Wound Care Information Network

 

 

December 1, 2005

 

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

I am a CSR manager in a long term care facility. I just recieved a request from a N.P. for Promagran Matrix by J&J are there any comprable dsgs ?
What are they? Thanks, Virginia
Possibly oasis by healthpoint

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY
 
what exactly is sinus tracking? how is it different from tunneling? thanks Michele The terms are used interchangeably.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY

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a sinus track does not have two openings, tunneling does.
CB homehealth RN

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Sinus tracking is more like a skinny tunnel that goes in one direction and undermining forms a "lip". I guess the best way to diffenterate is would be in the way you chart it... a wound may have tracking @ 3 o'clock or undermining from 3 to 5 o'clock.
Tina (L.V.N./ wound care nurse)

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The greatest difference is how the people you are working with differentiate between these two. The research DOES NOT differentiate between tunnel and track and literature does use them interchangeably. (I have asked this question myself of some of the leading teachers in wound care.) That being said, in your area you may find individuals/institutions establishing their our definitions for these terms. My peers have been using tunneling to describe a opening that extends under the epidermis and opens up into another area (like a tunnel in a road,two entrances) and track to describe an open area that extends out or down from the primary wound area that does not exit . Sinus tracks must close from the bottom up to prevent the surface from closing and leaving an open area underneath, ready to fill with bacteria/fluid/etc and abscess. Michelle, PT, CWS

I am trying to find out more information about a wound care product called Di-Dak-Sol. Can you please tell me how I can find out more about this product?

Thank you,
Cindy Green
This is a brand of Dakins Solution (Sodium hypochlorite aka bleach) that is pre-mixed and can be purchased through a pharmacy. It is used to debride and cleanse wounds with necrosis, to control odor in fungating wounds and to reduce bacteria in wounds with heavy bioburden.
Chris Berke RN CWOCN

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Cindy,
Di Dak Sol is made by Century Pharmaceuticals. It is a broad spectrum solution that is 0.0125% hypochlorite (bleach), but at this concentration it is non cytotoxic-dosen't kill fibroblasts. It kills bacteria, yeast and virus's. This company makes Dakins solution which 0.50% which is harmful to healthy tissues and is usually only used for short periods of time in very infected wounds.
Sharon Mendez RN CWS

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Cindy,

Di-Dak-Sol is diluted sodium hypochlorite solution AKA dakinís solution used as an antimicrobial to cleanse wounds. It is usually made up of 0.5% chlorine. It is used short term because it also kills epithelial tissue.

Carmen LPN
Woundcare Nurse

Is the Dec. 1994 the most current publication for
Pressure Ulcer Treatment Quick Guide for Clinicians

Bonnie

These guidelines were written by a group of experts put together by the Government. They are still considered gold standard. A more current publication can be found published by the National WOCN which can be found in the on-line store on their website @ www.wocn.org. They have guidelines for Pressure Ulcers, Lower Extremity Neuropathic wounds, Lower extremity arterial wounds and Lower extremity venous wounds. They were all expertly compiled after extensive literature review.
Chris Berke RN CWOCN

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I had my hopes that an updated version of the clinical guidelines would be forthcoming, but I remember reading in Advances in Wound and Skin Care a year or two ago that this was not going to happen. I think they said that was because the basics of wound care were pretty much unchanging.

Nancy B. RN, CWCN

I am a home health nurse. When I worked in a wound care clinic, we used iodosorb gel in a surgically dehisced chest wound. The person I have right now is on a lot of steroids. Is there something better to use on these slow healing surgically dehisced chest wounds? Contact KCI for a wound vac.

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I would explore the Wound Vac marketed by KCI as an option to speed and facilitate the healing process. We have utilized this product and it has been very effective. The company has excellent literature on this, covered by Medicare, and a representative can come to your facility or pts home and help with the dressing and protocol regarding the use of this product.
Liz

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Sternal wounds are tough because they are right under your nose, and theres a lot of bacteria inyour nose. Iodosorb is good because it will keep the bioburden low. Has a Negative pressure dressing such as Blue Sky or KCI been considered to speed healing? You can continue to use the Iodosorb under either of those for added benefits.
Sharon Mendez RN CWS

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have you tried the KCI wound vac? This is a very cost effient way since you normally only need to change the dsg m-w-f and prn. Also I have had good
luck with iodoform gauze either qd or bid.
CB homehealth RN

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You could try applying topical Vitamin A (poke open the end of the Vitamin A capusle and squeeze out onto wound bed - use enough capsules related to size of wound), the Vitamin A reverses the effects of the steroids locally but allows steroids to still work systemically. Apply it after wound cleansing and before applying appropriate dressing. Reapply with each dressing change.
Chris Berke RN CWOCN

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The answer to this depends on the evaluation of the wound. If it is clean and granular and free of infection, Fibracol or a similar collagen may help If the wound is fairly dry the Fib can be moistened with saline to turn into a gel like substance before application. If draining leave the Fib dry when appliing.The Fib is 10 % alginate and 90 collagen It helps to lay down a bed of collagen in the wound to stimulate healing. After this does its job hydrogel sheets still work well in surgical wounds. If there is a small amout of slugh you could reverse this The hydrogel will liquefy the slough Be sure to use a good foam dressing over the sound to absorb drainage an protect the periwound andgently pack and underming to protect the edges from rolling and further slowing down healing

J Means RN Wound Care COOrdinator Long Term Care Illinois

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You might try a V.A.C. by KCI or other negative pressure therapy such as BlueSky Versatile One. Of course, the underlying nutritional support must be there - you'll need to check labs for pre-albumin etc.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY

Hi, I am a 55 year old. 23 years ago I sustained a degloving injury to my left foot which resulted in the loss of tendons and nerves to all the toes. 2 years ago I had partial removal of the big toe because of recurrent ulcers on that toe. I have had the big toe fused which has a large screw through the toe into the foot. I have had an ankle fusion and other joint fusions in the foot. Currently, I am trying to heal an ulcer that resulted from a blister that opened up. The toe drops down and takes a lot of pressure when walking. I have been changing the dressing every day. It has had copious amount of serous drainage but in the past week that serous drainage has changed. I have also had several episodes of profuse bleeding in the toe which was very difficult to stop. The drainage is now this, mucous type and is like a neon greenish yellow in color. The toe is very swollen. I have also had skin grafts and pedicle flaps on that foot. The circulation to the foot is not great. All summer the foot has been extremely painful and very swollen. I have been wearing a long surgical boot in order to control the pain and swelling. The toe area in the boot has been changed to allow the big toe to drop down so that there isn't any pressure on the toe.
1. Is the change in the color of drainage normal?
2. Is a local antibiotic ointment the treatment of choice? If so what is the best one to use?
3. Could this be an infection?
4. What other things can I do to heal this ulcer? I have no feeling in the toe and most of the foot so I can't tell if it is painful.
Thank you for any help that you can give me.
I hope you have been to see your Orthopedic Surgeon by now. Neon green, redness, swelling, pain are 4 of the 5 cardinal signs of infection. And with all the changes in your foot; injury, surgery, hardware, you are highly at risk. Get ye to the doctor! Antibaterial creame may just be making the bacteria stronger.
Sharon Mendez RN CWS

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Hello,

Any time I see a greenish or blue-greenish drainage I think there has to be some colonization at least (organisms growing superficially), possibly infection. An organism called pseudomonas is often a culprit that causes greenish drainage and a sweet, characteristic smell. Without seeing the wound, I cannot tell you what dressings would be appropriate. Find a wound specialist to help.

Vicki, MSPT,CWS
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I am concerned about what you are describing and much more information is needed to truly give an educated opinion. However, I would encourage you to find a wound care clinic or a wound specialist in your area. The color and quantity of drainage as well as the extent of pain all suggest infection. Bacteria also causes tissue to become friable and bleed disproportionately. That infection could extend into the bone. An x-ray will only confirm this in ADVANCED osteomylitis. It would be much more advisable to have an MRI or bone biopsy (this is a surgical procedure if you have deep sensation still intact in your foot). You can not (nor should you attempt to) heel a wound when there is osteomylitis (bone infection).

If you find out that there is bacteria on the surface of the wound, use any topical antibiotic ointment or a silver product. If a tissue biopsy indicates that the bacteria has invaded the healthy tissue then you should be on oral antibiotics and a topical antiobiotic. When you have poor circulation it is difficult for the oral antibiotics to get to the affected area in adequate concentration so often extended periods on antibiotics are need.

Having the inflammatory stage of heeling prolonged this long is complicating your healing process. With proper care you should be able to get back on the heeling track. If you visit www.aawm.org there are links to find a cws (certified wound specialist) in your area. Good luck!

Michelle, PT CWS

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Neon green drainage is a common occurence when pseudamonas is present Drainage from a wound is indicative of infection Recommend to see an orthopedist, podiatrist, Infectious disease specialist to rule out bone infection and to change your treatment accordingly

Sharon RN, NY

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You have a lot of issues it appears. For one thing, until it is healed, you must stay off of it. You need to be checked by a vascular surgeon and correct any circulatory problems with surgery or medication. The drainage could possibly be pseudomonas from your description. If the infection is local, I would use a silver product, if systemic, culture it and be put on
appropriate antibiotic therapy systemically. That's it for a start. If you continue to walk on it with all your complications, you will most likely lose it. Once it is healed, wear good footware without any areas of
pressure. Use a mirror nightly to check the bottom of your feet. It sounds like you have let things progress without knowing because of the desensitization from the nerve damage. You can never let that happen again. Alway practice good skin care nightly after checking your feet with a
mirror - rub a good cream into your skin - do not let globs get in between your toes.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY

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No, the drainage is not normal and the toe is badly infected.
Please try oral Antibiotic and Bactroban creme. If there is necrotic tissue you can use an enzyme, mixed with Bactroban creme. Like, Panafil, Accuzyme or even Santyl.
Clean it real good with Normal Saline or Wound Cleanser, apply the Creme or mixture cover it with 4X4's secure with tape or kling. Depends on how much drainage there is change the drsg at least twice a day. Monika LPN- WCN

My son had an accident with a chain saw, the inner aspect of his left foot was injured. Though he has been antibiotics, his foot has yellow drainage. He is now on another course of antibiotics. I recommended he soak his foot with h2o2 1/2 strength in h2o for 15-20 minutes at night then dress with the bactroban crm. When he began this procedure, his foot really seemed to respond, swelling is down, redness less and looks to be healing with healthy tissue. The drainage is less too. I told him not more than 7 days of this soak. Now, from what I am reading the h2o2 is probably not the best thing to do. Have I given him bad advice? Why the improvement so dramatically after he intiated this process if so? Thank you C Howard Hydrogen peroxide is cytotoxic. Never put anything in a wound that you wouldn't put in your own eye. The improvement is probably due to the change of antibiotics.

Gerry, LPN

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The initial improvement was probably because he was cleaning it more frequently and using the antibiotic. Peroxide at any dilution should not be used for any length of time. Keep the wound clean and moist...shower, use the batroban and a clean dressing only.
Sharon Mendez RN CWS

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You may have cleaned the wound up, and rid the wound of some bacterial colonization/infection. If it is now laying down healthy tissue, though, the peroxide can interfere with healing from this point, and a better choice from here might be an alginate (or silver alginate if you still suspect bacteria present) with an appropriate secondary dressing. There are lots of dressings to choose from. Try to find a wound specialist to look at the wound and help.

Vicki, MSPT, CWS
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Using H2O2 will delay healing but not prevent it. Many times the body heals in spite of us! a good analogy is that I can ride my bike 50 miles and still get to the next town but taking the car will be faster and more effecient etc.... H2O2 can be useful in very dirty superficial wounds (avoid use with cavernous or tunneling wounds).
Chris Berke RN CWOCN

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Though H2O2 is cytotoxic to some cells, it may be good for initially getting rid of debris and bacteria. Your suggestion had probably not done any harm.
I would keep it short term however and not soak in it, just irrigate (and then rinse with normal saline). Then look to a good wound care person for
therapy.

Deborah Harris, BSN, JD, RN, CWCS
Louisville, KY

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While I generally stay away from the topical agents that are cytotoxic to healing tissue (H2O2, betadine, dakins, etc), I sometimes use Iodosorb or Dakins if I find a wound has stagnated in healing; it may be due to a high bacterial burden which does not necessarily cause an acute infection but can cause wound deterioration. I don't use it for a long time, maybe a week or two. Don't beat yourself up over it; if his foot is still attached and has no further damage, that is a good thing. Just go forward from here and remember that one wound may require changing treatments several times during the course of healing.

Nancy B. RN, CWCN


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