Wound Email - September 15, 2008

Wound Care Information Network

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September 15, 2008

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I have had a Dr. ask me how long it takes for eschar to form. My initial response was that it could vary from patient to patient, but probably about a week. Do you have a more detailed answer? I really couldn't find anything in print to support this. Could you help me please? Thanks, Stacy RN,CWCN	sorry, no replies
Hello, I had an inguinal hernia repair through open surgery (not the keyhole surgery) back in March 2008. The medial section of this scar never healed (the rest is perfect). It became pus filled, would burst, then looked pink and like fresh skin but never fully fully healed, only to become full of pus again. I was put on flucloxacillin in May, to no avail, and upon seeing my surgeon on the day the pustule had popped, was informed that there was no infection whatsoever and looked clean. On my last visit to my surgeon in late July, he said he would excise this medial end as it wasnt healing (it was not gaping, but it was not healed skin, if you see what I mean). After the surgery, I was informed there was nothing of note and the wound was cleaned and subcutaneous sutures were used. This was on August 9th and it is worse than ever. It is gaping, oozing pus, was really really sore until I took some Augmentin (the course of which I have finished today) and now the soreness has diminished and it itches slightly now and again yet is still sore. It looks frightful and is really upsetting me as I believed this to be a simply procedure which would heal. I am healthy and at my wits end. I do not know what to do, could someone please help? Thank you Melissa	I strongly encourage you to find a medical practitioner who specializes in wound care (MD, RN, or PT) They will assist in determining why you are not healing and help develop a treatment plan specific to you. You can locate one near you at www.AAWM.org. or www.wocn.org. Good luck,Michelle PT, CWS --- Was a mesh used for the repair i.e. an implant? Kumkum --- I have completed dressings on 2 clients that their repairs wound not heal. The end result was that the mesh had to be removed related to being allergic to the mesh. BEE --- It may be that you have developed a sinus tract, that is draining periodically from a deeper fluid filled area. Ask your Doctor to order a sonogram - if yes, you will need to see the surgeon again to surgically open and drain it. Also, an infectious disease referral would be good, as you would need appropriate antimicrobial coverage until all is clear. Maiu Linde, R.N., B.Sc.N., Clinical Resource Nurse Wound Healing/Medical Clinics
I would appreciate information regarding ultrasound treatment parameters of multiple wounds from PVD to the foot region. Can the ultrasound for wound healing be administered underwater and what parameters are used? I have also been informed that there is MRSA in these wounds. Are there any contraindications and or precautions related to the infection? I appreciate your prompt feedback in this matter. Thank you. Martha Connor LPT	sorry, no replies
I'm hoping someone can help me. I'm 57,diabetic and sedentary due to a disability. I accidentally hurt my lower right leg over a skin area already scarred from cellulitis. A break in the skin causing a wound about the size of a nickel, 3-4 millimeters deep and constantly draining clear fluid from edema. I'm having to change the dressings every hour due to drainage. My doctor wants VNA to put on a Unna's boot but from what I've read it's very likely it will be soaked from drainage within a short period of time and I fear will not be effective. We have very little money for medical expenses. My question is will this type of therapy be effective with this constant drainage I'm having from edema? And if not, can you think of any kind of therapy that would be more beneficial that I can take care of myself at home? Thank you very much for your web site. I look forward to gleaning much information. Susan Vermont GreenMtnLady@gmail.com	An Una Boot is probably your best bet. What the Una Boot does with pressure is shunt the fluids that are pooling in your lower extremities back toward the core of your body. With this treatment you will find less and less drainage and your wounds should heal nicely. Keep in mind that the Una Boot must be applied by a professional as improper application could cause more damage. Another alternative is using Ace wraps in the same manner as the Una Boot. It is not as effective but does allow you to change the dressing daily or more often if necessary. Again, you should seek a professional for proper application and teaching. A Home Health agency should be able to provide this service. I wish you well. Angels be with you. Carol RN :) --- Susan, Edema is large quantities of fluid in the skin, Because of the opening is your skin that fluid is what is draining out. Compression will reduce the edema and therefore reduce the copious drainage. The pressure of the bandage will need to match or exceed the pressure inside the veins to overcoming the weeping. That may take a couple applications to determine how tight the dressing needs to be applied. Once that tension is reached, drainage will be very slight. Now, there are many different kinds of compression. The unnaboot (a type of in-elastic compression) is most effective on someone who walks. You mentioned that you are sedentary. If you are NON- ambulatory then a multilayer elastic compression would work much better. For edema related wounds, there is no better treatment then compression. I do like to use it with a antimicrobial dressing (like Acticoat 7 or one of the many other silver dressings on the market) so that bacteria does not grow under the dressing., This increases the cost of the dressing but decreased the final cost due to quicker healing and less expenses related to treating infections. Good luck to you, Michelle PT, CWS --- a "seweed" (calcium alginate) type of dressing can be put on the wound and the unna boot can be placed on the lower leg (over the dressing); the alginate will absorb drainage and heal the wound; the unna boot will reduce the edema, and once the edema is gone, the drainage will decrease and the wound should heal c. orzolek CWOCN, MSN , CNP --- What is the exact location of the wound/ ulcer? Is it on the shin, lower 1/3 or middle 1/3 of the leg or did you mean the foot? Maybe an absorbent sanitary pad could help to keep the area dry and thus allow it to heal. This to be accompanied by daily 2 or three washes with tap water and a mild soap. Kumkum --- control of the edema can be brought about by the use of the unna boot as well. However if the amount of fluid seeping from your leg is that extensive it is likely that the skin wound become macerated under the unna boot. Have you been in contact with any Physical therapy services in your area or a wound clinic which may be associated with a hospital in your area. Another suggestion may be to try silvadene and a dressing to the area and to use ace wraps to assist with fluid mobilization from the edema. I wish you luck in healing of your wound Lynette Flick, RN
Dear Sirs, My son had a partial amputation of his great toe the bone does show and was wondering the best way to dress and promote it’s healing? Was just sent home with a script for an antibiotic an no instruction. Carol	Not knowing your sons age, health history or why he had this surgery it is hard to proved and assistance/ direction however, bone exposed is a concern as it is a risk for bone infection. Please look for additional medial advise from his doctors or from a wound specialist. You can locate one near you at www.AAWM.org or www.wocn.org Michelle PT. CWS
Hi, We are a pediatric unit that frequently get babies with abcesses of the diaper area. We have been covering those wounds with guaze covered with op-site. We were trying to keep protect the dressing from urine and stool. One of the nurses felt the op-site was "holding the infection in." Others of us felt that op-site had drawing powers-in that it would draw out the infection. As well as protect it from getting soiled. Please let us know what is the correct line of thinking. Cindy RN	You don’t want to use gauze under opsite. You would be better off to use an alginate with silver under the op site; such as surgicell or aquacel ag; use a no sting skin prep on the skin around the absess to prevent skin tears corey CWOCN, MSN , CNP --- Opsite is just a barrier not allowing moisture in or out. If the retained discharge is a problem you could consider the VAC principle and apply it with the 'Redivac" or other plastic suction drainage system if the anatomical area allows you to get an air-tight seal. kumkum
My husband has been going through a series of issues over the last three months with regards to wounds. He is diabetic. He lost all toes on his left leg back in 2002, but actually was doing quite well until about 3 months ago. He got cellulitis on his 'good right' leg. To make a long story short, he had a below the knee amputation. Went to rehab, but stump was not healing well. Brought back to the hospital and had an above the knee amputation. He went back to rehab, but developed an ulcer on the back of his left calf and also one on his penis. The vascular surgeon did an angioplasty twice to try to obtain good blood flow. She was able to finally feel a pulsein his left foot. The hospital just released him today into rehab. I finally saw the ulcers as they are now. Not good. He has a nasty one on the back of his left heal, the one still on his left calf which looks worse to me and the stump on his right leg is weeping and that surgery has been a month or so. I do not feel that the hospital should have released him this early, but they basically told me they had to with the healthcareI rules in the US. I am looking for some guidance on what I can do to help my husband. He is still a young man of only 61 and need to see what I can do. Since he is on peritoneal dialysis, he is also getting Medicare. Please help. Pat in Ohio	Is he in a Skilled Nursing and Rehab facility? If so, he would qualify under the Medicare guidelines for wound treatment up to 100 days. The nursing staff should be assessing the wounds at least weekly to note improvement or lack there of. I would encourage you to communicate with the treatment nurse weekly and keep abridged as to the status of the wounds. If there is no improvement, the nursing facility should consult with a Wound Specialist. Good Luck. Carol RN --- Although the blood supply may have improved, the capillary pressures would be low and the oxygen demand being high because of the ulcers creates a situation of overall deficit. The areas need delicate cleaning and avoidance of any irritant or strong chemicals. Also off-loading of pressure. Good care of surrounding skin. Kumkum
Good afternoon, I need you input on the Products Sensicare and Duoderm. Do you think they are still appropriate for use of skin breakdown? Would appreciate any assistance you could provide. Look forward to hearing from you. Sharon - Director of Medical-Surgical Nursing	BOTH are great products; the sensicare is a thick barrier for incontinence, it has zinc oxide in it the duoderm is a hydrocolloid that has had thousands of studies on it showing it heals stage II and partial thickness wounds; i like the extra thin duoderm; i use no sting skin prep on the healthy surrounding skin; i often put a piece of an alginate dressing on the wound first, such as aquacel or kaltostat and then the duoderm- change it 2-3 times per week corey CWOCN, MSN, CNP
I am working with an individual who is 93 years old and over weight with “tummy folds” which harbor moisture. What is the best method to heal an abrasion type wound and to prevent from reoccurring? Thank you Liz	For this type of problem I usually cleanse the area with a wound cleanser or normal saline, lightly pat dry and allow time to fully air dry, then apply a thin layer antifungal cream, then dust lightly with a medicated powder such as Columbia or Gold Bond. This should be done 2-3 times a day until healed. Once it is healed, as a preventative measure, dust lightly with the Columbia or Gold Bond Powder. Best wishes, Angels be with you. Carol RN :) --- The best moisture barrier for skin fold excoriation and also for drying out excessive moisture is Calmoseptine Ointment, it main ingredients are: zinc oxide, calamine lotion and menthol in a thick paste. I think the paste composition is the mode of action. It is applied 3 to 4 x daily, you do not have to remove it from the tender skin just clean gently and reapply. Has slight antimicrobial and antifungal properties, soothing and cost effective. Go to Calmoseptine web site for uses of this amazing paste, and also free cme's. Also, I have a obese home health client that swears by spraying all folds with 50% isopropyl alcohol and 50% Normal Saline or water daily and gently patting dry. Calmoseptine is great for maceration, excoriation, contact dermatitis, eczema, psoriasis, sunburn, poison ivy and more. Hope this helps. It is now an over the counter product. Myra Badger, BSN, RN, BC, WCC
I am an LPN and I am interested in becoming wound care certified. There is only one facility that certifies LPN's and they have courses throughout the US. I understand that it is very expensive and the program is 5 days in length and a test is given on the 5th day, and you have to score an 85 or better to become certified that day. My question is this, I would like to know how to find information on wound care or a course on wound care, if there is such a thing, I haven't been able to locate any information. Before I sign up for a certification course, I would like to be somewhat prepared. Does anyone have any information on this subject? Thank you, Cheryl	You can go to www.AdvancingThePractice.AAWConline.org to find a variety of wound care courses, and much more wound care information. A couple things about certification. The AAWM has a certification that LVNs can sit for. It's not the CWS, but a different credential. You can find out more about it on their website (www.aawm.org). Also, not all certifications are accredited. You should consider that in your decision of which one to pursue. Lastly, not all certifications have the same level of respect from the wound community. Renee C, PT, PhD(c), MSPT, MPH, CWS --- Hi Cheryl, If you are thinking about taking the WCEI course, do it. They prepare you for the test. They are very thorough. Just study the material each evening after the class. And listen to what they are saying. I took their course and it was just the start of my learning. Good luck, Robin Sheeran, RN,CRRN,WCC, --- Cheryl, I, too, am an LPN. I work for a VNA agency and work with wounds daily. I took the 5 day wound certification classes followed by the exam on the last day. There is a lot of information/education given but I feel it was well worth it. I am now Wound Care Certified through National Alliance of Wound Care. I took a few one day CEU courses over the years related to wounds but this was more intense. If you are working with patients which have wounds, doing wound care, then you could very well take the certification course, without any prior wound care classes. If anything, get a manual or book on wound care which is always a good reference even after you take the class. You could also call the National Alliance of Wound Care. They have a website where you can get a contact number and they could give you a list of books or manuals which would be helpful. I don't know if this was the information you needed but I hope it is helpful. Please do not hesitate to email me with any questions. Good luck to you. Deborah Clark LPN, WCC --- Hi Cheryl, I was certified as an LPN, through WCEI.net, I believe that is the same course you are referring to. I went to the class completely unknowing what to expect. They are great and very supportive. Connie Johnson, RN, WCC, DAPWCA --- There are many ways to become a wound specialist. The most "reputable" are the ones that have INDEPENDENT licensing board examinations. I would recommend doing an internet search on the American Academy of Wound Management ( www.AAWM.org ) or The Wound, Ostomy and Continence Nurses Society ( www.wocn.org ). Becoming a CWS was not a terribly expensive endeavor however it was a board examination based on proving what I knew ( the expense of learning was separate and spread over time). Where I gathered that information was up to me. I choose to read wound textbooks, attend conferences and read/ talk a lot. I had also been working with wounds for 5-6 years when I took the exam. There are many difference conferences available. More information for you to research would be The Wound Care Congress, The Association for Advanced Wound Care and PESI Health Care. Keep looking for continuing education on line. There are many out there of all levels (advanced/ beginner) and there are classes just to prep you for the examinations. Before making a career defining choice, explore your options. I did and I have nothing but pride for where I am now! Michelle --- I believe you are talking about the National Alliance of Wound Care certification exam WCC that has a prep course given by The Wound Care Education Institute. It’s a great course and well worth the money. There is also another certification available for LPN’s thru The American Academy of Wound Management CWCA. Check out all three of these web sites. I also found Smith & Nephew’s Global Wound Academy online helpful and you can take mini exams on there for CEU’s. Good Luck Kathy M. LPN,WCC,CWCA ---- Hi Cheryl, The certification course you are referring to sounds like the one I completed through WCEI (Wound Care Certification Institute). It is an excellent course. There are courses through PESI Healthcare on the Wound Challenges that are coming up in Oct. in Charleston, Columbia and Greenville S.C. that are reasonably priced. I suggest you" google" for other wound care courses near you. I have attended programs through this company and find them very useful, information that can be applied immediately on the job, and easy to comprehend. Another suggestion is to follow the Wound Care Seminar Clinical and Economical Realities (formerly The Buck Stops Here). It is a one day seminar with a wealth of information that will help prepare you for the certification preparation course. I hope this helps. Good luck. Belinda RN, BSN, WCC

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