Dr. Sherman was kind enough to author an article for us on the topic.

See it by clicking here.

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We have used medicinal maggots in my facility with very good results, once you get past the "yuck factor".
Please see article with photos in Podiatry Management magazine June/July 2006 by Dr. Robert Snyder and Debby Hans RN.

Debby Hans RN CWS

NPWT link

What are the highest pressures that you go up to when using negative pressure and under what circumstances, has anyone come across problems with high negative pressures etc?

Elizabeth

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Problems with wound vac...yes, if over or near an artery or if patient is on coumadan or anticoagulant that makes it a little risky. Usually, if its 125 and try to put it to intermittant as soon as possible to increas wound granulation. Sometimes, though, if the wound has alot of drainage the only setting that will keep the vac on is continuous. Hope this helps.

Michelle RN, WCC in San Diego

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Terry,
Your husband would benefit from seeing someone in a wound center where advanced wound care is available. I would start by asking for a referral from your current physician or family physician.
Sandy Bruns RN CWON

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Hi, my name is Pam Mitchell and I am not a health care professional but I do think I know something that can help to totally heal and close your husbands wound. Maggot Therapy! Before you get grossed out--Maggot therapy is FDA approved. They are sterilized maggots raised and sold just for medicinal purposes. The maggots can do more than anything man can come up with. They eat just the dead infected tissue, excrete enzymes to promote healing and they kill all the bacteria. They are very cost effective and minimally evasive. Please do the research and save your self a lot of time(and money) trying so many other treatments. Maggots DO work, I know. You can get info from The BTER Foundation.org and or Monarch Labs.

Good Luck,
Pam Mitchell
Patient Advocate
BTERFoundation

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Dakin's is recommended for infected, necrotic wounds and not for clean granular wounds. I believe it is usually mixed 1/4 strength, it is a bleach solution and may also hlep with foul odor. If this doesn't describe your patient's wound I suggest a less toxic form of moist woound healing depending on the stage of the pressure ulcer. The patient may also benefit from a pressure reducing mattress or overlay.
Sandy Bruns RN CWON

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Considered an antiseptic solution containing .25 sodium hypochlorite (Bleach) and developed to treat infected wounds, Dakin's is a old treatment for bed sores as it kills bacteria . However I do not recommend using it , as it not only kills the bacteria but it also kills the good healthy skin cells.
Better to use a sterile saline irrigation and a wet-moist dressing as moisture allows for cell epitheliazation (growth) and healing.
Dakin's is very harsh and must be used for short durations of time if at all
Also do not use Hydogen Peroxide, Betadine or other chemicals that dry the wound bed out

Connie RN BS
Nursing Instructor

Alison

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Hello..
This patient needs a doppler assessment, and if no contraindications - compression bandages, with antibiotic treatment - if this is cellulitis, and not varicous eczema? when wound is healed the patient should continue with compression hosiery, to help circulation, and reduce oedema.
Hope this helps..
Mary Devon. UK

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Tubigrip if measured correctly using the tape measures provided by Convatec and applied doubled provides approximately 20 mm Hg pressure at the ankle. It sound as though your client may need more compression than tubigrip can provide. If there is a vascular clinic, a vascular medicine specialist or a wound center in your area the patient can find someone to treat the edema with the correct amount of compression. The etiology of the edema must be determined.
Sandy Bruns RN CWON

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I would bet there is bacterial colonization occurring. That yellow layer sounds like a biofilm is forming over the wound- a lovely mix of bacteria and cellular debris. Is the wound bed pale? Has the wound gotten smaller at all in the past two weeks? I would ask the doc for a wound culture(deep tissue, not swab), and perhaps try a silver product, depending on the amount of drainage. Also, you might want to consider offloading. Are you sure that pressure has been relieved from the area?

Kristen, RN

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Sam,
I think that the wound specialists are likely correct. You can try Panafil ointment from HealthPoint. It is recommended for wounds with 30% or less fibrin slough and it prevents reoccurrence of the fibrin. I would also recommend a culture and sensitivity be taken after you remove the fibrin and cleanse the wound with Normal Saline to be sure that a resistant organism isn't preventing the wound from healing.
Sandy Bruns RN CWON

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If you are in long-term care, it most certainly is a pressure sore. As are sores caused by multi podus boots or any other device. This might lead me to think that daily skin checks are not being completed as they should. Sue, CWS
 

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Hi MC:

Based on your description of UC and wound getting larger with debridement:

Pyoderma Granulosum is a skin condition associated with inflammatory bowel disease such as Crohn’s disease, ulcerative colitis and arthritis. The exact etiology of pyoderma is unknown but many discussions exists. Diagnosis is based on presentation and association. The usual treatment recommendation consists of steroid therapy to treat the underlying condition. Other treatments are being explored. According to the literature sharp non-selective debridement is contraindicated as these ulcers get larger. A good web site to visit for further information is www.worldwidewounds.com.

Best Regards,

Jamie Pinnock BSN, R.N., CWCN

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Prisma is supposed to remain in the wound. It is not to be rinsed out or removed since it binds the MMP's in the wound allowing growth factors to work. In my practice in a wound center we would only debride this wound if it was draining beneath the promogran or it was healed and the promogran could be removed over the healed wound. We instruct pts to apply it dry to a wet wound and moistened with NS to a dry wound. With a wet wound it usually requires reapplication daily and with a dry wound every three days.
Sandy Bruns RN CWON
 

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Burns should be cleansed daily with an antibacterial soap and water. Non-viable tissue should be debrided. If your physician is not comfortable with performing debridement of your burn wound ask him to refer you to a plastic surgeon or a wound center.
Sandy Bruns RN CWON