There are several types of dressing that have carbon impregnated ( most are foams) in them that you use as a secondary dressing, but they are EXPENSIVE and will not work if they become saturated with drainage. You can also use Metrogel gel to the wound bed but it also expensive if your wound is large. Dankins solution at 0.025% is very effective and inexpensive for a wet to dry daily to three times a day dressing and at this dilution it is not likely to be cytotoxic and it is bacterialstatic if the odor is caused by an infection such as pseudomonas.
Another trick if the odor is just a minor wound odor is to change your dressing as normal (wet to dry, whatever) and on the top of the dressing place a "downy" dryer sheet, this just masks the odor.

Sunny CWOCN
---

I would recommend the product Didaksol, from Century Pharmaceuticals. It is a prepared, buffered, stabilized solution of sodium hypochlorite, or Dakins Solution, at 0.0125% This is 40 times more dilute that the standard solution of .5% At this dilution, it will effectively kill all bacteria, including MRSA, but will not kill that cells that make the new tissue. By reducing the bacterial load, there will be less drainage and odor, pain and inflammation. Cost $5 for 16 oz. Very easy to use as a wound cleanser or wet gauze dressing. Best of luck!
Trish , RN, MSN, ANP, CWOCN

---

Brenda,
We use a Charcoal based dressing if the wound has mod to severe exudate. If
it is light, you can use a Acetic acid wash.

Patricia, PT

---

There are lots of approaches to dealing with odiferous wounds. If the goal is more palliative, then approaches like Dakin's dressings or even kitty litter or charcoal in the room will help.
If healing is a goal, then consider one of the charcoal dressings. Even better is to go after the cause of the odor, which is necrotic tissue and/or infection. Silver dressings or cadexomer iodine (Iodosorb) can help, as can crushed Flagyl
sprinkled over the wound. Topical and/or systemic antibiotics can help. Lastly, sharp or surgical debridement is needed to
clean the wound, and remove the dead tissue.

Renee C, MSPT, MPH, CWS

---

I have found the use of Panafil, with chlorophyl in it helps to control odors. If concerned about bacterial load, try Iodosorb-gel.

Dan  DPM, CWS

I AM A CAREER COUNSELOR WORKING WITH A WOUND CARE NURSE. WE ARE TRYING TO FIND WORK WHERE SHE WILL DO SOME WOUND CARE NURSING. SHE SAYS SHE NEEDS SPECIALIZED TRAINING BUT WE CANNOT FIND ANY.

DO YOU HAVE ANY CLUES.

SINCERELY,

SUSAN
She can go through a WOCN training program, and sit for that certification exam. www.wocn.org will have a list of programs,
including web-based ones if there is no local school. If she doesn't want to make that level of committment, then there are many wound courses and conferences out there.
www.woundcaresymposium.com www.symposiumonwoundcare.com are the
two major conferences. Someone will probably suggest the course by WCEI to get the WCC in one week. However, it is generally not
respected or recognized by wound care clinicians, since its requirements are significantly less (only a one week class with a
test, no experience needed) than the other certification options, which require significant experience and training. www.wocn.org www.aawm.org

Renee C., MSPT, MPH, CWS

---

The best program to do is an Enterostomal Therapy Program. There are several in the US

K. Paige, NP, CWOCN
---

I am an LPN and board Certified in Wound care and Management through the American Academy of Wound Management.
www.aawm.org
Good luck
Dawn

---

The web site of the Wound, Ostomy, and Continence Nurses Society (WOCN) at www.wocn.org has information on education programs for baccalaureate prepared nurses.

Trish, ET

I have found a great deal of material on collagen dressings including that they are for exudating wounds. The animal collagen apparently combines with the exudate providing a protective barrier. Does this sound right for all collagen dressings?

Also, I have not found any recommendation for frequency of change of dressings. Would you be able to tell me this?

Judy
I'm not sure about the first question, but Promogram is usually changed based on drainage (Promogram-collagen dressing). I could be wrong but believe it is active in the wound for 72 hours--can contact J&J.
Why is dakin's sol'n used for decubitus ulcers? Is it a cleaner, disinfectant , debrider? I would love to know Thanks
Barbara
Dakin's is a cytotoxic antimicrobial solution. It kills cells, both bacteria and healthy tissue. It has a role if healing is not a goal (eg: fungating wounds, terminal patient), or for a few
days of irrigation, followed by NS rinses, to reduce bioburden. However, for a wound with a goal of healing, it should not be left on the wound or used for more than a few days.
Renee C, MSPT, MPH, CWS

---

Dakin's solution should not be used on wounds. It impedes the healing and
is not recommended for any type of wound.

Anne RN, BSN, Onc.
Clinical Nurse Educator

---

Hello. Dakins solution is necrotic to tissue and should not be used. I have physicians order a 1/2 strength "Paint" to wounds but even this is frowned on. Heide C. RN

---

It's bleach that's basically used to control the odor of foul-smelling
ulcers. Was widely used once but it's very caustic to wounds so its not
part of the national wound care guidelines. Hope this was helpful.
Elaina R.N

---


Dakins solution is not used much any more, however it was used to decrease odor.

unsigned

---

Dakin's solution is sodium hypochlorite, and has been used for many years. It does indeed cleanse and debride wounds. The standard solution is .5%, but at this dilution, not only are the bacteria killed, but also the cells that help the wound heal. A more dilute solution of 0.0125% is available from Century Pharmaceuticals. At this dilution, the wound will be cleansed of bacteria and dead tissue, but the cells needed for healing remain active. The cost is only $5 for 16 oz. It is used by moistening gauze and applying it to the wound. The dressing should be changed daily. I have used this solution for ten years with consistently good results on many kinds of wounds. Good luck!
Trish , RN, MSN, ANP, CWOCN

---

YES dankins is all of those.

For use on Pressure Ulcers you would use it IF the wound has minimal necrotic tissue (although I would use an enzyumatic debrider instead), I would use it if contaminated with bacteria, especially psuedomonas which stops the wound healing progress and creates an odor. It is really inexpensive, so if the patient had limited finances it is acceptable, I would recommend the strength of 0.025% which has very low potential for cytotoxicity.

Sunny CWOCN

---

Barbara,
We use it for cleaning the wound when there is significant odor. It is used for approximately 5 days then changed to normal saline cleaning. Hope this
helps.

Patricia, PT

---

BARBARA,


DAKINS SOLUTION IS A LONG TIME OLD REMEDY, IN THE WOUND CARE CENTER WERE I WORK WE USE AND RECOMMEND DAKINS SOLUTION FOR WOUNDS INFECTED WITH PSEUDOMONAS. ITS WORKS, GOOD RESULTS. GOOD LUCK!!

MARYANNE R.N.

I am a community nurse , I always come across chronic leg ulcer patient, Their wound edge has already rolled in, slow epithelialization, only granulation, how can I solve this problem in order to speed up epithelialization? Thanks!
Flora
Are they having compression therapy with the dressings? Deborah

---

Using silver nitrate sticks around the wound edge can help with the rolled edges. Leg ulcers is vague. If it's a venous ulcer, then compression is crucial (if the arterial supply is adequate). If arterial, need need evaluation by a vascular surgeon if they haven't already.
Renee C, MSPT, MPH, CWS

---

when the wound edges roll in the wound thinks that it has healed itself. I have found success with silver nitrate sticks used around the wound edges can promote granulation again.
C.B., LPTA

---

FLORA,

WHEN YOU SEE THE EDGE OF WOUND ROLL IN YOU NEED TO SUGGEST AND SURICAL DEBRIDMENT, THE WOUND EDGE NEEDS TO BE REMOVED, THIS MAY CAUSE THE WOUND TO INCREASE IN SIZE BUT IT WILL HELP THE WOUND HEAL QUICKER. GOOD LUCK

MARYANNE R.N.

---

These patients really need to be evaluated by someone experienced with wounds. The only way to heal true venous stasis ulcers is with compression, but compression is not to be done unless you have ruled out mixed etiology arterial disease. These patients need vascular studies to determine if they can tolerate compression especially if they have untreated, undiagnosed heart disease (esp. CHF). Once healed, these patients need to ALWAYS wear some sort of compression hose to prevent reoccurrence.

Sunny CWOCN

---

When a wound edge rolls in, it impedes healing. I've found that silver nitrate works best in these situations. Yves


Please note that this email summary page was compiled from emails submitted to the Wound Care Information Network. It is simply a forum for healthcare providers to discuss wound care cases, treatments, products, etc. Email replies included in this forum are not evaluated for accuracy or correctness. Please verify all information presented with your own sources of information, such as; doctors, nurses, manufacturers, published literature, etc. We do not know who the authors of the email replies are and their stated credentials have not been verified or validated. Read the disclaimer below.

Disclaimer - Acceptance and publication by this email and/or web page of an advertisement, news story, or letter does not imply endorsement or approval by the owner of this website of the company, product, content or ideas expressed in this email. Any medical condition should be evaluated and treated by the appropriate healthcare provider. This email is for informational purposes only and is not a substitute for competent human intervention. The owner of this email list and web site does not check for accuracy or legitimacy of ideas expressed by the individuals who post messages.

Automated removal Instructions shown below.
 

 

Copyright 1995 - 2013