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I have never done this myself but often heard, Rubber cement. Apply rubber cement to the skin, allow to dry then peel. Many of the barbs should become trapped in the glue and be removed with the glue. Worth trying!

Michelle

Kathy

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I would try lightly packing the wound with Normal Saline soaked 1/4" nugauze (or some other t/4 sterile stripping). Cover with some 2x2's or 4x4's and paper tape. Change it once a day. You could probably go to your local drug store and get these things. Make sure you are not packing the wound too tightly. I do wound care where I work. This is what we do for open wounds such as this and it works great. Good luck and let me know how it progresses.

Karen Tucker RN

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Hi,

I would recommend to first culture the wound to make sure it's not growing something wierd. There may be a high bacterial count...maybe using silver aliginate might help with decreasing bioburden.

Also how is nutritional status(Albumin) and CBC. How is the oxygenation? Are there any other health problems like diabetes? Are you drinking 2 liters of water per day and eating lots of fruits and vegies that are high in Vitamin C?

Not sure what else to suggest....maybe even consider wound vac if doesn't improve.

Hope this helps

Michele in San Diego Rn WCC

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Since there is a change in the drainage color and no change in the wound closure in the past 5 weeks I would advocate for a culture and sensitivity to make sure you do not have a bio contamination/ infection preventing you from progressing. After that is done and treated (if need be) I would suggest packing with an absorbing silver dressing (Aquacell Ag or silver cell). It will absorb, provide antimicrobial protection against bacteria/virus/fungus, and can stay in place for 3 days! Maybe you can find a wound care specialist in your area to help determine what is best for you. Good luck. Michelle,PT, CWS

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I am familiar with a surgical abdominal wound which has just now closed in.

3 months ago the suture line became infected and when staples were removed post-op, the wound was infected and opened.

1st.
Fluidly apply wet normal saline dressing and re-pack snugly daily.

Next tx tried was: N/S irrigation, betadine soaked idoform packing into open wound and sterile dressing daily.
C&S swabs done as nec. And appropriate p.o. antibiotics.

Next:
Daily wound irrigation with ½ N/S and 1/2 peroxide. Follow with betadine packing firmly and sterile dressing.

Re-suturing done at Day Surgery once wound considered clean.

Cleanse with N/S and daily dry sterile dressing.
Next:

Due to seeping sero-sangenouse flid ; cleanse healed suture line with N/S and place sofra tulle dressing and sterile dry dressing. Hypoallergenic hypafix utilized for taping.
Now, f/u 2 times week and no dressing unless warrents.
Client has a mesh internally and this was also questioned if allergic.
Trust this is of some help.
BEE---L.P.N.

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Hello Atenda,

If no significant change in wound healing occurs in two weeks we usually notify the physician for evaluation or order change.

William RN

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Usually try to modality for 2 weeks and if no improvement then move on from there.

Michelle
 

unsigned1

The doughnut creates a ring of compression around the pressure sore which could result in
a) venous compression thereby resulting in venous congestion in the enclosed area & thus worsening of the sore
b) a greater pressure could result in decreased arterial flow into the area from dermal, subdermal & subcutaneous plexuses increasing the central damage

The dressing
Depends on whether there is slough or granulation tissue, if there is a lot of discharge or not etc etc. Cleansing of the wound and the surrounding area without damaging the granulation tissue or the surrounding skin pH and natural defenses provided by the sebum should be done as often as need be and the application on the wound would be dictated by the slough / granulation tissue / wound infection etc.
Kumkum

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This sounds like a bad situation that will get worse without proper care.

Alot of times patients are told to stay in prone position but this may not be possible with a ventilated patient.

There is a Clinitron bed that is called Rite Height that has pressure relief in the buttocks area and the head of bed is low air loss so the head of bed can be elevated.

As far as the wound has it been cultured. Is there osteomylitis in the wound?? Has that been ruled out??

Would like to know more about this patient and feel bad for people like this but hope this helps

Take care

Michele in San Diego RN WCC

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Listen to me and listen good! I am a wife of a diabetic who stepped on a piece of glass five years ago and was given the same treatment. He and I know one thing to be true - if what your doing isn't working IT'S TIME TO DO SOMETHING ELSE. Look for a wound care specialist in your area NOW! I have no credentials but have been trained by our podiatrist/surgeon who was aggressive enough to get the help we needed. Get aggressive. Ask about hyperbaric treatment in your area.

I'll be praying for you
Cheryl

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Dressing unit which may be beneficial:

Cleanse with gentle stream of normal saline. 30 ml syringe with # 18 introcan safety. Hold back from ulcer.

Iodosorb ointment, bactigras dressing, and some apply duoderm extra thin or none adhesive allevyn. Diabetics need to be cautiouse re: allevyn. Check with wound care.

Observe for maceration around outer wound edge. A good protective product is 3M Health Care.(Cavilon).

Intra-cit gel is also very popular.

Trust this will be helpful.
BEE L.P.N.
 

A " straight forward" venous ulcer can be prevented from reoccurring with compression stockings. If you have tried this without success then you may not have a high enough level of compression. If you have underling arterial disease, you may not be able to safely use an adequate amount of compression. If you have lymphatic edema then you should seek manual lymph drainage therapy to get optimal results. And lastly, there are surgical interventions that can be discussed with a vascular surgeon. Keep investigating your options.

Michelle

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Dear Diane,

Venous stasis ulcers can definitely heal, however, it will keep on coming back if you do not address the main problem, which is the vein itself, Surgical procedures such as vein stripping, ligation of perforator veins are usually performed to decrease the reoccurence of these problems, however, the cheapest way is to wear a graduated compression stockings to prevent venous stasis hence avoiding ulceration.


Dale ,WOCN

Sara

Unsigned3

I suppose you have tried barrier creams e.g. ZnO paste to protect the excoriated area from further damage.
kumkum

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To begin with you need to have a proper diagnosis as to the cause of the ulcer. Unless the cause is detected and then adequately treated "if possible", the ulcer may refuse to heal or even if it were to heal it may continue to recur.
kumkum

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Unna boots are time consuming to apply and remove and very messy. We are using Coban 2 layer compression by 3M at our facility. It's easy to apply and remove. Patients are much more comfortable than the Unna Boot or the Profore. They are doing great with this product. Then can also get their shoes on which encourages ambulation.
good luck
Carly RN CWS