Wound Email - July 15, 2007

Wound Care Information Network

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July 15, 2007

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I am a physician who has a 92-year-old mother who has developed a necrotic Ulcer over the past six weeks above her left heel which is affecting her tendon. She has severe aortic stenosis and is fluid and salt restricted.A number of Circulatory tests were performed which showed poor circulation to the affected area. She has been very functional until recently.Because she experiences severe pain When she walks she has Limited Her walking substantially. I am looking for a good Wound care type center So that she can be treated With medication And ancillary methods Because she may not be a candidate For surgical intervention.Please e-mail me at intelod@gmail.com Or call me at 954-701-8292. Thank you, Dr. Laurence Ecker	sorry, no replies
My mother suffers from ovarian cancer, and, as a result of multiple blockages, had a g-tube placed for stomach drainage as needed. Unfortunately, the hole around the tube enlarged and her stomach contents were leaking out around the tube on a regular basis, causing what appears to be a chemical burn to a rather large area of her stomach. The tube has since been removed, but the copious amounts of drainage from the site have made the area very difficult to manage. My mother experiences severe burning, and it seems impossible to protect the surrounding skin from constant exposure to stomach fluids. Being a physical therapist who works primarily with wound care, I suspect some sort of barrier may be of assistance if we can avoid infection. Do you think SSD (silver sulfadiazine) might work with a foam dressing for fluid containment? We have tried a colostomy bag to catch the fluid, but the skin and position of the hole do not allow for a good seal (my mother also has a fistula and colostomy bag just below the site). I am open to any suggestions at this point as are the other healthcare workers involved in her care. Thank you for your time! Sincerely, Sheryl Wolowice, MPT	I WISH YOU MOTHER LUCK I AM A OVARIAN CANCER SURVIVOR BUT I AM A WOUND CARE NURSE SWAB THE AREA WITH MYLANTA IT DOES THE SAME THING ON THE OUTSIDE AS INSIDE ROBIN WOUND CARE NURSE LTC --- HI--I HAVE HAD A PT WITH SIMILAR CIRCUMSTANCES AND WE HAD A COLOSTOMY BAG OVER THE OPENING, HOWEVER, THAT DEPENDS HOW CLOSE THE OSTOMY IS!!! YOU ALSO HAVE TO KEEP IN MIND IF HER SKIN ON THE OUTSIDE IS THAT PAINFUL AND BECOMING EXCORIATED, WHAT DOES IT LOOK LIKE BETWEEN THE COLON AND THE SKIN--THE PT I HAD REQUIRED SURGICAL INTERVENTION!! HOW THIS HELPS!!!! TAMI, RN WCC
Hello, I am desperate for help and information regarding my wound sites. On May 2nd I had to have emergency surgery to remove my appendix. It was done via laporoscopy; therefore, I have one incision from my navel about an inch down. Another small hole on the left side of my abdomen and another small hole below my bikini line. One week post-op(May 10th) I went to my surgeons office to have the bandages removed. All looked well. Two days later I had itching and what appeared to be little blisters around the incision sites. -The tiny blisters only contained clear fluid, but the itching was unbelievable. I called the surgeons office on Monday, May 14th but could not be seen and called my dermatologist in desperation. I was seen by my dermatologist, but he refused to treat me or even discuss what was going on with my skin and said I needed to go back to my surgeon. -He called to get me an appointment for the next day. My surgeon saw me and basically told me that my dermatologist should have treated me as it wasn't surgery or infection, but a skin condition, possibly fungal. He told me not to take the oral antibiotic that had been called in and to give it a week and call him. Well, it's almost been a week and the itching and rash look has not gone away or improved. In desperation I have used aloe from my own plant to give me relief from the itching. There is a visible rash around each incision site and the lower site's rash seems to be increasing in size. Does anyone know what this could be, what I need to do or who I can see to get some help? I feel I am being failed by the medical community and don't know where to turn. Thank you for any help or direction that you can give me. Sincerely, Melody	sorry, no replies
I have a patient with controlled diabetes (usually below 150 gluocse) who developed ulceration on the right heel with black necrotic eschar. I supported the eshar for sometime and have been doing indirect method E-stim until the eschar loosened up with a mild drainage. The podiatrist and I decided that this was the right time to debride. We debrided the eschar and attained a cleaner wound bed for a week then after that the black eschar re-appeared. The patient has a poor ciruclation with an ABI of .57 and .75 (Post tibial artery and DP artery). WIth the re-apperance of the eschar, what would you do with this situation? Shall you you wait until it loosens up again and becomes unstable before you debride? What if it re-appears after that? It is obvious that the black necrotic eschar cannot support angiogenesis and it is a manifestation of poor circulation. I also understand that this is a nature's proctector for the heel as long as it is stable and not good medium for infection. Any great ideas out there? Saturn	sorry, no replies
If I remember correctly, blisters on a diabetic leg and toe should be left intact and not be opened/lanced. Is this correct? If the blister opens it is an open wound to be healed. Basically, should you open a blister or just let it be? Thank you unsigned	sorry, no replies
I am attempting to locate an ICD-9 number for a Kennedy Terminal Ulcer. Any ideas? Thanks Barry M. Loflin, R.N., DNS	sorry, no replies
Hi, I'm a Tissue Viability Nurse in Ireland and have a patient who has a history of scleroderma and who frequently gets ulcers on her fingers. I am finding it difficult to get a dressing that is padded, waterproof and remains intact on her fingers and would be greatful if you could give me any information or advice, Regards, Adelene Greene.	sorry, no replies
I am a homecare nurse. I have a patient with bil stage 2 heel wounds. On the right side measures 6cm x 4.5 cm (approx) there is early granulation/ sloughing @ center of wound ( yellow in color) my wound margins are pink with areas of macerated tissue. No evidence of infection. Care giver is totally against duoderm dressings ( bad experience in the past). I am currently using panafil cream on the slough areas, and wound gel on the healthy tissue. I don't see any improvements.. Please help. On the left heel stage 2 approx. 2cm x 2.5 cm wound edges I am noticing areas of macerated tisssue. Wound bed pink, red early granulation. I am currently using the wound gel. Once again no evidence of infection but no improvement either. Lissette	sorry, no replies
Please adivse on non-healing arterial ulcer currently using woundvac and have noticed some pink elevated areas to ulcer base that were not there before, does not appear to be graulation or swelling, ulcer was 4.25cmLX4.5cm/WX.5cm/D on 050707 and is now 4.5cm L X 5.0cm W X .3cm D on 051607 seems to be getting bigger but flatter edges still well defined, ulcerbase is pink, cultured x3wks ago n took levaquin x14d, no odor, mod amt serrous yellow /white exudate. Woundcare tx is cleanse ulcer with wound cleanser, pat dry apply amerigel cover with vaselinebase adaptic and apply woundvac@125mmh using the granufoam on continuous therapy q M-W-F only. Patient has had ulcer x2yrs has PVD, 1+ swelling to extremities most days. Pt has gone thru apilgraft, vein stripping, una boot. with no significant changes, currently also going to HBO for 90min M-F. Can we do something better or different for this pt? Thanks for any suggestions, Eva	Dear Eva When we use the wound vac we use the black foam that comes with it . We cut it to fit the wound but not tight so that it can draw in the sides of the wound. We then cover it with a top dressing that is somewhat like opsite. The Amerigel and the adaptic with vaseline may be keeping it too moist. Have KCI come in an assess the wound and they can tell you what needs to be changed. You can also use duoderm around the edges of the wound to protect the skin. Valerie S. Downard LPN
Hello, I was wondering about a treatment one of our Doctors ordered for a patient... I am trying to find some information on it. The treatment to a stage 3 is 30 cc of Milk of magnesia and 2 tsp sugar .. apply to the wound, leave open to the air... What do you know about this treatment? Thanks Wanda	This treatment is 40 years out of date, not compliant with any published guideline, and is not supported by any evidence. Consequently, it is a liability risk. Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS
I am a community nurse, my department was adopted push tool as a wound care assessment tool, I would like to know this assessment in details, and the tool is widely used in the world or not, I found another department is seldom to use this tool in my hospital! Flora, RN	sorry, no replies
Hi, My patient is being discharged home with a Wound VAC. Besides wound management, what are other patient teachings I would need? Thanks. Merida	sorry, no replies

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