Wound Email - June 15, 2006

Wound Care Information Network

June 15, 2006

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Looking for advice and information on both Oasis and Integra. When do you use it? Why? How effective is it? Thanks, Alfred, MD	Oasis is a Matrix dressing / Integra is a hydrogel dressing and I believe there is also a Integra skin substitute Oasis is marketed by Healthpoint / Integra marketed by Integrity Medical Devices Suggest you review indexes: Ostomy Wound Management Buyers Guide www.owm.com and Wound Source By Kestral www.woundsource.com. You can get marketing brochures from manufacturers. Pat - RN CWOCN
I understand that a pressure ulcer starts on the inside and workd its way out to the surface of the skin. How long does it take to appear as red and some broken skin to reach a stage 2? and then a stage 3? The pressure to both buttocks? Thank you, Tera T. Treadaway	sorry, no replies
Hello. I am a Diabetic (44) and have occasionally had leg blisters that take some time to heal. Last year I had a larger outbreak following a physically stressful move. I developed cellulitis and required IV antibiotics at home. It took 3.5 months to heal. I recently developed another outbreak on the other leg (right) and after several months of oral antibiotics and Fucidin along with Burosol soaks 90% has healed, but the remaining 10% runs down the centre of my shin and looks like I have had an accident shaving - red under the surface. At night I routinely awaken around 5am and the burning is phenomenal - truly beyond belief. I have to apply the Fucidin and use Tylenol w/Codeine for the pain which is a 15 on a scale of 1-10. I have a strong pain tolerance level - but this is like a burn and it is relentless. During the day when I am moving it is not as severe. I was using oral Cipro until recently. I am using Benuryl now with the Fucidin. The wounds are not very deep - as I said, like a shaving wound. Is there anything I can use that would be more effective at closure of this last area, help with two new ones on the back of my leg before they become like these and the terrible burning pain? Is there is difference to wound healing with IV antibiotics versus oral antibiotics? I have an appt with a new Endocrinologist, but can't get in until August. Thank you for your suggestions. I am exercising (walking on a treadmill) and have a lot of weight to lose. I get the exercise connection and the blood flow importance - I am really trying. Rebecca Rebecca MacBride Beckspapergarden@sympatico.ca	The location of your wounds sounds like your wounds are a result of venous disease and not diabetes. Although, your diabetes does make it more difficult to heal. Are your legs swollen, red, brownish stains? Do you have varicose vein? If this is true, and the redness/swelling decreases when legs are elevated (above the heart) then you should talk to someone about being treated with multilayer compression dressings. Michelle, PT, CSW
Need your expertise & advice regarding the following: Perineal Area. A Reaction to phosphate enema, area became immidiatly swollen around the anal & perineal region, then tissue breakdown with in a day sitting being (paraplegic) wheelchair bound. skin broke down to a grade 3 pressure sore from the anus. Wound measured 9cm by 6cm - full thickness of skin damage. Used Manuka honey - medi-honey to deslough the wound.now 100% clean wound now 1/2 cm deep presently dressed with aquacell Ag silver & silvercel hydro - alginate dressing & a coloplast dressing. need your expertise & advice with following problems.. 1.Apart from bed rest, What creams & dressings etc, may further be used to aid promote healing? 2. Are there any dressings to put around tissue over laping broken down tissue to normal tissue to aid healing? 3.continence care, when bowels open they open in to the wound any advice here would be very greatly appreciated wound is cleaned thourally. also as things progress are there any non evasive enemas natural medical enimas that could be used analey, ie. so this may never happen again. we are in England U.K. Thanking you in Anticipation. Kind regards Michael	I have had to treat a similiar area with one of my patients. What we have used with great success is the following treatment. Flush the wound with carraklenz, then apply a very thin layer of silvadene (we applied with a q-tip to prevent too thick of an application)to the wound base. To wound edges we applied xenederm also a very thin layer. And we applied fibracol (a calcium alginate) to the wound base only . We changed this daily and kept the patient on bed rest turning every two hours. As the area healed I applied Bag Balm to the healed peripheral areas, to protect the new tissue. We now almost have this patient healed. This wound began as an area of 5 inches wide by 7 inches long to teh peri scrotal area and is now an area of 1 inch by one half inch. Good Luck to you this one might work. unsigned --- Sounds you are doing well with choices of treatment / products. Best thing for healing - good nutrition .... protein protein protein ..... lots of liquids and vitamins (need A B C D and the element Zinc for healing) If stool getting in the wound is an issue you can cover the dressing area with plastic. There are numerous plastic dressings on the market. Some brand names... Tegaderm / Poly skin / Bioclusive transparent dressing... to name a few..... Pat RN CWOCN
I have a pediatric home care patient who has a GJ tube for feeding purposes he has lots of leakage and skin break down,a stoma that does not want to heal do you have any information on wound care for this type of wound? the area affected is quite large and the skin seems very thin .thank you for any information you are able to provide Heidi Keitz	I am a direct service L.P.N. My client is to use aquacel gauze to absorb the moisture. It was also suggested to cleanse with 2 TBS. of vinegar to 4 TBS of water. Place a dry sterile drainage 2 by 2. Trust this is helpful. BEE --- try hydrofera blue, it works great for more info, --- Try using 3M No Sting Barrier Film around tube. It can be placed on open skin and will not burn. It doesn't have any alcohol in it. It will create a waterproof barrier and allow the denuded area to heal. I would also look into why the tube is leaking so badly with the GI doc. Carly RN CWS --- If you can get hold of "non sting" skin prep (3M makes a non sting brand) and apply this to the area you will have a nice invisible but protective layer against fluids. It toughens the skin as well making it less thin. Skin prep is used for people with colostomies but works very well as a protective barrier for other areas especially soft heels. You can use if often and it doesn't wash off. Good luck Theresa Keesee, LPN Wound Nurse --- Heidi- You might want to check tube for proper size and placement. Are there any diagnoses which might be causing the leakage? You don't mention characteristics of the peristomal skin other than it appears thin. I imagine it is irritated and possibly fungal. You might try to apply to peristomal skin in this order... layer of non-sting skin prep, nystatin powder than another layer of non-sting skin prep barrier. Or maybe a thick Antifungal cream with an outer layer of Cavilon Cream. Each could be done 2-3 times daily. Skin should of course be thoroughly cleansed and dried. For the stoma, you might want to try an alginate dressing. It will absorb drainage and decrease any hyper granulated tissue which may be present at the stoma site. Good Luck, Kim, LPN
Hi, one of my colleagues has question whether we should use 95% silver nitrate caustic applicator sticks or 75% to use on over granulation tissue on wounds. Within are own department we have only ever used 95%. Literature that I have from manufacture Bray Health & Leisure on use of 95% do advocate the use of 95% for over granulation tissue, yet they do also (Dr SJ Pearce CChem. FRSC) concur that the medical professional uses their judgement based on their expertise and detailed knowledge of the particular case. I am interested in knowing which strength is generally used by nurses competent to be using silver nitrate on over granulation tissue. I myself do use 95% but I am now questioning myself whether or not I should in fact be using 75%. I have never experienced any problems or concerns with using 95% yet my colleague has made me question why do some doctors or nurses use 75% sticks instead of 95%. I would appreciate any information or experience anyone is able to share. Thanks Terri (uk)	sorry, no replies
I had a c-section 10 weeks ago. My incision opened up and left me with a wound that is currently 2 cm deep and 1.5 cm wide. Yesterday, my doctor discovered a tunnel that measures 4 cm from the wound opening. What is the best way to treat this wound? So far I’ve been treated with plain packing strip, Prisma, Oasis, Aquacel AG, and Regranex. Nothing has worked. I also have had a hip replacement so I worry about infection that could settle in my hip. So far it has not been infected. Am I a good candidate for any advanced treatment to quicken this process? My baby just gets bigger and heavier every day. I need to do something, but my doctor just wants to pack it with Aquacel only. Any advice would be appreciated.	I would request the use of a wound vac like that made by KCI. It uses negative pressure to pull drainage from the wound while stimulating the cells to grow and fill in the space. If you are eating well (1.5 grams of protien/kg of body weight and vitamins), and do not have an infection, then you have good healing potential. Good luck Michelle PT, CSW --- Two suggestions: Replace the Aquacel with an alginate with silver (Silva Cell by J&J) ..... At dressing change, the alginate will come out of the tunnel easier than the Aquacel (which turns to a gel when wet). Flush the wound well with saline at each dressing change. OR You can try vacuum therapy. "The Vac" by KCI will speed your healing along. Also don't forget good nutrition and hydration (and vitamins) Pat - RN CWOCN --- You might want to ask about the KCI Vacuum Assisted Closure system. This is a negative pressure system used for wounds which have little or no dead tissue visible. Phone in the U.S. - 1 888 275 4524. Do you have a wound clinic or wound specialist in your area or a plastic surgeon who specializes in wound care/closure? As a new Mom are you getting enough of the proper nutrients? A multivitamin and extra protein in your diet would be advantageous also. Kim LPN --- First of all, was the wound cultured? Your physician should have done this already, any infection will delay your incision from healing. Regranex is not appropriate in your case, only approved for diabetic foot ulcers. Whoever prescribed this treatment for you--run for the hills! Your wound needs to be packed lightly to heal from inside out. I would recommend seeking out a certified wound specialist to help with your care. Look at AAWM's website for a list of certified wound specialists. Good luck. Debby RN WCC --- I use a "wound vac" by KCI and the dehised C-sections I treat heal within 3-4 weeks depending on the size.....Angela Savage,RN,WCC,DOW
What type of Physician is best to treat Venous or Arterial Ulceration? My mother has had ongoing problems with ulcers on her feet. It has been approximately 1 year that she has had the same ulcers, and she has been to several physicians, including her primary and a neurologist. Can you also give me more information about Trental? How does it increase circulation? She has also been diagnosed with a bacterial infection in one of the ulcers, that is currently being treated with Cypro. unsigned	If the ulcers are on the feet the problem is most likely peripheral vascular disease of arterial nature. You need to have vascular studies by a vascular doctor. Trental enhances circulation by opening blood vessels - side effect lowering blood pressure - Can't use if the patient has cardiac problems. Hope that's helpful. Pat RN CWOCN --- Has any physician or nurse done a culture swab or biopsy of ulcer, Has hyperbaric oxygen therapy been suggested? Has she had a leg ulcer assessment/vascular? If so ? candidate for compression wraps/stockings? Is footwear an issue, has she been referred to foot care wound clinic? W.Wood RN --- A wound Care specialist or a Podiatic Surgeon who specializes in wound care would be helpful. And ongoing podiatry care should be a must for anyone who is Diabetic. The fungal infection is probably caused/exacerbated by use of the Cipro. Antibiotics can cause fungal infections. Ask about the use of Diflucan. Our physicains here often order Diflucan 100mg daily for 5 days. Again as a Diabetic please review your nutritional status. Multivitamin, and if you are able to take in extra protein that would be beneficial. You can ask about nutrition with your attending physician or a dietician/nutrionist. Kim LPN --- It would be wise to have her see a Vascular Surgeon or a MD that is well versed in wound care. Angela Savage,RN,WCC,DOW
I am a 78 year old male, non-diabetic and have been tested and found to have good circulation in the lower part of my legs. My problem - I have an ulcer on the outer tip of my left ankle. It is a little over 1cm in width. This is a recurrence of one 3 years ago which was eventually closed (1yr spent almost entirely spent in bed & on leave of absence from work) by using primarily wet-to-dry bandages and after months of using that switched to carasyn get. I have used actocote and now am using solo site. The home health nurse wants to debread the shallow area, then use oasis followed on top with actocote and a sponge to keep the area moist. There is terrific pain in this area most of the time. Do you have any suggestions for better results. The ulcer occurred about 4 months ago. Would appreciate any input. Thanks. unsigned2	According to wound care theory: You first remove any dead tissue then kill the germs then try to enhance healing. - Can be done by using "topicals" or active dressings. Sounds like your HH nurse is following good theory. Debriding will remove dead tissue - Acticoat is a silver dressing - silver is an anti bacterial I would probably engage in one goal at a time and take one step at a time. Although your vascular report came back good - to have a recurrent - long standing wounds on your outside / lateral ankle is a strong indication of peripheral vascular disease of arterial nature. Try to cover your ankles with foam to prevent further trauma and keep your legs warm to keep the blood vessels dilated. Hope that's helpful. Pat - RN CWOCN --- Is this area from pressure ( shoe?) or is it vascular?...depending on the etiology would be how you would need to treat the wound........Angela Savage,RN,WCC,DOW
Hi. I am a student nurse and I have a quire. an 85 year old lady has just been admitted to my ward following a right CVA.The lady was found lying on her kitchen floor. her condition indicated that she had been lying there for at least 24 hours. She had developed reddened areas to her left elbow and her left hip, which are now blanching. There is also a stage 3 pressure ulcer on her left lateral malleolus. The ulcer has a small amount of slough at the base of the ulcer, with minimal exudate. Please explain to me the factors which assist the healing process. and what dressing do you think would be the most appropriate to be applied to this ulcer, and why. thank you. I appreciate your feed back	sorry, no replies
hello, My name is Michael, and I was looking for information regarding the amount that Medicare and other insurance companies reimburse clinics for wound care changes and management. Any information that you could give me or if you could steer me in the right direction, I would very much appreciate it. Thank you very much, Michael Park	sorry, no replies
I work in hospice and recently took over the care of a sacral wound that was a stage IV, heavy exudate, very strong odor (you could smell it down the hall). I started a calcium alginate dressing with a foam absorbant pad. After a week, the odor is essentially gone, and the wound bed is now bright red with a moderate amount of drainage. Since the wound looks so much different now, It seems that the type of dressing should change, but I am not sure what type would be best. Any suggestions or direction toward resources that would help provide guidance?	You can continue with the alginate and foam secondary dressing, maybe decrease dressing change to every other day, depending on the exudate .If the dressing is too dry you can repalce alginate with hydrogel Remember it is important to protect the periwound When choosing a dressing, consider the wound bed, peri wound, amount of exudate, odor control, trauma to wound when changing dressing, including pain management unsigned --- You are going to get alot of responses to this question I'm sure. HealthPoint (makers of Accuzume, Panfil and many other products) has a wonderful interactive wesite that offers free CEUs. It is a great learning tool and the CEU's are a great bonus. There are alot of things you can do but as long as the wound is clean, not draining and starting to show granulation, I would just use an appropriate wound cleanser and pack the wound gently with hydrogel impregnated gauze and cover with a moisture retentive dressing (foam). Perform the changes often enough so that the dressing does not dry out and pull the granulation tissue out when the old dresing is removed. You did a great job of cleaning out the wound from you description, it sounds like it is ready to start granulation Jeri Wound Care Coordinator --- Old fashion wet-to-dry dressings will work, but at least twice a day. The gauze should be damp not dripping and loosley packed. It will work beautifully, but will take some time.. I have a pt who had the same type of wound and was admitted with wound approx 11cm x 8cm x 7cma now is about 5cm x 5cm x 3cm in about 2 months. Good luck Theresa Keesee, LPN Wound Nurse

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