where is your son from, you say you are from PA
and recluse bites in your part of the state are very rare. unsigned

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regarding care and treatment, close follow up is necessary after any sort of procedure where a recluse is involved, many people have had to have partial amputations due to those nasty little critters.
you do not specify as to what type of surgery your son had done, but most important is careful monitoring of surgical area for obvious signs of infection such as redness, warmth, swelling. or if he develops fever.
stay on top of it and without complications all should heal well, but does he have any underlying medical conditions such as diabetes that could slow or delay healing?
Pain is normal for up to about 2 weeks after surgery, so since it is now long past that he may want to consider a pain managment service in your area.

RN from Sunbury,PA

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I am assuming he had necrotic tissue (dead tissue) that needed surgical debridement. If the wound bed is beefy red (granulation tissue) and no signs of infection he may be a candidate for a vaccum assisted device (Wound Vac or Blue Sky). One complaint that most people have with the wound vac is the sponge sticking to the skin edges and new tissue. I have recommended to use an adaptic gauze (course weave vaseline gauze) to the skin edges and can be used to the wound base as well, this eliminates the pain associated with dressing changes. If infection is not a concern, this should heal in a timely manner. If there is no progression toward healing, something in the wound bed preperation is not correct, and I would have a wound care specialist assess the wound. Hope this helps.
R DeLaney LPN, CWS, FCCWS

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Mesalt has been successful as a treatment. I've also been told the Hyperbaric Chamber is indicated for spider bite.

good luck

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We have used unprocessed honey-sugar paste with whirlpool therapy, and have had great results.

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These can be challenging to deal with. I recommend you find a local specialist to help. www.aawm.org and www.wocn.org have directories of certified people.

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

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You should consider a advanced wound care center for his treatment and the possibility of hyperbaric oxygen therapy.

Most insurance companies will pay for these treatment for brown recluse spider.

Good luck

Patrick Q. McMahon, Director
Guthrie Center for Wound Care &
Hyperbaric Medicine
Robert Packer Hospital, 4th Floor
1 Guthrie Square
Sayre, PA 18840
Phone: (570) 882-6639
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Hello,

I have worked with several brown recluse bites. The vital part of their care is keeping the wound clean so that bacteria doesn’t have place to grow, and staying on antibiotics to decrease the bacterial infection also. A wound center/specialist familiar with spider bites is vital.

Vicki, DPT, CWS
 

Can she not bill the hospital as a consultant? The hospital being responsible for paying the consultant according to the fee proposed, wether by the hour or by the patient. Then when the consultant makes recommendations the charge nurse contacts the on call physician to get the approval to follow the wound care specailist recommendations, then writes the order.
R DeLaney LPN, CWS, FCCWS

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My understanding of billing issues is just as you described. Yes, you can still utilize the PT visits for outpatient wound care, but PTs can only be reimbursed for wound care if they are doing debridement, pulsed lavage or whirlpool (whirlpools are usually not the best choice, lavage is almost always better in my opinion), or electric stimulation (in specific instances, ie the wound must have failed standard care for e stim to be covered by medicare). The PT cannot bill for care on days when the patient has seen the MD, and this is an area where you can get in trouble as you have to constantly quiz the patient as to when their MD appts are so that you don’t accidently see them that day too. Often I see patients on an outpatient basis for lavage and debridement 2 or 3 times a week and our hospital home health sees them on other days to help with dressing changes. Or, I see them on certain days and they go to the OP wound center for a nurse or MD to do dressing changes. Only one insurance company that I ever dealt with allowed me to see a client and do dressing changes without lavage or debridement, on a large complicated wound that I was packing.

Vicki, DPT, CWS
 

Mary

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Go to KCI1.com, that is the contact for the KCI Wound Vac and they should have the information you need, not only on the use of the product but also any seminars in your area and the KCI representative in your area.
R DeLaney LPN, CWS, FCCWS

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try www.kci.com
Robin
Wound Care Nurse

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If you go to the KCI website, there is a lot of information, as well as article citations you can go look up to see the full article. There are several mechanisms of action, including promoting tissue growth through mechanical stresses and removal of bacteria and excess fluid. The person must be adequately nourished for it to really be effective. Check the pre-albumin level. You can also to go www.pubmed.gov and search for "wound vac" or "negative pressure wound therapy" to find articles and abstracts for more information.

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS
 

Hunter

Undermining is when you can sweep a cotton swab under the edge of a wound (like a cliff overhanging) Tunneling is a canal or tunnel that goes into a wound deeper than the majority of the base of the wound.
you can measure both by the same method. Using a gloved hands put the cotton swab gently into the area and mark the edge with your free hand by pinching the swab. Now hold the swab against a disposable ruler and record.
Use the clock system for noting where the tunnel or Undermining is at.
example
wound measures 4.0 cm x 4.0cm x 3.0cm (head to toe x side to side x
depth)
with undermining noted at 11:00 to 1:00 with a max depth of 2.0cm and tunneling at 6:00 with a depth of 4.0cm I hope this helps.
Marie Simons RN
Wound Care Nurse

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tunneling has a opening
undermining i tunneling under the skin and doesn't have a opening
Robin
Wound Care Nurse

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Tunneling is a tract between tissue structures. Undermining is an erosion under the wound edge. It can be a tough concept to grasp. When I teach, I offer a rule of thumb of: longer than wide = tunnel, wider than long = undermining. It's not 100% accurate, but helps give people a tool to work with.

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

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Hello,

We define undermining, tunneling and tract as follows in our facility. You might want to look in your facility’s P&P manual to see how they are defined there.

Undermining is when the perimeter of the wound has open space under it, like the skin is a shelf over a wide cavity. Tunneling is a narrow, deep “tunnel” that begins in the floor or edge of a wound, and that is open at both ends, by exiting at another area of the body. A tract is a narrow deep opening in a wound that does not have an exit opening.

Vicki, DPT, CWS
 

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Pig intestines and neonatal (human) foreskin mostly.

unsigned

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Collagen can be used as a primary wound dressing. Colagen is available in many forms such as gel, paste, powder and sheets. Collagen is derived from cow, pig and chicken tendon. Collagen absorbs wound exudate, and during the repair process provides support for cells and can attract fibroblasts and macrophages to the wound. Collagen is a wounderful dressing for wound repair.
R DeLaney LPN, CWS, FCCWS