yostmp@lomadeluz.net
 

---

Peggy,
Please send me a letter that I can use to
round up support for your cause. Something I can
bring to our church and even to our company.
The period for enlistment for grants may be passed but I can forward for the next period. It would help you send me a letter on an official letterhead. What stuff do you need most for wound care for diabetics?
Maria Carunungan, DPT, CWS
Beckley, West Virginia
MDCarunungan@aol.com

---

Hello Peggy,

I have come to your hospital a few times with a missionary group from our local church. I have tried to share my knowledge with those who would listen. There are 4 main things that are needed to heal diabetic foot ulcers. 1) Off-loading. This means removing weightbearing forces from the ulcerated area. In your area, the main mode of transportation is walking. I hope that some shoe company reps or medical supply reps will respond with donations of aliplast or plastizote insoles, extra-depth shoes and Cam-Walkers. The next time I come, I will teach Cheryl how to make a total contact cast out of Cam-Walker. 2) Infection control. The wound must be kept clean of bacteria and dirt. Another difficult task to accomplish in this poverty stricken area of Honduras. 3) Inexpensive wound care products. This is probably the most challenging. Providing as much emphasis on the other 3 points will help reduce the need. I hope some CEO's from J&J, Smith & Nephew, Ferris or any of the others will contact you about providing some MUCH, MUCH needed wound care products. 4) Periodic (every 10-14 day) wound debridement. Cheryl has done as fantastic a job as I have ever seen at getting the wound clinic going. I pray that the wound care specialists reading this posting will seriously consider contacting you about donating their time and efforts to Hospital Loma de Luz. I will tell anyone reading this now, that they will blessed beyond words can describe with an extremely rewarding experience if they make a mission trip your facility. I can be emailed at coastalp@bellsouth.net to answer questions.

Paul Hilbert, DPM, FACFAS

---

Dear Mike & Peggy

To treat the diabetic ulcers, the best herbal way I can suggest is Aloe vera / Aloe barbadensis plant. You cut the suucculant leaf remove the skin and wash the gel repeatedly with plain water several times to remove the smell and stickyness. Apply it on the wound after washing the wound with saline and do a normal dressing. Repeat it twice a day till the wound heals.

The plant can be grown in pots.

Raghavan B, G
Scientist (on Herbal Medicine)
Email : schiwaz@hotmail.com

---

I know the perfect solution for you situation. "Maggot Therapy". It is "very" cost effective and it works great!! If you would like more information please check out our new site. BTERFoundation.org. There you can get all the information you need. Maggot Therapy has also been approved by the FDA giving it more credibility in some eyes. Not mine, I know it works. It saved my feet from amputation and healed up my osteomyelitis. Please consider this I think it is the "perfect" answer for you.

Pam Mitchell
Board of Directors
BTER Foundation

---

I have been participating in a study on "alternative wound care" for almost a year and have found wonderful results with using aloe vera plants for treating ulcers (some have been diabetic). It has antibacterial and antifungal properties, it has also proven to be a vasodilator, reduces pain, and vitamins and minerals.
Tina (L.V.N./wound care nurse)

---

I think there are several things you can do that are easily accessible and inexpensive. First, controlling blood sugar is critical. Eating whole grains instead of refined and so forth will help. If you have diabetes meds available that is important. For the wound, they need to
stay off it. Crutches, even wheelchairs if feasible, are helpful. I know your patients probably feel they need to be active for their daily needs, but they need to stay off that wound. Lastly, debridement of the wound and the callus will help it heal better.

Thanks for doing this important work.
Renee Cordrey, MSPT, MPH, CWS

catherine lpn home care

---

The spelling is wrong: Hyrdofera Blue. It is a PVA ( polyvinyl alcohol) dressing impregnated with methylene blue and gentian violet. The website is www.Hydrofera.com. I haven't used it, but I recently attended a conference organized by the American Professional Wound Care Assoc. and this product was never mentioned, positive or negative. Contact the company for info. Cheryl

---

Hydrofera Blue
860-456-0677
www.Hydrofera.com

Hydrofera is awesome, the key is that the product needs to be used correctly.
Call the manufacturer and they will be happy to send you samples and refer you to your local rep.
Let them know I referred you. Good Luck!!
-Sharon, RN, WCC

---

Susan,

The product is "Hydrofera BLUE". It is an absorptive, bacteriostatic foam dressing. It is used to minimize bioburden and maintain a moist wound environment. One of the nice things about this product is it can be left in place for up to 3 days. They do have a web site if you'd like to contact them for information www.Hydrofera.com .
Hope this was helpful to you.

Kimberly cox R.N.W.C.C.

---

Hydoferra Blue is a product I am very fond of.
Basically it is a polyvinyl alcohol sponge complexed with two organic pigments----methylene blue and gentian violet. It provides a broad spectrum bacteriostatic protection.
Effective for a wide variety of wounds especially infected wounds, burns, and stasis ulcers.
I have had great success using it on non-healing wounds in several instances. Follow the directions fairly closely, it requires being constantly moist, needs to be covered with transparent dressing, I like to use the dressing that comes with wound vacs. It can be rehydrated with a syringe through the dressing by making a small pin hole and a 3cc syringe, needs to be checked daily between dressing changes for moistness, needs to be changed when the hydroferra blue becomes saturated with white crystals (incicates it has done all it can.) Also, when first initiated I like to change it every other day, as opposed to 3-5 days as suggested by the manufacturers just to keep an eye on it. If wound is draining heavily you can use a protective barrier on the perwound to protect it.
Cheryl LVN wound care nurse

Leah

---

for susan micelli. I am an RN at a CHHA in westchester county, ny. I have used HYDRO-FERA BLUE for a few pts. it healed a stage 3 pressure ulcer in about 2 weeks. the wound had mostly slough and green, purulent drainage. it stays on for 2-3 days but must be dampened qd with NS. even the peri-wound area healed nicely. good luck MJB

---

Skip:

We'd be happy to provide you with information on our product, WoundExpert, which assists with documentation and compliance. Feel free to call me at the number below.

Thanks in advance,

Mark Rickard
Client Advocate
Net Health Systems, Inc.
800.411.6281 ext. 13

I have used Autologous platelet gel on my own body several times. The first time I did, my wound closed 75% in 5 days, one dressing change. It’s my magic bullet. It works, and fast. I have no financial relationship with the company that owns all the patents (Cytomedix) but am a huge supporter. I encourage you to incorporate this amazing therapy into your practice.

Laurie M. Rappl, PT, CWS
Clinical Support Manager
Span-America

Cheryl
Wilkerson BSN, WCC from PA
 

Cheryl,

Contact any one of the major wound care product manufacturers, and they will be happy to give you a copy of their wound management programs that usually include lovely photo's of wounds of many etiologies that describe the stage, thickness, degree of burn, etc., and of course their product that would be most appropriate for that particular wound. For the partial/full thickness wound classifications, they are essentially defined by the anatomy found/not found in the wound. As you know, this varies among the various body areas (e.g., buttocks vs. elbow differences in subcutaneous tissues). Good luck.

James A. Patrizi, PT, CWS

----

All other wounds are classified by partial or full thickness - you have it
already. You then measure, give %of type of wound bed tissue (i.e. yellow
dried eschar, granulation, epethelial), amount of exudate etc.

D.Harris CWCS

Wendy,
Try talking to the Doctor and educating him first that you feel it is a political war with the reps. Then see if you can get the doc to just write
a generic order for the wound vac. Let him know the wound presents as deteriorating. The man should be on extended release pain meds that should be adjusted to inhibit his pain.
Lori Siegel, RN
Clinical Director

---

Wendy,
You certainly are caught in a political war!! I heard wonderful things about KCI. Maybe someone is getting a kick back? They both offer negative pressure and if you are seeing good results, be your patients advocate. Call blue sky to get more info about their system. It's FDA approved and at present the only competitor to KCI. Orders should be for negative pressure intermittent at whatever pressure, not KCI Wound VAC!!

---

Wendy,
The main difference between the VAC and Blue Sky is the alarm on the VAC. The VAC machine will tell you if the system is malfunctioning, which could be a key for wound management. If you don't have an alarm, how do you know if the cannister is full, or if the dressing is leaking? The Blue Sky is basically suction, like the wall suction or portable suction that every facility in the world has available. I don't understand why you would buy something that is a duplicate of a product that is already available in your facility.
Granted, I haven't personally used Blue Sky and they have some documentation that it does heal wounds, but my question is, what healed the wound, the Blue Sky dressing, or the fact that you were attentive to the wound??
KCI has well documented that the VAC improves wound healing significantly and is my choice for negative pressure therapy.
Dawn, RN, CWOCN
Sioux Falls

---

You certainly are in a dilemma. I have used the KCI version of negative pressure healing. The Wound Vac does work. If your patient was experiencing pain with the VAC, check the setting. Was it intermittent or constant? Intermittent setting causes less stress and pain. Research in this area found a greater healing with intermitent pressure. The Blue Sky operates on the same basis, but at a reduced cost. The unit seems to be more cumbersome than the portable VAC. Ask the physician the reason for his choice. Maybe he had the rep from KCI in his office and not the Blue Sky rep? Blue Sky website: www.blueskymedical.com
Cheryl Wilkerson BSN,WCC,DAPWCA

unsigned

---

Also you can ask about compression wraps.
This depends again on ABI results on how much
compression you can apply, like pressure wraps
(light) with Profore, or setopress. You do not have to
worry about the elastic that binds the leg around the
wound, and this can be left on for a few days,
and used over primary dressings also.
Maria Carunungan, DPT, CWS

---

I agree with your assessment/concerns. If you can do an ABI and show arterial insufficiency, you can make a better argument against compression. Also, a middle ground might be wrapping for edema with Ace or the like, so you can avoid severe pressure on the met head.

Vicki, MSPT, CWS
---

Have patient get another opinion.

unsigned

----

Dear Unsigned,
Unfortunately there is a common misconception that TED hose are to be used for edema. They are NOT! The manufacturer will be the first to tell you that they are effective only for the prevention of superficial emboli (hence the wording "anti-embolism" stocking on the package). It sounds like there are two different and distinct pathologies with your patient's legs; pressure ulcer and edema (of unknown origin, i.e., venous hypertension vs. CHF vs. lymphedema vs. many other possible causes). The pressure ulcer needs to be addressed as such, and obviously the elimination of pressure to the site is essential. For the edema, let's assume for the sake of this response, that the etiology is venous hypertension. Although compression garments (made of short stretch elastic... TED's are made of long stretch) may be indicated in the future, if the edema is quite significant, edema reduction via some sort of compression wrap/dressing may be indicated to reduce the edema, and prepare the leg for garments, once the volume of the leg is plateaued. Graduated compression garments are not to be used for edema reduction, but rather to maintain the reduction gained with compression wraps, elevation, diuresis, etc. Circumferential measurements at the same locations are an objective way to determine when the volume has plateaued. So, treat the pressure sore as you know how, and employ the best intervention for edema reduction (which includes exercise, or at the very least, AROM of the legs, and ambulation if possible) that will be effective, and prepare her for compression stockings in the future. Good luck!
James A. Patrizi, PT, CWS

---

What is the etiology of the wound? Venous vs arterial? Is the swellling edema or inflammation? Maybe suggest ACE wraps if the Doctor insists on compression? Cheryl Wilkerson BSN, WCC, DAPWCA
Hope to see you soon, Cheryl

---

Ted hose are contraindicated in those with dcubes stage 2 and greater. Ask
the doc about using and ace wrap for swelling instead.
Lori Siegel, RN

---

I am a podiatrist that works with wounds. It is a
most enjoyable part of my practice. I see two issues with your situation. First we often think of the arterial problem as primary. I believe more people are beginning to appreciate the compromise to the capillary bed that edema from venous insufficiency produces. So I think that if the support hose is indicated for reducing edema I might consider how to use them and deal with the problem of having pressure on the wound. If the wound is over a bunion, I would consider using a felted foam dressing to offload the wound. I am not sure if you are aware of felted foam. I get mine through a supply house in Florida called Steins. It is cut to go around the wound. It is beveled with a grinding wheel to eliminate the edge effect. It is applied with rubber cement on the skin and the felted foam. It is covered with Fabco and tape. A hole is cut where the wound is and appropriate topical wound products are then applied. I think the felted foam would allow offloading the wound while allowing application of the support hose. It might be useful to consider a wrap rather than a support hose to accomadate the felted
foam. I'm sorry I am not in my office. I would be
better able to provide information about the sources for the materials I use. I hope this might help.

Craig Holman, DPM
Twin Falls, Idaho

---

If the doctor is concerned about the edema you probably won't be able to talk him/her out of compression and wounds do tend to heal faster when there is less swelling to the periwound tissue... you could try Unna Boots, however over a Stg. III it would not be my first choice. My personal first choice if the edema is 3-4+ would be to treat the wound with Polymem (if it has significant drainage) and a lymph-edema wrap (both can stay on for three days at a time), however if the wound lacks drainage, I would use an impregnated gauze (like Derma Gran) then cover with a foam to pad the area and reduce the pressure and continue with the TEDS. Again personal opinion, TEDS are the lesser of the evils when it comes to compression, they tend to give more then other compression stockings or wraps.
Tina (L.V.N./ wound care nurse)

unsigned2

---

For fragile skin, the foam tapes are safest. Also, if the wound is appropriate for semiocclusive dressing, a self-adhesive foam dressing such as Mitraflex or Flexzan might work as the dressing.

Vicki, MSPT, CWS
---

one inch paper or silk tape. Just be gentle when removing it!

---

3M's Medipore tape is my favorite for it's ability to stick well, but also not to stick too well. It is more of a fabric material than a paper or a plastic. If it is too adhered when the time comes for removal, you can saturate the back of the tape with either an adhesive removal pad (like the alcohol wipes), or just with rubbing alcohol. Good Luck.

James A. Patrizi, PT CWS

---

My wife has an abdominal tumor that is on the outside of the skin and underneath as well. This site started as an open staph infection and is part of the tumor. The wound/tumor has a dressing that is changed 4 time per day and the final dressing is a 5X9 inch abdominal battle dressing known as an ABD. We started with cloth tape then a paper tape. These tapes were very irritating to the skin. A wound care nurse that started coming to our home told us of a tape called Hypafix, the tape is made in Germany by BSN medical Gmbh & Co. KG, Hamburg, Germany and is distributed in the U.S.A. by Smith & Nephew, Inc. Largo, Florida. The customer care number is 1(800)876-1261. Prior to applying the tape there is a spray or a small pad with a solution called skin prep, this makes it easier to remove the tape. A lot of medical people were not familiar with Hypafix Tape but they say it’s the best they have seen. My wife can certainly attest to that. My wife gets her supplies through a local drug medical supply house for free, she is part of an HMO with Blue Shield/Medicare. The tape sells on the internet. The price range is from approx. $10.50 to 12.00 per box. The tape comes in various widths. We use the 2 inch tape and the length is 10 yards per box. If you have any questions you can call me at (818) 980-3325 here in California, My name is David Brown.

---

Molnlycke Health Care just came out with a new tape. It's called Mepitac. It's not an adhesive so it doesn't tear the skin or cause any skin reactions. It's made from soft silicone and it comes in a roll like the Mefix. I believe that it came out for the neonatal units, but my rep gave me some to pilot on elderly patients and I love it and so does my patients.

good luck
Carly RN CWS

---

you use the dressing the wound kit came with. picturing the wound helps protect the good skin if the dressing were to move or not be air tight. the dressings that come with the wound kit for the blue sky is thinner than what comes with the kci machine and is tougher to use. the skin around the wound is very delicate and you don't want to aggravate that skin with other chemicals such as the zinc.

Joyce lpn

---

How about Hypafix tape or the transparent dressing used in wound vacs.
Cheryl

Leah

---

use skin prep around the edges where the tape would go, this protects the skin from the tape, RN WCC

---

Most of the time I use paper tape, since it is gentle on the skin. If it's a highly flexible area, like over a joint, I like to use the dressing retention sheets like Hypafix or Omnifix.
Renee Cordrey, MSPT, MPH, CWS

---

The pink tape you are referring to is Hytape. Personally, I like Hypafix tape.
Debby WCCRN