Wound Forum Archive

Wound Management Forum - Archive (1999-2000)

This is the archive of old messages from the wound management forum at http://www.smtl.co.uk/cgi-bin/HyperNews/get.cgi/wounds.html

Messages

Wound management with FIR Dressing

Date: 1999, Sep 21
From: Joey M. Sinchioco, M.D.

Hi to all
I'm just wondering if anyone has an expereince using bioceramics far-infrared surgical dressing for wound management.
Thank you and have a pleasant day
Joey M. Sinchioco, M.D.

HELP NEEDED OPEN WOUND

Date: 1999, Nov 06
From: Kris

Today, it is 5 November, 1999. Exactly one month ago, I fell in an open sewer and a rod impailed into my leg and took off a large chunk of my leg to the right of my shin. The wound is now about 1 inch wide and an inch and a half long as well as deep. The doctor started my on hydra therapy which ended this week. I still have difficulty walking and the wound has only closed up 6 millimeters. I have a few questions:
First the doctor started me on a wet to dry with saline not packing the wound. Just a cover over the wound. This went on for one week.
Second the wound became infected...gross, so the doctor sent me to a surgeon.....the surgeon sent me to hydra therapy, I did not need surgery.
The physical therapist had me whirlpool and after the whirlpool, they packed the wound with saline and packing strips for 1 week.
Week 2, the therapist started using something called Intrasite which was much better and comfortable for the wound.
Then week 3, on the last day of therapy, the therapist started me on something called saf-gel with alginate. That was yesterday. HELP IT BURNS.
I called the therapist..she said to go back to a wet to dry if it burns...does this sound right? I do not like the wet to dry because it dries into the wound and pulls and is in a spot that is painful. The only thing that I have liked was the Intrasite gel. I am just confused about how to treat the wound, and I do not think my doctor has much experience with wounds.
My other question is when can I stop packing the wound? Or what is the next step in managment after the gels?

wound management

Re: HELP NEEDED OPEN WOUND - (Kris) Date: 1999, Nov 09
From: Sue Dunn

This sounds horrendous. Here in the UK, nurses tend to deal with wounds not GP's. We tend to use a moist healing environment, and there should be plenty of stuff you can find on the web to give you information regarding dressings and their methods of working. I'm sure you did find treatment with Intrasite more comfortable than gauze strips, I can't remember the last time I packed a cavity with gauze. Try www.smtl.co.uk for some dressing and wound management information. Good luck, I hope it heals soon

Home wound care

Re: wound management - (Sue Dunn) Date: 2000, Feb 17
From: Tricia Kirksey

I am a PTA student currently in a 5 week clinical. As my clinic performs a great deal of wound care, I have been asked to present an inservice. I am looking for any information to provide for a patient to care for a wound at home. Any information would be greatly appreciated.

please tell me how to treat an open wound

Re: Home wound care - (Tricia Kirksey) Date: 2003, Sep 01
From: monica

hi, a week ago i cut myself with a knife pretty badly.a chunk of flesh was mising.i obtained medical help,and recieved 4 stitches.the nurse closing the wound said they were out of the proper sutures so she used the next best thing. now 6 days later when the stitches were removed , the wound is still wide open. please tell me how i can treat this myself.i work in a public place and am sure to be infected. your help is greatly appreciated.

bed sore ,burns wounds treatment without graft

Re: wound management - (Sue Dunn) Date: Aug 22, 20:17
From: <Anonymous>

It is worth noting that I have reviewed the patients and also the response to the patients by the doctors about the way of treatment was received. The European and American pharamcaucists have no effective medicine for the ultimate treatment of the bed sore and of 2nd and 3rd degrees and superficial wounds whereas the number of injured patients has been increasing day by day and the world has been suffering a disaster. There has been no country to have had a declinning trend in the disease . The prevetion method of the treatment of the wounds has not been found.I advise that the bed sore and burns medicine has been discovered by me and entered into the international market.Some of the patients photos of the burns patients and bed sore ones treated by Kimia ointment without graft can be viewed in my web site www.avicennaherbalmedicine.com there are some new photos of the patients which will be presented to those who are interested. Dr.Mohammad Nejadi e-mail info at avicennaherbalmedicine.com Tel 0098 21 7600912 7511702

wound management

Date: 1999, Nov 09
From: Sue Dunn

This sounds horrendous. Here in the UK, nurses tend to deal with wounds not GP's. We tend to use a moist healing environment, and there should be plenty of stuff you can find on the web to give you information regarding dressings and their methods of working. I'm sure you did find treatment with Intrasite more comfortable than gauze strips, I can't remember the last time I packed a cavity with gauze. Try www.smtl.co.uk for some dressing and wound management information. Good luck, I hope it heals soon

Fill in the blank of wound care

Re: wound management - (Sue Dunn) Date: 2001, Feb 01
From: a.c.

This is a must see for any open wound patients, Dr. Xi's formulas have been used in hospitals for last 40 years, over 200,000 patients. Just look at the photos of the progress. Compare to the formula's effective, Western conventional wound care technique is just a baby..
http://www.psp.bc.ca click on Dr. Xi's formula
Very truly yours,
A. C.

The use of a betadine wick in abdominal wounds post surgery

Date: 2000, Apr 13
From: <eunmaj at gofree.indigo.ie>

Can anyone inform me as to the objective of placing a betadine wick in the abdominal wound of a patient post abdominal/pelvic surgery. I have seen this regime in practice, with the wick being removed, the wound irrigated, and a new wick placed in situ. This regime is continued until there is evidence of granulation.I forgot to mention that the patient also had tension sutures insitu and skin sutures. Is this practice evidence based?

wound mgmt with wicking

Re: The use of a betadine wick in abdominal wounds post surgery - Date: 2000, Sep 10
From: Rae

At this time I have a wound over L4 L5 from a spinal fusion. The day after surgery the P.T. person tried to put on my brace and when he had difficulty, pulled the brace through and the edge of the brace pulled a staple loose. Later this became my wound. It eviscerated and tunnelled because of failure to heal. At this time I have a worm-hole (known as a tunnel in medicalease) in my back about two inches plus. Twice a day dressings are removed, it is irrigated with sterile normal saline, and a wick of nu-gauze is inserted loosely, the purpose of which is to draw out the drainage so that it will not heal on the outside and form an abscess on the inside. In the beginning this is exactly what it did and the abscess would break through periodically and drain and so it was opened up by the doctor and the wicking procedure started. It does seem to be successful because no more abscess is being formed and it is not infected. I am still taking an antibiotic. Healing is taking place very slowly and I do not know if it is granulating yet. I have asked my surgeon what we are going to do after it heals (granulates) and he has said that we have choices depending on the healing and we can create a new raw surface and re-close this new surface in order to get healing. Maybe. Of course, I am unhappy because in my case I would not have this ugly wound and risk of infection if it were not for careless handling by my physical therapist ! In the case of an abdominal wound, perhaps it is the site of a drain and is taking the place of a drain. Let me know how you progress. Your fellow patient.

wound mgmt with wicking

Date: 2000, Sep 10
From: Rae

At this time I have a wound over L4 L5 from a spinal fusion. The day after surgery the P.T. person tried to put on my brace and when he had difficulty, pulled the brace through and the edge of the brace pulled a staple loose. Later this became my wound. It eviscerated and tunnelled because of failure to heal. At this time I have a worm-hole (known as a tunnel in medicalease) in my back about two inches plus. Twice a day dressings are removed, it is irrigated with sterile normal saline, and a wick of nu-gauze is inserted loosely, the purpose of which is to draw out the drainage so that it will not heal on the outside and form an abscess on the inside. In the beginning this is exactly what it did and the abscess would break through periodically and drain and so it was opened up by the doctor and the wicking procedure started. It does seem to be successful because no more abscess is being formed and it is not infected. I am still taking an antibiotic. Healing is taking place very slowly and I do not know if it is granulating yet. I have asked my surgeon what we are going to do after it heals (granulates) and he has said that we have choices depending on the healing and we can create a new raw surface and re-close this new surface in order to get healing. Maybe. Of course, I am unhappy because in my case I would not have this ugly wound and risk of infection if it were not for careless handling by my physical therapist ! In the case of an abdominal wound, perhaps it is the site of a drain and is taking the place of a drain. Let me know how you progress. Your fellow patient.

Wound management following a spinal rod insertion

Date: 2000, Aug 21
From: Irene Cooke

Has anyone experience of nursing a patient who has had a thoracic spinal rod insertion for spinal metastatic disease ( a course of XRT followed the surgery)which subsequently develops into a full thickness wound some 2 years later. The rod appeared to protrude from the patients' skin and over a period of almost a week, the rod became visible due to the degeneration of the surrounding skin and underlying tissures. It was difficult to determine the causation of the prosthetic protusion and attempts were made to reduce the external tissue interface pressures ,however the wound continued to deteriorate. Any correspondance in relation to this specific issue is welcomed. Irene Cooke

Redness around wounds after larval therapy.

Date: 1999, Sep 20
From: John Byrne/Tamara Hawk

Wondering if anyone has reported and/or seen a chemical like burn around the periwound region where the drainage has sat for a day or two.
The tissue is a bright, intense red in color and has the appearance of a chemical burn. The doctors that I am working with feel it is due to the breakdown of certain bacteria.
I have been doing maggot therapy for 2 years now and have never experienced this before. It has only been the last two patients that have had this difficulty.

Redness around wounds after larval therapy.

Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 1999, Sep 20
From: Dr Steve Thomas

Hi
We are aware of this effect. It is caused by the maggot enzymes spreading onto the skin around the wound. These attack the keratinized epidermis (which is effectively dead tissue) leading to the redness you have observed. It generally only happens when the maggots are feeding well and producing large quantities of secretions.
To prevent this problem occurring we normally recommend that the skin surrounding the wound is protected with a hydrocolloid dressing or zinc paste.

effects of isopropyl alcohol on neonatal skin

Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 1999, Sep 20
From: valerie @irvingv.freeserve.co.uk

In order to raise the awareness of medical and nursing staff on the importance of evaluating all cleansing products used on the very preterm infants I am trying to find information on the effects of isopropyl alcohol on the skin of this vulnerable population. can anyone give any research based information on this matter?

wound/ulcer volume measurments

Re: Redness around wounds after larval therapy. - (John Byrne/Tamara Hawk) Date: 2000, Jan 05
From: Wamid

What do you use to measure the volume/area of the wound? and can you tell the type of the ulcer from its volume?

Untitled

Re: wound/ulcer volume measurments - (Wamid) Date: 2001, Mar 27
From: <wddesmond at telstra.easymail.com.au>

Most definately cannot define ateiology by wound measurements & the easiest way to calculate volume wound be the old fashioned length x width x depth. Deb D

Redness around wounds after larval therapy.

Date: 1999, Sep 20
From: Dr Steve Thomas

Hi
We are aware of this effect. It is caused by the maggot enzymes spreading onto the skin around the wound. These attack the keratinized epidermis (which is effectively dead tissue) leading to the redness you have observed. It generally only happens when the maggots are feeding well and producing large quantities of secretions.
To prevent this problem occurring we normally recommend that the skin surrounding the wound is protected with a hydrocolloid dressing or zinc paste.

effects of isopropyl alcohol on neonatal skin

Date: 1999, Sep 20
From: valerie @irvingv.freeserve.co.uk

In order to raise the awareness of medical and nursing staff on the importance of evaluating all cleansing products used on the very preterm infants I am trying to find information on the effects of isopropyl alcohol on the skin of this vulnerable population. can anyone give any research based information on this matter?

ISOPROPYL ALCOHOL DEADLY

Date: 2000, Oct 10
From: <Anonymous>

YOU ASKED FOR INFO RE IPA........SUGGEST YOU READ 'CURE FOR ALL DISEASES' BY DR HULDA CLARK (OR ANY OF HER BOOKS)

Nasal Spray

Date: 1999, Sep 20
From: Sandra Tremblay PT, MS, CWS

A dermatologist recently prescribed a nasal spray for a granulating stage III pressure sore, followed by a hydrocolloid dressing. What is the action of the nasal spray?

Nasal spray

Re: Nasal Spray - (Sandra Tremblay PT, MS, CWS) Date: 1999, Sep 20
From: Liza G. Ovington, PhD, CWS

This is a new one! I am wondering if the doctor has had experiences with hypergranulation with hydrocolloids and is perhpas using a corticosteroid nasal spray as sort of a "prophylactic" to avoid this effect before placing the hydrocolloid? We would really need to know the exact nasal spray to answer this since there are different types - there are corticosteroid (beclomethasone) sprays, vasoconstrictors (oxymetazoline) and even nasal sprays that are just plain old saline - See if you can find out more and let us know Curiously yours, Liza

Nasal spray

Date: 1999, Sep 20
From: Liza G. Ovington, PhD, CWS

This is a new one! I am wondering if the doctor has had experiences with hypergranulation with hydrocolloids and is perhpas using a corticosteroid nasal spray as sort of a "prophylactic" to avoid this effect before placing the hydrocolloid? We would really need to know the exact nasal spray to answer this since there are different types - there are corticosteroid (beclomethasone) sprays, vasoconstrictors (oxymetazoline) and even nasal sprays that are just plain old saline - See if you can find out more and let us know Curiously yours, Liza

"Warm Up" Active Wound Therapy

Date: 1999, Sep 21
From: Brenda Ramstadius

Greetings from down under,
Has anyone had any clinical experience with the "Warm Up" active wound therapy device. It is currently being promoted in Australia, but I am very hesitant to trial it. The cost of the device is not readily disclosed by the company (which sets alarm bells ringing) and its use will appear to restrict patient movement (needing to be plugged into a power source) in comparison to moist wound healing products. It just seems a bit too gimmicky for me...what are your thoughts &/or experiences with this device?

Warm-Up Therapy

Re: "Warm Up" Active Wound Therapy - (Brenda Ramstadius) Date: 1999, Sep 21
From: Kathy Williamson, BS, BSN, MSM

I have used the Warm-up Therapy on two patients without success on either patient. There are basically two costs - one incurred is the rental fee on the warm-up which includes the small pad which slides into the dressing, and the dressings. In all, the cost for therapy was approximately $2000+ for the patient. Insurance and MCARE and MCAID are hesitant on paying for the therapy. The idea behind the product is to keep the wound bed moist and warm to promote healing. Dressings will not adhere to legs which have become banded due to venous insufficiency, on people who sweat heavily or who are active, and our patients complained about the dressing being uncomfortable. We do not use this therapy in our wound department.

Warm-Up Therapy

Date: 1999, Sep 21
From: Kathy Williamson, BS, BSN, MSM

I have used the Warm-up Therapy on two patients without success on either patient. There are basically two costs - one incurred is the rental fee on the warm-up which includes the small pad which slides into the dressing, and the dressings. In all, the cost for therapy was approximately $2000+ for the patient. Insurance and MCARE and MCAID are hesitant on paying for the therapy. The idea behind the product is to keep the wound bed moist and warm to promote healing. Dressings will not adhere to legs which have become banded due to venous insufficiency, on people who sweat heavily or who are active, and our patients complained about the dressing being uncomfortable. We do not use this therapy in our wound department.

Warm Up Therapy

Date: 2001, May 28
From: Greg Wain BSc. RGN. RMN. ENB 264 / 870

Yes i have had some very successful outcomes using warm up as an adjunct to vac therapy, while working as CNS Tissue Viability, Royal National Orthopaedic Hospital Stanmore, London. It appears to speed up the process of autolytic debridement by improving blood perfusion to the wound. I noticed the slough in grade 4 pressure ulcers became liquefied in 2 to 3 days. This treatment is useful in preparing spinally injured patients for plastic surgery reconstruction of their deep cavity pressure ulcers. I think more work is needed in looking at myocutaneous flap survival rates following warm up therapy. I suspect that by applying warm up prior to flap surgery, the risk of distal flap necrosis would be diminished. Greg Wain Plastic Surgery Specialist Nurse Chelsea and Westminster Hospital London UK

Re. "Warm Up"

Date: 1999, Sep 21
From: olli

I have used the "Warm-up" unit and found it to be expensive and not very effective. The patient was a 65 yr old female with a medial malleuos wound caused by a dehiscence of tarsal tunnel surgery. The wound was going into its 8th mth and we were not making much headway. The first week we assessed a change in the color of the wound which had been very pale with no granular tissue The color of the wound base did improve within the 1st week however after 3 weeks no further improvement was noted and the "Warm-up" was discontinued

Wound Data Bases

Date: 1999, Sep 21
From: Rae Johnson

Is anyone using data bases for data collection on wounds partiicularly burn wounds. I'm using Access and I'm interested in descriptors, definitions and body charts.

Untitled

Re: Wound Data Bases - (Rae Johnson) Date: 1999, Sep 29
From: Simon Booth

We currently have our own unit database (using access) which audits all patients which come throught he unit (looking at causes,wound depth etc) If you are involved in burns then you should be aware that BIBID (british isles burns interest database) is about to be released if not can send more details

Wound Database

Re: Wound Data Bases - (Rae Johnson) Date: 1999, Dec 13
From: R Johnston

You may want to check out the Wound Tech program by Ocean Informatics at www.oceanmedical.com The program allows you to track wounds, healing rates, attach photographs of the patient's wounds directly to their chart and do searches for specific demographic information such as healing rates for certain types of patients. There number is 877-576-4410

databases

Re: Wound Data Bases - (Rae Johnson) Date: 2000, Mar 19
From: Ian

We use Access data base in the community. Leg Ulcer database monitor healing rates of over 900 patients.We can determine types of ulcers compression systems used recurrence rates, stocking compliance correlate size of ulcer with healing.Location (Clinic vs Home)age,sex etc.pivot tables utilised to compare data. Provide reports to authority.

Wound Database

Date: 1999, Dec 13
From: R Johnston

You may want to check out the Wound Tech program by Ocean Informatics at www.oceanmedical.com The program allows you to track wounds, healing rates, attach photographs of the patient's wounds directly to their chart and do searches for specific demographic information such as healing rates for certain types of patients. There number is 877-576-4410

databases

Date: 2000, Mar 19
From: Ian

We use Access data base in the community. Leg Ulcer database monitor healing rates of over 900 patients.We can determine types of ulcers compression systems used recurrence rates, stocking compliance correlate size of ulcer with healing.Location (Clinic vs Home)age,sex etc.pivot tables utilised to compare data. Provide reports to authority.

My introduction

Date: 1999, Sep 21
From: Kathy Howson

Hi, I am Kate (a colleague of Brenda's actually). I am a Clinical Product Manager for a health service and have an interest in wound care and would love to share information about wound care products, and get others opinions of products. Thanks for the opportunity

Untitled

Date: 1999, Sep 21
From: k.khadalia

any experience with ozone therapy for wounds

Ozone in Wounds

Re: Untitled - (k.khadalia) Date: 1999, Sep 21
From: Ted Yeoman

Ozone would appear to be a bad idea, unlike hyperbaric 02, Ozone, O3, is unstable and breaks down to O2 + O (a free oxygen radical). These radicals have a nasty habit of destroying most enzyme systems. If anybody has clinical data to the contrary, I stand corrected

ozone

Re: Untitled - (k.khadalia) Date: 2000, Apr 13
From: roberto

We are using ozonized water in cleasing some wound. There is not any observation about toxic effects of ozone on fibroblast or macrophages. On the contrary the antiseptic effect of ozonized water is good (there are some german articles)and ozone is cheap and you can use a lot so you have two activities, antiseptic and cleansing. It is only our experience without any scientific demonstration, I am sorry. Bye Roberto (Florence - Italy)

Ozone in Wounds

Date: 1999, Sep 21
From: Ted Yeoman

Ozone would appear to be a bad idea, unlike hyperbaric 02, Ozone, O3, is unstable and breaks down to O2 + O (a free oxygen radical). These radicals have a nasty habit of destroying most enzyme systems. If anybody has clinical data to the contrary, I stand corrected

Quality of Life Instruments for Wound Care

Date: 1999, Sep 21
From: <kris.kieswetter at dptlabs.com>

Hello. I am interested in what (if any) instruments are used in assessing the quality of life of wound care patients. I would be particularly interested in knowing if any of these are being used in palliative care settings. Thank you.

Kate - quality of life re wound care

Re: Quality of Life Instruments for Wound Care - Date: 1999, Sep 23
From: Kathy Howson

Hi Kris, I can't answer this now but as I have contacts in Palliative Care I will ask about. When I worked in PC it was mainly up to the patient and carer what they preferred and able to manage - particularly if at home.
Kate

Kate - quality of life re wound care

Date: 1999, Sep 23
From: Kathy Howson

Hi Kris, I can't answer this now but as I have contacts in Palliative Care I will ask about. When I worked in PC it was mainly up to the patient and carer what they preferred and able to manage - particularly if at home.
Kate

re: hypergranulation

Date: 1999, Sep 21
From: <donnasalata at yahoo.com>

hi all, new to the site and very excited by the concept. i have a patient whose stasis ulcer has become stubbornly hypergranulated and has not responded well to traditional therapies i.e. bactroban, compression wraps. abi's are good. any suggestions? (i know you will) thanks....donna

Untitled

Re: re: hypergranulation - Date: 1999, Sep 22
From: olli

I attended a wound conference today and there was discussion regarding hypergranulation. There were 3 suggestions 1. to apply pressure with rolled gauze. 2. apply pressure with the fingertips to the tissue in question 3. use silvernitrate stick to tissue. I have used silver nitrate sticks successfully, have not tried 1 or 2

hypergranulation

Re: re: hypergranulation - Date: 1999, Sep 22
From: Luk De Crom

Hello Donna, Have you already changed your local-basic therapy? I made good experiences by using an alginate (i.e. Tegagen 3M) in combination with a transparent film (i.e. Tegaderm 3M). This combination is less "active" as an hydrocollo�d and reduce the prevalence of hypergranulation. Complementary to this, I use compression to rebuild hypergranulated tissues. bye Luk De Crom

Hypergranulation

Re: re: hypergranulation - Date: 1999, Sep 22
From: Ted Yeoman

Harris & Rolstad reported in "Hypergranulation Tissue: a nontraumatic method of management" (sorry I don't have the full ref to hand) Lyofoam ( SSL International) is an effective non-traumatic method for reducing overgranulation. I must declare an interest tho, I am employed by SSL International. There are several other case studies confirming this conclusion.

Causes of and Solutions to Hypergranulation

Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 23
From: Amanda Woodcock

Hi Donna -
In the same way that new seedlings search for light, it is thought that granulation tissue may search for oxygen.
It has been suggested that high moisture and low oxygen levels can stimulate granulation tissue formation and for this reason, some companies advocate the use of occlusive dressings to encourage granulation tissue formation.
If this theory is correct, then the converse environment may be a possible solution for hypergranulation - relatively increased oxygen levels and lower moisture levels.
This could be the reason why hypergranulation sometimes resolves under a more breathable dressing where previously an occlusive dressing was used.
This is one of the solutions proposed by Christine Moffatt and Peter Harper in their book "Leg Ulcers":
ISBN 0 443 05533 5 (1997)
Together with the option of a more permeable dressing, they suggest light, local pressure or, in extreme cases (and under medical supervision) corticosteroid cream or silver nitrate pencil (75%).
Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Hypergranulation

Re: Hypergranulation - (Ted Yeoman) Date: 1999, Sep 24
From: Marie

Hello Donna! I have often found a less occlusive environment suitable for reducing hypergranulation. Lyofoam has also been used with success. For stubborn cases, a corticosteroid cream such as Teracortil has been prescribed with excellent results. Good Luck, Marie.

Hypergranulation and the use of corticosteroids.

Re: Hypergranulation - (Marie) Date: 2000, Jun 18
From: Emma Beesley

I have read articles which briefly discuss the use of
corticosteroid creams in the treatment of hypergranulation,
but have been unable to find any concrete research about
this. Has anybody done any research or know where I can
gather more evidence for its use.

Emma.

Full Reference For Lyofoam

Re: Hypergranulation - (Ted Yeoman) Date: 2000, Jan 09
From: Ted Yeoman

Hi Donna The full reference for the Lyofoam work mentioned above is:- Harris A, Rolstad BS (1992) Hypergranulation tissue: a non traumatic method of management. 3rd European Conference on Advances in Wound Management Proceedings, Macmillan Magazines, London. Amanda's answer descibes the theory of Hypergranulation in an ellegent way using the same model as I use when asked about the problem.

Untitled

Re: re: hypergranulation - Date: 2000, Dec 07
From: <peterhider at onetel.co.uk>

Have you tried Terr-cortril

Untitled

Date: 1999, Sep 22
From: olli

I attended a wound conference today and there was discussion regarding hypergranulation. There were 3 suggestions 1. to apply pressure with rolled gauze. 2. apply pressure with the fingertips to the tissue in question 3. use silvernitrate stick to tissue. I have used silver nitrate sticks successfully, have not tried 1 or 2

hypergranulation

Date: 1999, Sep 22
From: Luk De Crom

Hello Donna, Have you already changed your local-basic therapy? I made good experiences by using an alginate (i.e. Tegagen 3M) in combination with a transparent film (i.e. Tegaderm 3M). This combination is less "active" as an hydrocollo�d and reduce the prevalence of hypergranulation. Complementary to this, I use compression to rebuild hypergranulated tissues. bye Luk De Crom

Hypergranulation

Date: 1999, Sep 22
From: Ted Yeoman

Harris & Rolstad reported in "Hypergranulation Tissue: a nontraumatic method of management" (sorry I don't have the full ref to hand) Lyofoam ( SSL International) is an effective non-traumatic method for reducing overgranulation. I must declare an interest tho, I am employed by SSL International. There are several other case studies confirming this conclusion.

are there any journal articles which drescribe the best outcome in the management of hypergranulation

Re: Hypergranulation - (Ted Yeoman) Date: 2000, Sep 10
From: <s.dixon at net2000.com.au>

Does anyone know of a foolproof, easy method of managing hypergranulation in relation to PEG and Tracheostomy sites?

Causes of and Solutions to Hypergranulation

Date: 1999, Sep 23
From: Amanda Woodcock

Hi Donna -
In the same way that new seedlings search for light, it is thought that granulation tissue may search for oxygen.
It has been suggested that high moisture and low oxygen levels can stimulate granulation tissue formation and for this reason, some companies advocate the use of occlusive dressings to encourage granulation tissue formation.
If this theory is correct, then the converse environment may be a possible solution for hypergranulation - relatively increased oxygen levels and lower moisture levels.
This could be the reason why hypergranulation sometimes resolves under a more breathable dressing where previously an occlusive dressing was used.
This is one of the solutions proposed by Christine Moffatt and Peter Harper in their book "Leg Ulcers":
ISBN 0 443 05533 5 (1997)
Together with the option of a more permeable dressing, they suggest light, local pressure or, in extreme cases (and under medical supervision) corticosteroid cream or silver nitrate pencil (75%).
Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Hypergranulation

Date: 1999, Sep 24
From: Marie

Hello Donna! I have often found a less occlusive environment suitable for reducing hypergranulation. Lyofoam has also been used with success. For stubborn cases, a corticosteroid cream such as Teracortil has been prescribed with excellent results. Good Luck, Marie.

Hi Volt information needed

Date: 1999, Sep 21
From: Cathy

I need scientific studies on the use of Hi Volt electical stimulation used to help heal diabetic ulcers. I have the studies on the use of Hi Volt on pressure ulcers, but the doctor I'm am talking with wants scientific studies on diabetic ulcers. Any help would be appreciated!

Untitled

Re: Hi Volt information needed - (Cathy) Date: 1999, Dec 19
From: Chan

Hi Cathy We are currently in the process of evaluating a portable hi voltage device,we have treated a level 4 ulcer non healing for approx 6 years,so far 90% healed,a diabetic ulcer non healing 70% healed in within 4 treatments,my E mail ad in Aus feroxin at powerup .com.au,you are searching in the right direction. Regards chan

Untitled

Date: 1999, Dec 19
From: Chan

Hi Cathy We are currently in the process of evaluating a portable hi voltage device,we have treated a level 4 ulcer non healing for approx 6 years,so far 90% healed,a diabetic ulcer non healing 70% healed in within 4 treatments,my E mail ad in Aus feroxin at powerup .com.au,you are searching in the right direction. Regards chan

Problems with some of our web pages ?

Date: 1999, Sep 22
From: Pete Phillips

I have had some email saying that some of the pages on World Wide Wounds are problematic on MS Internet Explorer.
For example, on the Question and Answer page , some browsers appear to lose the first letter of the headings.
Could readers of this forum please send me details of the browser (MSIE, Netscape, lynx etc), and the version you are using, and the OS you are using it under (Win 95, Win 98, etc), and whether or not you see this problem ?
I would like to nail this, as the pages have tested out OK with various HTML compliance tools.
thanks in advance
Pete Phillips - SMTL Webmaster

Silver Sulphadiazine

Date: 1999, Sep 22
From: Pete Phillips

Someone asked this question last year in World Wide Wounds Question and Answer section. Does anyone have any comments on this ?
QUESTION: When is it appropriate to use silver sulphadiazine (Silvadene/Flamazine) in wound care? I find many doctors using it, but they can't really tell me why.
I have had one answer as follows:
ANSWER:"It is only FDA approved in the USA for use in burns. I find betadine gel works just as good if not better in burns(there are studies to back this up). Plus, silvadene has been shown to give rise to resistant strains of bacteria.
I refuse to use the stuff. I find that most people use it for the wrong reason and end up macerating the wound."

Silver sulphadiazine

Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 22
From: Rae Johnson

I have used Silvazine, a product which contains chlorhexadine for 20 years. The other products are essentially the same without the chlorhexadine component. The antibacterial action is mainly through the silver, and improved by the sulphur and chlorhexadine. I use it for the following wounds.
1. Used in burns to reduce the bacterial numbers colonizing the eschar. Silvazine maintains eschar "intact" untill such time that it is surgically debrided and grafted. If the eschar becomes highly colonised, the acidic nature of the highly exudating wound reduces the ability of the graft to adhere to the wound bed and the graft is digested by the enzymatic process.
2. A diabetic patient with a partial or deep partial burn. These wounds get overwhelmed with the normal colonization process and often become clinically infected. Use for 5-7 days until all redness is resolved. Then promote separtion of slough/eschar and epithelialisation through wound management or surgical intervention.
3. Dirty or infected wounds, or wounds in certain sites such as genetalia or axillas. Once the wound is clean, then promote separation of devitalised tissue and then promote epithelialisation.
I change the dressing daily or prn in genitalia. It is impregnated into a chux-like material, 2 layers thick, 2-3 mm thick followed by a secondary dressing. I've used this product for 20 years without any problems of resisance, however I have seen sensitivity to it but only after a extended period of application to an area where it should have been ceased once the wound was clean. It has been demonstrated to inhibit healing but then there are certain times when the use of these agents is required so that the wound can move onto to the next phase.

Untitled

Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 23
From: Brenda Ramstadius

I (in Australia), like Rae Johnson, use Silvazene in selected patients. Unfortunately, I find many clinicians do not understand what their objective of management is when it comes to wound care. Moist wound healing products are most appropriate in most situations but there are patients whose wounds may not progress to wound closure eg tumours, diabetic foot wounds, etc where it is not appropriate to continually use an expensive dressing regime when the outcome "wound closure" is not possible. Silvazene therefore can become a cost effective, soothing regime which is painless to remove in comparison to moist wound healing products or antiseptics & dry dressing use. I have used Silvazene on painful diabetic foot wound gangrene prior to surgical intervention when other clinicians wanted to use Alginates...these would have been expensive & painful to remove & would not have provided any greater benefit to the wound. The objective in this case was palliative managment of the wound prior to surgical intervention whilst also reducing the bacterial load of the wound. Some clinicians also wanted to use Hydrogels in this instance, but whilst it would have been painless to remove it offered no protection from increasing bacterial colonisation in a wound which was lacking in blood supply & at grave risk for infection.....Wound Care is about individual assessment & the objectives of management for the wound whilst reducing patient discomfort. Other clinical examples eg 1.extensive bilateral limb venous insufficiency ulcers, heavily crusted & infected with pseudomonas in a sedentry, morbidly obese patient....Silvazene excellent for cleaning up area, impregnated the Silvazene into Chux like towels (as Rae Johnson does), (with mild compression) easy application for clinician, soothing for patient, legs improved within a week of application then reverted to full 4 layer compression only. 2.extensive cellulits, weeping of a lower limb...painful , copious fluid exudation from area - used Silvazene impregnated into Chux like towels as above with incontinence pads used as absorbent layer with crepe bandage over,again soothing for patient & easy for clinician to apply. I would not use Silvazene routinely for all patients (exception burns) but it is a significantly helpful product in the "right" circumstance. I prefer this regime to applying painful antiseptic packing regimes to patients...I actually refuse to follow orders such as "Betadine packs".

Silver Sulphadiazine in Partial Thickness Burns

Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Sep 23
From: Amanda Woodcock

Silver sulphadiazine is commonly used on non-infected wounds to prevent infection. It appears that the eschar formed by silver sulphadiazine could affect the rate of healing.
Catherine Gotschall (ScD), Maria Morrison (RN) and Martin Eichelberger (MD) - Washington, USA, compared silver sulphadiazine (Silvadene) with a soft silicone wound contact dressing (Mepitel) in non-infected paediatric partial thickness burns - with the following outcomes:
1. A faster healing time for the Mepitel group (p < 0.001)
2. Less eschar in the Mepitel group (p < 0.05)
3. Less pain at dressing changes in the Mepitel group (p < 0.05)
4. Lower mean daily hospital charges in the Mepitel group (p = 0.025)
5. No difference in the clinical infection rates
Mepitel does not have an antibacterial action. It comprises soft silicone gel coated onto a flexible polyamide net. The dressing is hydrophobic and, while it adheres gently to dry skin, it does not adhere to moist surfaces. The healing times for acute wounds dressed with this soft silicone wound contact dressing are in line with those for technical dressings deemed to provide a "moist wound healing" environment. The outcomes of this study have been repeated.
This study can be found in the Journal of Burn Care and Rehabilitation Volume 19, Number 4 1998.
Amanda Woodcock Clinical Research Manager Molnlycke Health Care Ltd, Dunstable, UK.

silver sulphadiazine and ions in hair folicles

Re: Silver Sulphadiazine - (Pete Phillips) Date: 1999, Oct 12
From: louise gibson

Hi There, Does anyone have information/research regarding Flamazine/Bactrazine (Silver Sulphadiazine) causing secondary inflammatory response around the hair folicles, due to the silver ions. Many thanks Louise

Silver sulphadiazine

Date: 1999, Sep 22
From: Rae Johnson

I have used Silvazine, a product which contains chlorhexadine for 20 years. The other products are essentially the same without the chlorhexadine component. The antibacterial action is mainly through the silver, and improved by the sulphur and chlorhexadine. I use it for the following wounds.
1. Used in burns to reduce the bacterial numbers colonizing the eschar. Silvazine maintains eschar "intact" untill such time that it is surgically debrided and grafted. If the eschar becomes highly colonised, the acidic nature of the highly exudating wound reduces the ability of the graft to adhere to the wound bed and the graft is digested by the enzymatic process.
2. A diabetic patient with a partial or deep partial burn. These wounds get overwhelmed with the normal colonization process and often become clinically infected. Use for 5-7 days until all redness is resolved. Then promote separtion of slough/eschar and epithelialisation through wound management or surgical intervention.
3. Dirty or infected wounds, or wounds in certain sites such as genetalia or axillas. Once the wound is clean, then promote separation of devitalised tissue and then promote epithelialisation.
I change the dressing daily or prn in genitalia. It is impregnated into a chux-like material, 2 layers thick, 2-3 mm thick followed by a secondary dressing. I've used this product for 20 years without any problems of resisance, however I have seen sensitivity to it but only after a extended period of application to an area where it should have been ceased once the wound was clean. It has been demonstrated to inhibit healing but then there are certain times when the use of these agents is required so that the wound can move onto to the next phase.

Untitled

Date: 1999, Sep 23
From: Brenda Ramstadius

I (in Australia), like Rae Johnson, use Silvazene in selected patients. Unfortunately, I find many clinicians do not understand what their objective of management is when it comes to wound care. Moist wound healing products are most appropriate in most situations but there are patients whose wounds may not progress to wound closure eg tumours, diabetic foot wounds, etc where it is not appropriate to continually use an expensive dressing regime when the outcome "wound closure" is not possible. Silvazene therefore can become a cost effective, soothing regime which is painless to remove in comparison to moist wound healing products or antiseptics & dry dressing use. I have used Silvazene on painful diabetic foot wound gangrene prior to surgical intervention when other clinicians wanted to use Alginates...these would have been expensive & painful to remove & would not have provided any greater benefit to the wound. The objective in this case was palliative managment of the wound prior to surgical intervention whilst also reducing the bacterial load of the wound. Some clinicians also wanted to use Hydrogels in this instance, but whilst it would have been painless to remove it offered no protection from increasing bacterial colonisation in a wound which was lacking in blood supply & at grave risk for infection.....Wound Care is about individual assessment & the objectives of management for the wound whilst reducing patient discomfort. Other clinical examples eg 1.extensive bilateral limb venous insufficiency ulcers, heavily crusted & infected with pseudomonas in a sedentry, morbidly obese patient....Silvazene excellent for cleaning up area, impregnated the Silvazene into Chux like towels (as Rae Johnson does), (with mild compression) easy application for clinician, soothing for patient, legs improved within a week of application then reverted to full 4 layer compression only. 2.extensive cellulits, weeping of a lower limb...painful , copious fluid exudation from area - used Silvazene impregnated into Chux like towels as above with incontinence pads used as absorbent layer with crepe bandage over,again soothing for patient & easy for clinician to apply. I would not use Silvazene routinely for all patients (exception burns) but it is a significantly helpful product in the "right" circumstance. I prefer this regime to applying painful antiseptic packing regimes to patients...I actually refuse to follow orders such as "Betadine packs".

Silver Sulphadiazine in Partial Thickness Burns

Date: 1999, Sep 23
From: Amanda Woodcock

Silver sulphadiazine is commonly used on non-infected wounds to prevent infection. It appears that the eschar formed by silver sulphadiazine could affect the rate of healing.
Catherine Gotschall (ScD), Maria Morrison (RN) and Martin Eichelberger (MD) - Washington, USA, compared silver sulphadiazine (Silvadene) with a soft silicone wound contact dressing (Mepitel) in non-infected paediatric partial thickness burns - with the following outcomes:
1. A faster healing time for the Mepitel group (p < 0.001)
2. Less eschar in the Mepitel group (p < 0.05)
3. Less pain at dressing changes in the Mepitel group (p < 0.05)
4. Lower mean daily hospital charges in the Mepitel group (p = 0.025)
5. No difference in the clinical infection rates
Mepitel does not have an antibacterial action. It comprises soft silicone gel coated onto a flexible polyamide net. The dressing is hydrophobic and, while it adheres gently to dry skin, it does not adhere to moist surfaces. The healing times for acute wounds dressed with this soft silicone wound contact dressing are in line with those for technical dressings deemed to provide a "moist wound healing" environment. The outcomes of this study have been repeated.
This study can be found in the Journal of Burn Care and Rehabilitation Volume 19, Number 4 1998.
Amanda Woodcock Clinical Research Manager Molnlycke Health Care Ltd, Dunstable, UK.

silver sulphadiazine and ions in hair folicles

Date: 1999, Oct 12
From: louise gibson

Hi There, Does anyone have information/research regarding Flamazine/Bactrazine (Silver Sulphadiazine) causing secondary inflammatory response around the hair folicles, due to the silver ions. Many thanks Louise

Silver sulphadiazine

Date: 1999, Dec 10
From: Simon Whitfield

Silver sulphadiazine is a broad spectrum antibacterial effective at reducing bacterial numbers in infected wounds including those contaminated by MRSA. Its main indication is to reduce the risks of wound sepsis but there has been some evidence published that it can promote faster healing - Bishop JB, Vasc Surg (1992) 16 (2) 251-257 - Geronemus et al, Arch dermatol 1979 (115) 1311-1314

Licenced indications include burns, leg ulcers, pressure ulcers and finger-tip injuries with numerous publications demonstrating efficacy.

Untitled

Date: 2000, Jan 05
From: <Anonymous>

In the Uk Silver sulphadiazine ( commonly known as Flammazine from Smith and Nephew) has been superseded by Flammercerium (produced by Solvey) which contains cerium nitrate in combination with Silver sulphadiazine This has a wider antibacterial effect forms a soft eschar, does not mask wound depth and can be left intact for three days. unfortunately It can only be used in burns units as it has to be prescribed on a named patient basis
Much of last years European burns association meeting was spent looking at comparisons of Flammerceru=ium against other treatments used in burns..
NB Silver Suphadiazine should only be used in Full thickness injuries. if any one disagrees I would love to discuss it!

full thickness only?

Re: Untitled - Date: 2000, Feb 20
From: Chan

Why do you say that SSD is for full thickness wounds only? What are then effects for applying it to partial thickness wounds? Appreciate your comments.

Why not to use betadine in cavity wounds

Date: 1999, Sep 23
From: Lynne Gill

I am looking for information on why not to use betadine in cavity wounds and problems and advantages of using iodine based preparations on acute and chronic wounds

octenisept instead of betadine

Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 23
From: Luk De Crom

Hello, If my Informations are right, betadine (iodine) is a very good local desinfectans for short applies (5-10 minutes) - unfortunaly it even has a toxic effect on the granulozytes which means that it can't be used for continuous desinfection (i.e. 24h a day) which may be usefull in fall of an infected wound. That means that after applying betadine a good cleaning with i.e. NaCl 0.9% is indicated by chronic wounds. Mostly I use Octenisept (octenidini dihydrochloridum) instead of betadine which is also again gram positvs and covers a large spectrum of bacteries. That you should not use betadine in cavity wounds is new for me but I explain it like follwing. The risk you don't retire the whole betadine is great and then its toxic for the granulozytes so it is better use another desinfectans. greetings Luk De Crom

betadine

Re: octenisept instead of betadine - (Luk De Crom) Date: 2000, Dec 05
From: aulia

Betadine use in wounds

Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 24
From: olli

Betadine in a wound is contra indicated because it destroys fibroblasts and healthy tissue. There are several studies which suppport this. In the A.H.C.P.R guidlines {Agency for Health Care policy and Research)it is recommended that it not be used. This is written by the National Pressure Ulcer Advisory Committee and is considered "the Bible" of wound care in the States. Despite these recommendations we still have physicians who order it. I have also seen quite nasty looking burns to the peri ulcer area after repeated use.

Betadine is cytotoxic

Re: Betadine use in wounds - (olli) Date: 1999, Oct 09
From: Catherine

The use of betadine in wounds slows healing and in documented cases has caused injury and death. An earlier writer, Ollie, noted the AHCPR Guidelines for the Treatment of Wounds advises against the use of betadine.
A couple of years ago my colleagues and I did an extensive literature review on the use of betadine in wounds, most of the studies that supported the use of betadine for wounds were written by or supported by the manufacturers of povidone-iodine.
In 1989, Dr. George Rodeheaver,wrote Controversies in Topical Wound Management. (Wounds: A Compendium of Clinical Research and Practice Vol. 1, No. 1.) In the article he notes that not only is betadine cytotoxic, but that wounds treated with betadine had an increased number of infections. In the article Dr. Rodeheaver describes a report published by Dr. Gary Becker. There were 35 patients with contaminated head and neck surgery cases. "In 18 of those patients just prior to closure, he had irritaged the wunds with povidone-iodine in the other 17 patients he irrigated with isotonic saline. Of the 28% of the study group that developed a wound infection all had been treated with povidone-iodine.
Dr. Rodeheaver also reports of an animal study by Brennan and Leaper. A rabbit ear model was treated with a 1:1 dilution of povidone-iodine which resulted in the complete cessation of blood flow in the capillary bed. Since a pressure ulcer is the result of an ischemic event, this study indicates that the use of 1:1 dilution of povidone-iodone in a pressure ulcer could result in the "complete cessation of blood flow".
Another article, reports of a patient who had a hip repair surgery and developed an incisional wound. The orders were to irrigate the wound with betadine and then pack the wound with betadine satuated gauze, the patient went into renal failure, the patient was found to have toxic iodine levels, and later died.
Kaup R. Shetty, and Edmund H Duthie,Jr., Thyrotoxicosis Induced by Topical Iodine Application. Archive of Internal Medicine,Vol 150, November 1990. Shetty and Duthie note that regardless of the route increased iodine availability can result in iodine induced thyrotoxicosis.
I hope this helps Catherine

betadine swab for dry eschar

Re: Betadine use in wounds - (olli) Date: 2001, Apr 13
From: laurie

I am looking for a reference for using betadine swab to dry eschar on toes to decrease the bacterial load. I can not find a reference to this in the AHCPR guidelines. I know it is common practice, but I can not find documented support. Does anyone know of a place I can look?? Thanks!!

Untitled

Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 24
From: Nicky Perkins

Hi, AS far as i know betadine is not licenced in the UK for open wounds and i find it increasinly worrying that surgeans still use it when there is evidence to sugest that it damages granulating tissue and prolongs the inflammatory response. Given the choice any wound care professional should steer well clear of this substance.

You Can

Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Sep 30
From: Ted Yeoman

First declare an interest, SSL Int., my employers manufacture and sell Betadine. I refer you to:- 1 Elenor Davis, Don't Deny The Chance to Heal. 2nd Joint Meeting of The Wound Healing Society and The European Tissue Repair Society, Boston USA 1996. 2 B Gilchrist, on behalf of the European Tissue Repair Soc., Should iodine be recosidered in wound management? Journal of Wound Care, vol6,No3,1997. Which concludes "Should iodine be reconsidered? The unanimous consensus is yes."

Povidone-iodine toxicity.

Re: Why not to use betadine in cavity wounds - (Lynne Gill) Date: 1999, Nov 21
From: Donald Saye, DPM,CWS

Povidone-iodine in large wounds has caused death from iodine toxicity, but I could not find that specific reference. It may be helpful to read the following references:
1.Zamora JL. Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions. Am J Surgery1986;151:400-406 2.Lammers RL, et al. Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic contaminated wounds. Ann Emergency Medicine 1990;19:709-714 3.Lineaweaver W, et al. Topical antimicrobial toxicity. Arch Surg 1985;120:267-270 4. Brennan SS, Leaper DJ.The effect of antiseptics on the healing wound: a study using the rabbit ear chamber. Br J Surg 1985;10:780-782 5. Dire DJ, et al. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med 1990;19:704-708 5. Kjolseth D, et al. Comparison of the effects of commonly used wound agents on epithelialization and neovascularization. Am College Surgery 1994;179:305-312 6. Lineaweaver W, et al. Topical antimicrobial toxicity. Arch Surgery 1985;120:267-270 7. Terleckyj B, et al. Antiseptics and disinfectants. JAPMA 1995;85:439-445 8. Mertz, PM, et al. A new in vivo model for the evaluation of topical antiseptics on superficial wounds. Arch Dermatology 1984;120:58-62
You should also read a letter to the editor in Wounds, pA12-A14(I do not know which year or volume) from Janet Welch, Associate Director Medical Services and Drug Surveillance, The Purdue Frederick Co. in response to an article by Patricia Mertz. There is a response to the letter by Patricia Mertz. There is also a reference to another letter to the editor in ONF 1991;18(4):68-59-660 by Janet Welch.
I hope the above helps.
Don Saye

videne

Re: Povidone-iodine toxicity. - (Donald Saye, DPM,CWS) Date: 2000, Nov 08
From: cristina dolcetti

anybody has information on the new povidone iodine based product "Videne"? Thanks.

Saline gels

Date: 1999, Sep 24
From: <cindy at busynet.net>

Has anyone had experience with saline gels replacing enzymatic debriding agents in stage lll and lV ulcers? I'm relatively new to this field and learning a great deal from this web site. thanks cindy

Hypertonic Saline Gel for Debridement of Eschar

Re: Saline gels - Date: 1999, Sep 24
From: Amanda Woodcock

Hi Cindy
Etris Associates, Inc, Stanfield & Associates, Connecticut Clinical Nurse Associates, ET Nurse Enterprises and Bryant Rolstad Consultants performed a randomised, controlled, comparative clinical study to evaluate the effectiveness of a Hypertonic Saline Gel (Hypergel) and a Collagenase Enzymatic (Santyl) in debriding eschar on a variety of dermal ulcers.
The outcomes of this study have been presented both orally and in poster form in the US. You can contact Joan Halpin-Landry at Molnlycke Health Care, 500 Baldwin Tower, Eddystone, PA 19022, for further information.
Kind regards,
Amanda Woodcock Clinical Research Manager Molnlycke Health Care, Dunstable, UK

Help please, "colsed presser ulcers", PU development time

Date: 1999, Sep 24
From: Jill Thomas

I have been looking for references for closed pressure ulcers without sucess. Can anyone help?? I attended a seminar recently and was told that it can take up to 21 days for a pressure ulcer to develop from time of insult (ie, lying on OR table for extended of time) at the same seminar we were told that there was a 50/50 chance of pressure ulcer development (from original significant insult)vs. healing even if preventative measure are instituted. Any comments/information or references would be greatly appreciated. Thank you, Jill Thomas JillThomas at aol.com

References on the healing of pressure ulcers

Re: Help please, "colsed presser ulcers", PU development time - (Jill Thomas) Date: 2000, Nov 07
From: Thomas A. Sharon, R.N., M.P.H.

There is much information in the medical literautre about the Diapulse Wound Treatment System. Randomized double blind clinical trials and clinical case studies have shown remarkable results in healing stage II's, III's and IV's. Key in "diapulse" on Medline for 28 citations. You can also go to http://nursetom.healthcareforums.com and http://www.diapulse.com for more info.

Cornified Hypergranulated Tissue

Date: 1999, Sep 24
From: Kathy Williamson, BS, BSN, MSM

68yo black male who presented to our clinic with venous stasis ulcers bilaterally and had been treated with unna boots. When the boots were removed, there was extensive ulceration, scaley skin on the skins and top of the feet, and thick yellow cornified skin surrounding the heels. We have resolved all issues with the exception of the cornified skin. We have tried saline soaks, vaseline, aggressive debridement and this has done nothing. Any suggestions on how we can get rid of the cornified skin? All suggestions welcomed and needed ASAP! Thanks, Kathy

Community Nurse RGN

Re: Cornified Hypergranulated Tissue - (Kathy Williamson, BS, BSN, MSM) Date: 1999, Sep 24
From: Nicky Perkins

Re Cornified skin if you mean hard dry skin try 50/50 soft white parrafin and liquid parrafin mix. i have found this most helpfull in rehydrating varicosr exzema patients

granulated sugar in cavity wounds

Date: 1999, Sep 24
From: Maria

In Brasil, many people still use dressings with granulated sugar in wounds (like stage IV pressure ulcer) when the patients cannot afford any other kind of material and the ulcer has slough material and foul odor. The dressing is changed at least 2 times a day as it gets soaked. I have read about hypertonic saline gel and I am wondering if the principles are the same. Is it a research based practice? Thanks. Maria

Sugar

Re: granulated sugar in cavity wounds - (Maria) Date: 1999, Oct 07
From: Wayne Naylor

Hi Maria
You may be interested to know that sugar was one of the first wound dressings used in recorded history. Sugar and honey were probably used as dressing about 4000 years ago. There has been renewed interest recently in their use in wound management, particularly in infected wounds. They appear to exert their effects on wound healing due to their high osmolarity which prevents certain bacteria from growing. In the case of honey, the low pH and the presence of antibacterial substances also has an effect. Granulated sugar is not the ideal form of sugar to use as it may produce an intense burning sensation when applied directly to an open wound as it draws up wound exudate. The use of a sugar paste is recommended to prevent this. In this form it also keeps the wound bed moist thereby promoting the natural healing process. There is a reasonable amount of research around at the moment about sugar paste and honey use and there is a very interesting article in SMTL's Dressings Times recounting the experience of sugar paste use in Zanzibar. It is available at this web site
http://www.smtl.co.uk/WMPRC/DressingsTimes/vol4.3.txt
Here are some other references.
Cooper, R. and Molan, P. (1999) The use of honey as an antiseptic in managing Pseudomonas infection. Journal of Wound Care 8(4), 161-164.
Miller, M. and Glover, D. (1999) Wound Management. Nursing Times Books, London
I hope this is helpful.
Wayne :-)

Another good reference

Re: Sugar - (Wayne Naylor) Date: 1999, Oct 07
From: Wayne

This is another interesting article in the Dressings Times http://www.smtl.co.uk/WMPRC/DressingsTimes/vol3.2.txt

Why not to use Hydrogen peroxide for wound cleansing?

Date: 1999, Sep 25
From: Sharon Radcliffe

I am seeking information as to why hydrogen peroxide should not be used for cleaning wounds and/or for using to saturate gauze as a wound packing. I work at a small hospital in the Caribbean and it is proving difficult to influence the medical staff that this practice should be abandoned. They particularly like using if to ward against'infection'

Hydrogen Peroxide is unsuitable for use in wounds.

Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: 1999, Nov 21
From: Donald Saye, DPM,CWS

Please refer to the following references: 1.Lineaweaver W., et al. Topical antimicrobial toxicity. Arch Surg 1985;120:267-270 2. O'toole EA, et al. Hydrogen peroxide inhibits human keratinocyte migration.Dermatologic Surgery 1996;22:525-529 3. McKenna PJ, et al. Antiseptic effectiveness with fibroblast preservation. Ann Plastic Surgery 1991;27:265-268
I hope the above are useful.
Don Saye

Hydrogen peroxide use on a degloved wound

Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: 2000, Jun 05
From: Joni Dunn

What complications can arrise when using over the counter hydrogen on a wound that has become degloved?

...

Re: Why not to use Hydrogen peroxide for wound cleansing? - (Sharon Radcliffe) Date: May 31, 22:26
From: <stevecass18 at comcast.net>

YOu suck

Help! Images/pictures of wounds

Date: 1999, Sep 25
From: Sharon Radcliffe

I am an RGN working in a small hospital in the Caribbean. I am organising some lectures on wound healing and dressing in an attempt to provide up to date wound care education. I am in need of some images/pictures of various types of wound for my lectures - infected, necrotic, sloughy, Granulating, epithelialising, venous ulcers, arterial ulcers and malignant. Can alnyone help me?

wound photos

Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 1999, Sep 27
From: Maria

We have a page related to pressure ulcer prevention and management in our shool of nursing home page. It is not done yet as we have to correct a lot of thing. We do have some pictures from my research that you can use for your lecture. Bye,

Maria

suggestions for pictures

Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 1999, Sep 29
From: <howsonk at mpx.com.au>

Sometimes the wound care product companies are willing to help for education purposes - It worthwhile approaching the representative in you area for assistance. They also sometimes have the images as clipart so you can use them in aword processor or a power point presentation. I haven't tried it but I wonder if there are images on other websites - start by trying the compny websites.
Kate

Web Site Suggestion

Re: suggestions for pictures - Date: 2000, Sep 17
From: Dr. S. Kinatukara

www.medscape.com has a library of images which are free to download for its members (& membership is free). I know they have pics of ulcers. If what they have is not enough, email me & I'll send you whatever you still need (re: lower extremity ulcers only).
Dr. S. Kinatukara 2nd yr Podiatric Surgical Resident

Wound Pictures

Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 1999, Oct 08
From: Amanda Woodcock

Hi Sharon
If you e-mail me your postal address, we can send you some non-promotional wound pictures. Do you have access to a computer with a CD-ROM drive, if so, we can send them on disk.
Kind regards, Amanda Woodcock Clinical Research Manager Molnlycke Health Care Ltd UK

If you have wound care pictures please send

Re: Wound Pictures - (Amanda Woodcock) Date: 2000, Jul 12
From: <starsnthemoonlight at yahoo.com>

I am doing a project on wound care and am having a hard time finding visual aids

Pictures of wounds

Re: Wound Pictures - (Amanda Woodcock) Date: 2001, Feb 26
From: Gino Schuerman

Hallo,
I'm looking for pictures of wounds of all kind. I want to use the picture for a study. I give first aid lessons to new coming fireman. The lessons belongs to a first respons team special trained for help directly by accidents.
You can send the information to:
Gino Schuerman Het Zand 1 4576 CA Koewacht Holland-Europe
Thanks on forehand.

Need Wound phtotos

Re: Pictures of wounds - (Gino Schuerman) Date: 2004, Mar 26
From: <slolnc at sbcglobal.net>

Colleagues: I am searching for photographs of all types of wounds and particularly pressure ulcers of different stages with exudate, eschar, etc. This is for an education project for a medical center. Thank you.

Wound Pics for teaching

Re: Wound Pictures - (Amanda Woodcock) Date: Aug 27, 05:27
From: db

Please send wound pictures to me so I can use them to teach Practical Nurses about wound care. Thank you. db

Wound Management photos

Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 2000, Nov 01
From: Sharron

Hi Sharon, I am teaching 1st aid in Northern Canada. I am in need of wound injuries photos in my classes. Did you come up with photos that would be helpful to me. If so so you E-mail them to usschief at mcbridebc.net
If you know of somewhere to go for this info, please let me know if you have time.
Thanks Sharron

providing wound care

Re: Wound Management photos - (Sharron) Date: 2004, Feb 07
From: roxanne

good day.... im roxanne and a nursing student here in philipines, i need some information about providing wound and some photos of it. maybe you can help me out.... if you do have idea about it please send me to xyra_123 at yahoo.com.... thanks a lot

Wounds

Re: Help! Images/pictures of wounds - (Sharon Radcliffe) Date: 2001, Feb 02
From: <kirstkirst45 at hotmail.com>

Hi Sharon I'm an art student in London, England who paints wounds and other injuries, i am also in need of more photos. I usually go to www.altavista.com and search for IMAGES ONLY of wounds, trauma and accidents you have to traul through but you can see straight away if they are suitable. Then click on right mouse button to save and print. If you have any especially good ones from elsewhere could you email them to me Yours gratefully Kiki

Hydrogen Peroxide & Sutures ?

Date: 1999, Sep 29
From: BJ Krob

I am curious to know if there have been any studies on the efficacy of using hydrogen peroxide on granulating surgical wounds that are held together with dissolvable sutures.

Re: Hydrogen Peroxide and Sutures.

Re: Hydrogen Peroxide & Sutures ? - (BJ Krob) Date: 1999, Sep 29
From: claire taylor

Why would hydrogen peroxide be used on a healthy granulating wound? Indeed why is it used at all? Evidence would suggest that hydrogen peroxide inhibits the granulation of wounds and therefore delays wound healing.
Even in wounds that are sloughy there are effective, less damaging methods of debridement, for example intrasite gel or actisorb plus, which also serves to treat malodour. Although the actual type and size of wound are not described, a hydrocolloid, for example duoderm thin would suit to continue to promote granulation and epithialisation.

Wound irrigation

Date: 1999, Sep 30
From: Dave Lochhead ICN

Hi folks. Does anyone have current info' on what's 'known' to be effective during joint surgery. I'd also be most grateful for any ref's Thanks.

Radiotherapy skin care

Date: 1999, Sep 30
From: Wayne Naylor

I am currently involved in developing the skin care guidelines at the hospital where I work and am also doing an assignment on evidence-based practice in relation to radiotherapy skin care. As I'm sure everyone knows there is not a great deal of evidence about regarding this topic, and so I would like to know what people involved in this area are currently using/doing for skin care. Thanks, I look forward to hearing your replies.

Untitled

Re: Radiotherapy skin care - (Wayne Naylor) Date: 1999, Oct 04
From: Catherine

Is this the same as Radiation Therapy?

Untitled

Re: Untitled - (Catherine) Date: 1999, Oct 05
From: Wayne Naylor

Yes, specifically external beam radiation therapy. Thanks

Untitled

Re: Untitled - (Wayne Naylor) Date: 1999, Oct 06
From: Catherine

Although I have no literature in my possession, depending on how much radiation is used the treatment can result in an increase risk of cancers. In the early 50's they used radition to stop the growth of women that were considered to be "to tall" 15-20 years later a significant number developed thyroid cancer. In the 60's to 70's adolescent acne was treated with radition, many of these adolescents developed basal, squamous and melanomas within 15 years of the treatment. The practice of radition for acne was discontinued after the 50's results began surfacing. Hope this helps. Catherine

Radiotherapy and skin care

Re: Radiotherapy skin care - (Wayne Naylor) Date: 1999, Oct 08
From: Amanda Woodcock

Wayne,
The British Journal of Nursing is doing a rather good 3-part series of articles on radiotherapy and skin (it started either this week or last week). I am sure you can probably access the BJN where you work. If you can't, please let me know. In addition, we have some literature available for our soft silicone dressing, Mepitel, used both during radiotherapy treatment and after treatment to dress radiotherapy damaged skin. Please contact us if you require further details or information.
Kind regards, Amanda Woodcock, Clinical Research Manager, Molnlycke Health Care Ltd, UK.

Why no creams or lotions?

Re: Radiotherapy skin care - (Wayne Naylor) Date: 2000, May 19
From: domini

I keep on reading that you must not use any creams or lotions on skin being treated by radiotherapy. I know that some contain metals, and that this could increase any side effects, but is there any other reason? Can lotions and potions interfere with the radiotherapy itself?

creams and lotions

Re: Why no creams or lotions? - (domini) Date: 2000, May 19
From: Wayne Naylor

Hi Domini
I am not sure what you have been reading but the use of certain creams and lotions is certainly recommended for radiotherapy skin reactions. I have recently completed a literature review on the subject of skin care during radiotherapy. For Erythema and Dry desquamation the literature showed that simple moisturisers (i.e. with no perfume) or emollient creams, and hydrophilic creams (those that retain water) are the most commonly recommended treatment. 1% hydrocortisine cream is also used but only when there is burning or itching feelings associated with the skin reaction.
The use of these creams is not recommended in moist desquamation though, and in this case dressings that promote a moist wound environment should be used, such as hydrogel gels or sheets. Post-treatment the use of hydrocolloid sheets is recommended.
There are some creams and lotions that are not recommended for use in radiotherapy skin reactions. As you said, one of the reasons for not using a cream is if it contains a metallic ingredient, such as silver sulphadiazine (Flamazine) which contains silver. These creams will affect the radiotherapy particles and may increase the dose to the skin. Creams or lotions that contain topical antibiotics are also not recommended unless a proven infection is present and it is sensitive to the antibiotic in the cream/lotion.
Of the research studies I reviewed there were two creams that appeared to reduce the occurance of skin reactions and to promote healing of skin reactions. These were sucralfate cream and hyaluronic acid cream. Several studies found that simple moisturiser creams did not prevent the onset of skin reactions but that they provided significant relief of symptoms related to the skin reactions.
I hope this is helpful to you, if you would like further information please send me an e-mail.
Wayne :-)

Re: Radiotherapy skin care - (Wayne Naylor) Date: 2000, Sep 18
From: <Anonymous>

Info on radiotherapy skin care

Re: Radiotherapy skin care - (Wayne Naylor) Date: 2001, Feb 01
From: Wendy

Re: Wayne's message regarding skin care protocol for patients undergoing radiotherapy treatment. I'm in the process of researching the subject myself and as the hospital I work in does not at present have a policy on the subject I would be very interested in your findings. I would also be grateful for any pertinent references that you found particularly useful. Thank you, Wendy

Tap water for cleaning chronic wounds

Date: 1999, Oct 01
From: Carol Horbury

Does anyone use tap water for wound cleansing in chronic wounds? Also is anyone aware of any references to support this practice? The only references I can find in relation to using tap water to cleanse wounds relates to Emergency medicine. Many thanks Carol.

Tap Water for Cleansing Wounds

Re: Tap water for cleaning chronic wounds - (Carol Horbury) Date: 1999, Oct 08
From: Amanda Woodcock

Hello Carol,
If you look in the British Journal of Nursing Volume 4 Number 5 pages 286-289 (I think it's 1995!): Trudie Young (TVN Glan Clwyd Hospital) wrote an article "Common Problems in Wound Care - Wound Cleansing". In the article, Trudie cites a study by Angeras et al (1992) that looked at the use of tapwater for cleansing wounds. It was a randomised study of tap water versus sterile saline in 705 wounds. I can't tell if this is the article you already have but I hope it helps.
Kind regards, Amanda Woodcock, Clinical Research Manager, Molnlycke Health Care Ltd. UK.

Untitled

Re: Tap water for cleaning chronic wounds - (Carol Horbury) Date: Aug 04, 19:22
From: bobby cherian

Tap water with normal bathing soap is good in cleaning chronic wounds especially ones infected with pseudomonas...this is from my personal experience in the medical college hospital kottayam kerala, india..we had a patient with a degloving injury of whole of his left lower limb with pseudomonas infection ..his whole limb was green..covered with slough ..we just asked his wife to clean his leg with tap water and soap and gave her a brush to scrub..after which the regular normal saline dressing was done..within one week the wound was glowing with red granulation tissue... DR.BOBBY CHERIAN, ORTHOPAEDIC SURGEON, KOTTAYAM, KERALA, INDIA.

antibiotic use in diabetic foot ulcers

Date: 1999, Oct 07
From: <jenshirk at gateway.net>

I am a pharmacy student and I am wondering if there are any antimicrobial guidelines for bacterial diabetic foot ulcers? Any help or websites would be appreciated.

Antibiotic guidance for diabetic foot infections

Re: antibiotic use in diabetic foot ulcers - Date: 2000, Jan 07
From: Benjamin A. Lipsky, MD

The Infectious Diseases Society of America is working on guidelines currently. In the meantime you can get some guidance from the following paper: Lipsky BA. Evidence-based antibiotic therapy of diabetic foot infections. FEMS Immunology & Medical Microbiol 1999;26:267-76.

Untitled

Date: 1999, Oct 07
From: CATH

DOES ANYBODY HAVE ANY EXPERIENCE DEVELOPING MEASURING TECHNIQUES FOR LARGE OPEN ABDOMINAL WOUNDS OR KNOW OF ANY RESEARCH OUTLINING PROVEN TECHNIQUES?

Infected surgical wound

Date: 1999, Oct 08
From: sw

Seeking information regarding appropriate treatment course for a post surgical wound - posterior iliac crest site used for bone graft for spinal fusion - which developed deep pocket infected with escherichia coli.

How long is it appropriate to leave a sticking plaster on minor domestic wounds?

Date: 1999, Oct 08
From: <graham.marshall at boots.co.uk>

There is a school of thought to suggest that everyday minor children's wounds (such as grazes, cuts etc) may be best managed by regular re-application of sticking plasters, until the wound is fully healed.

This is said to cushion the wound, absorb exudate and offers protection from dirt, infection, contamination etc.

Does anyone know any authorative reference to support this approach or relevant publication?

vacuum assisted closure dressings

Date: 1999, Oct 10
From: Susan Zydzik R.N.

I am in search of data regarding the results of vacuum- assisted closure dressings to large sacral wounds. Also needed; any data which may include the combination of hyperbaric medicine and vacuum dressings. Susan Zydzik R.N. email: SEZME1996 at aol.com

V.A.C dressings

Re: vacuum assisted closure dressings - (Susan Zydzik R.N.) Date: 1999, Oct 12
From: olli

I have used the V.A.C. dressing on several sacral wounds. I find it to be a very time consumming awkward system to apply especially if one does not use it very often. I have observed a good granular base develop even in wounds that showed little or none previous to its use. Generally I have noted that this improvement is seen in the first 2 weeks and then tapers off at which time the wound has been closed with a flap. I have not used this system in conjunction with HBO. Olli

VAC dressing and HBO

Re: V.A.C dressings - (olli) Date: 2000, Jan 11
From: jane

We are quite sold on the use of the VAC at a major hospital in New Zealand. Only once have we used the VAC in conjunction with HBO - this took place at another centre due to the location of the chamber. The wound was a diabetic foot ulcer and the combination treatment saw rapid wound healing and excellent results - sorry I don't have better details.

correction

Re: VAC dressing and HBO - (jane) Date: 2000, Jan 14
From: jane

oops the HBO treatment was on a non healing burn of a diabetic pt

Untitled

Re: vacuum assisted closure dressings - (Susan Zydzik R.N.) Date: 2001, Jan 17
From: <Hilarysunman1 at cs.com>

My mother who is 93 has severe and long term leg ulcers; her consultant has proposed using VAC treatment on the wounds. Does anybody have experience in the effectiveness of the treatment for the very elderly, including likely impact on the wounds and the length of time of treatment whcih might be expected?
She is in generally good health but very debilitated froom the pain of the ulcers etc.

potassium permanganate

Date: 1999, Oct 10
From: Sue Dunn

Can someone please give me some info and/or references about potassium permanganate (excuse the spelling!!) I have heard of it, and heard of it being used occasionally for treatment of varicose excema I think, but can never find any references in articles Thank you in anticipation

nutritional research in wound healing.

Date: 1999, Oct 10
From: <howjnr at judylucy.fsn.co.uk>

does anyone know of a web link or journal to do with nutritional research in wound healing?

xyloca�ne, emla

Date: 1999, Oct 11
From: <fbiehlmann at laboratoires.genevrier.com>

Hello, Do you know if xylocaine and emla are cytotoxic for keratinocytes? I'm wondering whether they could be use before doing biopsie for keratinocyte culture. Thank's for any advices on the subject!

Zinc oxide around peri-ulcer skin-Ichthapaste improves intransigent ulcers

Date: 1999, Oct 13
From: Ian Mansell

I've had considerable success with zinc in preventing maceration and excorioration in the peri-ulcer skin, when wound exudate has proved problematic for skin integrity. Similarly venous ulcers treated with compression that have acheived some healing but only to a point and then stop and have been known to overgranulate. The application of Ichthapaste bandage has lead to comparatively rapid epithelialisation, sometimes within a matter of weeks. Whats the explaination?Is it the zinc in the paste bandage?A moister wound enviroment?No concurrent skin condition was evident at the time.

Pressure dressings?

Date: 1999, Oct 14
From: Doris

Hello I'm looking after post caesarian section women and find many having "pressure dressings" applied in OT on medical instructions. This practise is new to me. Doctors say they are applied to prevent problems with "superficial venous oozing". They consist of one Steripad dressing layer with layers of surgipad wadding on top and then Hyperfix elastoplast applied over everthing to about 3x3 feet wide. I worry about both the necessity for and the possible infection risk from this practise. I'm working in an area where access to informed wound care advice is unavailable and would be very grateful if anyone can point me in the right direction for relevant information. Doris

Pressure Dressings

Re: Pressure dressings? - (Doris) Date: 1999, Oct 29
From: Amanda Woodcock

Hi - just a note of care - adhesive retention dressings of any kind should not be applied stretched or under pressure, as this can result in shearing forces and blistering under the dressings.
Amanda Woodcock Clinical Research Manager, Molnlycke Health Care UK.

regranex

Date: 1999, Oct 14
From: <donnasalata at yahoo.com>

i'm using regranex for the first time on a diabetic foot wound that the md is calling a diabetic ulcer but it is actually more like a burn in nature, the pt recieved the blister from friction, which immediately opened. the middle of the wound actually has eschar similar to a burn. anyways, the doctor ordered regranex. my question is, is it normal to have increased exudate with the regranex use? the edges of the wound have become quite wet, not yet macerated, but that will be next. and yes, i'm protecting the edges with skin barrier. i'm more curious about the regranex that anything. thanks!..........donna

Untitled

Re: regranex - Date: 1999, Oct 15
From: olli

I have used regranex many times on ulcers but only after they are free of necrotic tissue. Everything I have read including the instuctions state that the ulcer bed needs to be clean (debrided) It may be that the regranex is moistening the necrotic tissue enough that you are getting slough resulting in moist ulcer edges . I have also found that if I use too much regranex the edges of the ulcer become macerated. Hope this helps.

Acetic acid as a wound dressing

Date: 1999, Oct 17
From: Margaret Knight

Does anybody have any information regarding the use of acetic acid on wounds. I have recently come accross the practice of applying daily acetic acid soaks to chronic leg ulcers and, so far, have been unsuccessful in establishing either the evidence base behind, or the rationale for, this practice. I should be grateful if anybody can help. Thanks.

Ascetic Acid Dressing

Re: Acetic acid as a wound dressing - (Margaret Knight) Date: 1999, Oct 17
From: Ian Mansell

I've seen ascetic acid used in leg ulcers with psuedomonas to irradicate the infection-- and it worked. Advocated by a vascular surgeon...no rationale, but I'll investigate further.

Reference: Topical antimicrobial toxicity. Arch Surg 1985;120:267-270

Re: Acetic acid as a wound dressing - (Margaret Knight) Date: 1999, Nov 21
From: Donald Saye, DPM, CWS

The following article concluded 0.25% acetic acid was unsuitable for use in wound care. Topical antimicrobial toxicity. Arch Surg 1985;120:267-270 Don Saye

Acetic acid

Re: Acetic acid as a wound dressing - (Margaret Knight) Date: 2000, Oct 07
From: deb

Have used vinegar diluted with water quite frequently on donor sites any any other wounds diagnosed with a pseudo infection with outstading and remarkable results. No need for systemic antibiotics and treatment is for 48-72 hours maximum. The rationale is that pseudo normal environment is pre dominantely alkaline, and the alteration to acidic is enough to erradicate. We soak our kaltostat in the 1-10 vinegar solution, no c/o of pain either. Cheers. Deb D.

Acetic Acid

Re: Acetic acid as a wound dressing - (Margaret Knight) Date: 2000, Dec 29
From: <Anonymous>

I used Acetic Acid on my daughters leg wound. Her leg became infected after a surgery and had a 3 inch depth in. The surgen had me soak gauze with the Acid and place inside the wound. This was used after the first tratment plan was not working to my satisfaction. The healing processe was very fast. I am now using the Acetic Acid to heal a pressure sore on her foot.

bed sore dressing

Date: 1999, Oct 17
From: sandeep saluja

CAN I BURDEN THE LIST WITH A REQUEST FOR GUIDELINES ON BEDSORE DRESSING?

Re Bed Sore Dressings

Re: bed sore dressing - (sandeep saluja) Date: 1999, Oct 17
From: Ian Mansell

Need more details here first. Grade of sore1-4.Exudate, wound bed, granulation or sloughy tissue.Are preventative measures in place risk assessment ie Waterlow score.Anti-pressure mattress- overlay or mattress replacement needed.Location of sore, type of dressing may depend on location ie.heel vs Sacral sore.No dressing is a Panacea. Holistic assessment will determine management. Thanks Ian Mansell

Untitled

Re: Re Bed Sore Dressings - (Ian Mansell) Date: 1999, Oct 19
From: <donnasalata at yahoo.com>

you can access information for nat'l standards for treatment of pressure ulcers from U.S. Department of Health and Human Services. Ask for Clinical Practice Guidelines Number 15. go to any search engine and ask for AHCPR (Agency for Health Care Policy and Research). they'll send you a booklet free. good luck!

Pressure Ulcer Guidelines

Re: bed sore dressing - (sandeep saluja) Date: 1999, Oct 29
From: Renee Cordrey

Look at the pressure ulcer guidelines, published by the Agency for Health Care Policy and Research (AHCPR). They were composed by experts after reviewing ALL of the literature ever done on the subject. There guidelines covering prevention, assessment, dressings, other treatment, etc. You can get one from your Santyl rep. Also they have a web site where you can purchase them, as well as the guideline on prevention, the quick reference books, and the patient guides. http://www.ahcpr.gov/info/pubcat/c%5Fgovord.htm Http://www.ahcpr.gov has lots of information about the guidelines on all topics. I believe the text is on-line as well, but my quick search couldn't fine it. Renee Cordrey, MSPT, CWS

Pressure Sore Guidelines

Re: bed sore dressing - (sandeep saluja) Date: 1999, Oct 30
From: Ted Yeoman

Sandeep, I can't help with specific guidelines, so much depends on where you are practicing, what resources you have available, what Dressings you can access. Personnaly I am uncomfortable about advice that talks of Wet to Dry Debridement & the use of gauze dressings but if thatsthe best available, thats the best available!! For alittle bit of UK based advice, it's pretty general tho' try my site at www.yeoman.org.uk

presure damage prevention & treatment guidelines

Re: Pressure Sore Guidelines - (Ted Yeoman) Date: 2000, Mar 21
From: fiona stephens

Internationally recognised guidelines are available on the Net from epuap - European Pressure Ulcer Advisory Panel.

Recalcitrant healing

Date: 1999, Oct 20
From: Brian Ellis

My wife suffered from a heavy piece of chipboard edge scraping the back of her leg last December, giving bruising and laceration over an area of about 50 cm2. As she is taking Warfarin (5 mg/day), the bruising was considerable.
Healing seemed to progress normally for about a month, although she complained of tenderness. Towards the end of January (six weeks after the accident), it appeared that two roughly circular sites were not healing, one with an area of about 2 cm2, the other about half that size.
A pathological specialist was consulted and he started treatment with a topical application of potassium permanganate solution, an antibiotic powder and an oral course of antibiotics. After one month of this regime, there was little apparent improvement and this doctor referred her to a surgeon who cleaned out the wounds (in the large one, he found a minute foreign body which may have originally been a wood splinter), to a depth of about 8 mm where he found what was deemed to be healthy soft tissue.
The small wound healed thereafter, but the larger one was still recalcitrant and he proceeded to use wet therapy which, after two months closed the wound (July). As there was still tenderness and inflammatio, antibiotic treatment was continued, going through the arsenal of suitable antibiotics, with the exception of penicillin and related drugs, to which my wife is allergic.
Today, the area is still visibly red and tender to pressure and the skin has a shiny, patchy aspect. The doctor is still prescribing topical antiseptics and she has just finished a 4 week course of the last available antibiotic, which has caused a minor improvement in the inflammation.
Do you have any recommendations to make? We live in Cyprus. She is 63 and has no known chronic illness, such as diabetes. Her use of anticoagulants is the result of a cerebrovascular accident 22 years ago, probably due to the "pill". Her weight is 4-5 kg above normal, blood pressure usually about 125/85. Do you know of any organisation or specialist to which she could conveniently be referred?
One thing the local doctors cannot seem to answer is whether she should exercise the leg to promote blood circulation or whether she should rest the leg as much as possible. Have you any advice on this subject?
Thank you in advance for any help.
Best regards
Brian Ellis

Recalctrant Wound

Re: Recalcitrant healing - (Brian Ellis) Date: 1999, Oct 21
From: <Leg at iman.netlineuk.net>

The continued use of topical antiseptics on healthy skin( or any other skin for that matter) is not recommended. Continued use may irradicate the natural bacteria flora or commensals which are the bacteria that natuarlly inhabit our skin and may actually protect the skin from other Pathogens(disease causing bacteria).Antiseptics can also be caustic.If I was to place bleach on your skin you'd say ouch!Antiseptics are for cleaning hard surfaces not your wifes skin.Continued use may lead to a contact dermatitis, as the skins integrity is evetually eroded by the caustic nature of the antiseptic. One of the main reasons for wounds not healing is that the underlying cause for the non - healing has not been identified. Particularly in the legs if a wound has not healed after 4-6 weeks it is then classified as a leg ulcer the main cause for which is venous disease.This is were damage to the valves in the veins has lead to poor venous drainage which through various processes can delay wound healing. Clearly a foriegn body is implicated in your wifes case, none theless other aetiologies should not be ruled out

Pyradermal Gangrinosa

Date: 1999, Oct 21
From: Gene Johnson

What is Purple Pus Painful Pyradermal Gangrinosa? Any pictures?

Pyroderma Gangrenosum

Re: Pyradermal Gangrinosa - (Gene Johnson) Date: 1999, Oct 21
From: Mark Long R.N.

PG according to Hampton and Bryant a rare inflammatory skin disease associated with ulcerative colitis, Crohn's, arthritis, leukemia, polycythemia vera and multiple myeloma. It is considered to be caused by an autoimmune response as opposed to infectious process although lesions may culture out gram-positive or gram-negative organisms (secondary)
The lesions produced may appear as solitary or multiple tender, red lesions that become indurated and ulcerated. The base of the lesion enarges, discharging purulent and hemorrhogic exudate. The lesions appear raised with dusty red to purplish margins, ragged, erythematous borders, and irregular shapes. The base of the lesion is deep red and is often painful, and peristomal lesions may communicate with nearby structures such as bowel. Commonly affected areas are the lower extremities, buttocks, abdomen and face. Occasionally mucous membranes are involved. Hampton,B. and Bryant,R. Ostomies and Continent Diversions.1992

Pyrodermal Gangrenosa

Re: Pyroderma Gangrenosum - (Mark Long R.N.) Date: 2000, Nov 19
From: Marianna Cooley

I was on a business trip to Sao Paulo and Rio de Janiero Brazil in January,1996. My legs began to swell and my ankles began to ulcerate. It was so bizarre as I was in excellent physical shape. I underwent a lengthy examination. I was tested for rheumatoid arthritis, diabetes, vascular disease, and multiple sclerosis. My physican diagnosed it as possible Wegener's granulosa--with pyrodermal gangrenosa. But I did not have any symptoms with bowel disorder. I was on Prednisone for 8 months. I began a stepped up regimen of nutritional supplements and weaned myself off the Prednisone. My ankles scarred as I had been warned would happen. I have been free of symptoms since then. The reason that I am writing is that I was cleaning out my files from that time period today and ran across the medical records. I thought I would get on the web to check out the possibility of others with this strange disease. Let me hear from others.

pyroderma gangrenosa

Re: Pyroderma Gangrenosum - (Mark Long R.N.) Date: 2000, Dec 21
From: Katie

My aunt is in the hospital and in terrible shape with this skin condition. She has no history of any bowel syndromes. It is spreading rapidly. What dose of steroids need to be given for this. Could someone talk about the treatment. I take it that antibiotics and steroids are given what about debridment? I would appreciate any response. She is also presenting as confused. The lesions are in both her legs.

pyroderma gangrenosa

Re: pyroderma gangrenosa - (Katie) Date: 2000, Dec 29
From: janet

my mother has been in hospital for twelve weeks in 1999 and is still suffering fromm an open wound she has just been admitted again with what looks like a huge boilon the whole of her finger, It is black green and i just dont think the doctors know what to do. At one point today we were told nobody really knows what this disease is. can anyone tell us what we are dealing with or give us imformation

Untitled

Re: pyroderma gangrenosa - (janet) Date: 2002, Jul 16
From: <Anonymous>

i have p g it was caused by chemical burns i have had it for 8 years please call dr.miller at vanderbilt 1-615-322-6485 get treatment asap,judy vaughn

Need information

Re: pyroderma gangrenosa - (Katie) Date: 2003, Nov 09
From: Mark W. Breymeyer

My mother is currently in the hospital being treated for Pyrodermal Gangrenosum. This is about the 5th or 6th time she has been in the hospital with this disease. I would like any and all information that could be provided.....basically what are the causes, treatments, is there a cure etc. Her affected area is always on her right hand, although she has been told it could break out at any time at any place on her body. She is in a little town in Illinois and I'm am not sure that they are familiar enough with this disease to treat her properly. Any help would be appreciated as she is in a lot of pain. Thank you. Mark Breymeyer

Untitled

Re: Need information - (Mark W. Breymeyer) Date: 2004, Mar 02
From: Carol

I have had pg, it was sucessfully treated with debreading and regranix to form new granulation tissue, i have had three pg wounds one 9cm, 4x4cm and 2x3cm all have closed with the exception of the larger one, the center is still open. We are currently using dermagrafts on that wound with some success

Untitled

Re: Pyroderma Gangrenosum - (Mark Long R.N.) Date: 2000, Jul 24
From: jackie

My brother has got this disease what is it? he is in and out of hospital all the time help me please jackie

info on pyroderma

Re: Untitled - (jackie) Date: 2000, Nov 14
From: Shelly

I'm not for certain but it's possible that my mother has pyroderma, she seems to get what we think are boils but they appear in the fold of her abdomen, at the peritaneal area,her axillary & under her breast occasionally, she recently has had an illiostomy done due to ulcerative colitis that we have been treating for over a year, and she was recently diagnosed with crohns. the areas are very painful,reddened, and have a purulent drainage from them, she runs fever, you can treat with antibiotics and it hepls for a while but they seem to return. Is there any pictures in which I can review,and do you have any avdvice.I'm tired of watching her suffer. thanks, Shelly

Graft Vs Host Disease

Date: 1999, Oct 21
From: Wayne Naylor

I am interested in finding out what other people apply to grade four graft vs host disease of the skin i.e. cracked and weeping skin. The haematology ward here uses some type of burns foam in severe cases, but they are not sure what it is called have no evidence to support its use (other than it seems to work).

GVHD

Re: Graft Vs Host Disease - (Wayne Naylor) Date: 1999, Oct 25
From: Penny Jones

Wayne: For severe GVHD, topical treatment can be extremely difficult. I'm caring for a child now with bad disease. He has bullae over much of his body. After showering, we are using a mixture of Aquaphor and zinc oxide. We then cover the areas with Exudry. This is changed once daily. Exudry absorbs draining well and doesn't stick to the wounds. We chose zinc oxide because we were cautious of the bone marrow suppression seen with Silvadene but wanted some bacteriostatic activity and topical healing. Its working very well so far. Early stages, we use topical steriods and/or Aquaphor. Best of luck. Penny

GVHD Dressings

Re: GVHD - (Penny Jones) Date: 1999, Oct 29
From: Amanda Woodcock

Wayne - for cases such as this and the treatment of similar wound symptoms as experienced with burns, cracked oedematous skin, radiotherapy treated skin, cancerous lesions and dermatological conditions such as epidermolysis bullosa, we can suggest the soft silicone dressing - Mepitel. Ointments can be applied over or under the Mepitel and inexpensive secondary dressing pads are changed quickly and painlessly as required to handle any exudate. If you would like to receive the product use and clinical information, please let me know.
Kind regards Amanda Woodcock, Clinical Research Manager, Molnlycke Health Care Ltd, UK.

Wall Suction vs VAC

Date: 1999, Oct 21
From: Mark Long R.N.

Has anyone had any experiences using wall suction to assist with wound drainage. We have been using the VAC but find it a bit problematic ie alarms and malfunctions. Especially in wounds where its hard to make a seal....peri rectal and sacral wounds specifically. Are there disadvantages to using wall suction?? Would enjoy hearing from those experienced with the concept...thanks

wall suction as VAC

Re: Wall Suction vs VAC - (Mark Long R.N.) Date: 1999, Nov 01
From: Wayne Naylor

Hi Mark
I have used wall suction in the past as a means of maintaining suction on wound drains. I have also seen Redivac or Medinorm bottles used as a vacuum device on pressure ulcers, with the drainage tubing inserted through the skin beside the wound into the bottom of the wound. The biggist problems I encountered using wall suction were: making sure the suction is not turned up to high, I would suggest using a low pressure suction unit to avoid anyone accidentally turning up the pressure, and the fact that the patient is attached to the wall.
I usually find the best way to overcome problems with sealing the wound is to apply a barrier film to the skin around the wound(such as Cavilon or Skinprep) to provide a good adhesive surface, and then using 2 film dressings to sandwitch the drainage tubing in between.
I hope this may be useful.
Wayne

legal and safety issues related to use of VAC

Re: wall suction as VAC - (Wayne Naylor) Date: 2000, Aug 09
From: Irene Jankowski

VAC-suction settings have been developed after extensive research and clearance by FDA.

Re: legal and safety issues related to use of VAC - (Irene Jankowski) Date: 2000, Aug 09
From: Irene

Suction settings on the VAC have been selected after extensive research to provide the optimal opportunity for wound healing while maintaining patient safety. The alarms on the VAC are designed to ensure that appropriate pressures are maintained throughout the therapy process. Inappropriate pressures could result in drying out the wound bed. As you know the VAC has undergone careful review and clearance by the FDA. If you are experiencing problems maintaining seals, KCI should be contacted and a Clinical Consultant can assist you.

Vac system use

Re: wall suction as VAC - (Wayne Naylor) Date: 2000, Nov 12
From: Robin

The vac system works well when using layers of sknintac dressing to hold the pads down. This at times ends up looking like a puncture kit gone mad but the vac results are excellent and worth the time and effort. As suggeted keeping the pressure low also helps. Most breaks in the seal are caused by patient movement so getting them to stay as still as possible will stop those alarms going off. Hope this helps. could anyone help me with information on Honey dressings. Thanks Rob

skin tears

Date: 1999, Oct 25
From: pat redding

I have been searching for information on the care of skin tears and unable to find anything on the subject. I'm talking about the type the elderly with "parchment paper" skin get with the slightest pressure applied to skin. I would like to hear from anyone with any information on treatment or prevention.

Skin Tear Dressings

Re: skin tears - (pat redding) Date: 1999, Oct 29
From: Amanda Woodcock

Pat, we have a collection of articles looking at the use of Mepitel soft silicone dressing over skin tears. If you would like to receive usage and clinical information, please let me know.
Kind regards, Amanda Woodcock, Clinical Research Manager, Molnlycke Health Care UK.

Mepitel

Re: Skin Tear Dressings - (Amanda Woodcock) Date: 2000, Nov 11
From: <frans.meuleneire at online.be>

We have done a very nice study about skin tears. (80 patients in 6 months). Wounds where closed in 7 days. Can somebody help us to search on publications about skin tears? Thanks, Frans Meuleneire R.N. Wound- and stomacare.

different wound dressings for my hospital to know

Re: Skin Tear Dressings - (Amanda Woodcock) Date: 2001, Jan 29
From: v.gallego

I am a nurse and have been hired to lead my department to the teachings and to train, how to eliminate and to avoid skin tears.
I know there are different dressings to apply. Please let me know, what You feel I should order. And teach me also. I work for a big hospital, scripps of san diego and they have given my a budget in which to order a supply of dressings, creams etc.,and learning material to the other nurses.
Thank you --veronica

Date: 1999, Oct 26
From: <Anonymous>

risk assessment tools

Date: 1999, Oct 28
From: joh

Does anyone know of any wound assessment tools which are effective for wounds such as pressure sores or fungating lesions, other than the "Norton" score or "waterlow" score. Any suggestions appreciated.

Wound Assessment Tool

Date: 1999, Oct 31
From: Diane

I am starting a general wound assessment tool for my company and would like to know some good examples of tools to get an idea of what is required. I would also appreciate any articles that would help with this task. THANKS

Wound Assessment tools

Re: Wound Assessment Tool - (Diane) Date: 2000, Nov 16
From: Katie Eves

I am a ward sister in a gastrointestinal surgical unit. I am studying my degree and I am on the wound module. Do any of you have a wound assessment tool which could be used for my client group. I am having great difficulty finding one. If you have any information that you could help please contact me
Greatful thanks

Managing Director, Nascent Pharmaceuticals

Date: 1999, Nov 02
From: Gene Barnett, Ph.D.

Is there any efficatious drug for chronic log ulcers? Would physicians be interested to participate in a clinical trial for a potential drug?

leg ulcers

Re: Managing Director, Nascent Pharmaceuticals - (Gene Barnett, Ph.D.) Date: 1999, Dec 29
From: Ulcer King

There are some effective meds for leg ulcers. I would certainly be interested in a trial. You need to be a little more specific regarding treatments for leg ulcers, ie the type of ulcers

urgent referral

Date: 1999, Nov 02
From: catherine

Hello I am a staff nurse working in a hospital. Lately I have a patient with leprosy present to me with a layer of dry brown necrotic tissue over the bilaterally lower limbs and extend to the lower trunk. Both the upper limb were also affected. Parts of the tendons were exposed too.There are some slough around the gengrene. I am wondering whether is there anyone can enlighten me with the type of management for this type of wound thank you. P.S. I am also very conern about the quality of life for this patient, he is in his early 80s and he is very conscious and alert.
Thank you very much if you could reply me asap.

malignency and chronic leg ulcers

Date: 1999, Nov 02
From: Jill Rakowski

I am trying to find evidence linking duration of leg ulcer and malignant changes in order to support a request for a wound biopsy.

Re Malignant Ulcers

Re: malignency and chronic leg ulcers - (Jill Rakowski) Date: 1999, Nov 15
From: Ian

National Guidelines Uk non-healing leg ulcer of>3 months duration should be referred for vascular or dermatological opinion. Provided a full holistic assessment has been done to determine the underlying aetiology.Venous and arterial ulcers will present with certain identifiable signs and symptoms, if these are not observable( and the list is lenghty)then another aetiology maybe possible remember that the majority of leg ulcers are venous 70%: arterial- mixed -Rheumatoid, then you may consider malignancy. But of course the type of malignancy can vary eg Squamous Cell Carcinoma;Basal Cell; Melanoma; Bowens.Medical opinion should then be sort for a biopsy. Thankyou

More details about the original question

Re: Re Malignant Ulcers - (Ian) Date: 1999, Nov 24
From: J Rakowski

To be more specific, I am looking for evidence to support the often quoted statement that long standing leg ulcers are at higher risk of malignancy. The items mentioned by Ian had already been actioned, but biopsy has not been performed. My literature search trying to link duration of ulcer and malignagncy did not reveal any specific research supporting this link.

Long standing varicose ulcer

Re: malignency and chronic leg ulcers - (Jill Rakowski) Date: 2001, Feb 16
From: Josephine Kemper

I have had a leg, or rather ankle, ulcer for 28 years. Sometimes it heals and then recurs. At the moment it is infected, and has been for some time. I have been given many prescriptions for Flucloxacillin which seems to work for a short time and then the problem flares up again. I do not wish to take any more drugs for obvious reasons. I have been told that a hospital in Suffolk uses Tea Tree Oil, in their ulcer clinic, to treat infections. Have you any knowledge of this treatment and how one should apply the oil? We are bee keepers and I have tried the first honey cappings from the hive. The pain nearly sent me into orbit but I know that this is the finest infection torpedo, could I stand the pain! At the moment it is being dressed with the four layer bandage method. Can you please help with the Tea Tree Oil treatment? Many thanks in advance Josephine Kemper

Radiotherapy Wound

Date: 1999, Nov 02
From: Caroline

I am currently trying to find a suitable dressing for a patient who has had radiotherapy for skin cancer on her scalp. The wound extends into the hair from the hair line at her forehead and is approximately 5cm in diameter. The surrounding skin is very friable with tunnelling underneath. There are high levels of exudate, yellowish in colour with no odour. There are no clinical signs of infection when observed or when swabbed. The patient complains of pain at dressing changes - which I guess could be a sign of infection or fear.
The medical staff have expressed that the cancer is very extensive and that surgery would not help. They have provided radiotherapy however there are new raised areas under the skin which appear to be new cancerous growths. The patient is almost 100 years old, totally independent and very alert mentally.
The main difficulties I have been experiencing with dressings have been caused by the location of the wound and the exudate levels. I have trimmed the hair around the wound to help dressings adhere: the patient refused to use a hair net and a special retention head dressing. I have tried various dressings including:
Mepital to reduce adherence and pain on dressing changes
NA Ultra
Alginates
Hydrofibre (stopped as I felt it may be prolonging inflammatory stage of healing)
Foams (stopped as too bulky and did not adhere very well)
I am currently using NA Ultra, an Alginate and gauze which is secured with tape. This needs to be changed after less than 24 hours.
I would appreciate any help or suggestions you can offer.
Thanks in advance.
Caroline Graham, Tissue Viability Nurse.

Radiotherapy Wound

Re: Radiotherapy Wound - (Caroline) Date: 1999, Nov 22
From: Amanda Woodcock

Hi Caroline, your question is a perfect illustration of how location can prove the major challenge in managing complex wounds. When using Mepitel on scalp lesions (Mycosis fungoides, Journal of Wound Care, October 1999), we used a bandage turban to hold the Mepitel and the secondary pads in place. Unfortunately, this is not always the best solution. We have investigated other methods of non-adhesive fixation and come across 2 others, the Snogg cohesive foam bandage (2 thicknesses) and the Medi-pluse tapeless strips. If you need any more info on these, please let me know.
Kind regards,
Amanda Woodcock Clinical Research Manager Molnlycke Health Care UK

wound dressing lotions

Date: 1999, Nov 04
From: sonyminhas

May i know where to find information about lotions used for wound dressings? Thank you for your advice!

Bone-structure in an open wound

Date: 1999, Nov 08
From: Luk De Crom

Hello all, I got a problem. We received a post-traumatic Patient (Road accident) with an open Wound on his leg. In the wound you see the bone (maybe he had an osteomyelitis), around the bone structure there is granulation without fibrin - we can say the wound is clean. My question is: What kind of local-Therapy can i made. If my informations are right an occlusiv Therapy with hydrocollo�d is contra-indicated when bone structures are free in the wound. Is this rigth or not. Does anyone can help me Thanks a lot Luk

bone in wound

Re: Bone-structure in an open wound - (Luk De Crom) Date: 1999, Nov 17
From: <johnson_rae at hotmail.com>

I have managed exposed bone and tendon following burn injuries with hydrocolloid paste. Occlusion with a wafer dressing is not supported by the companies. However, I butter Comfeel paste 2-3 mm, onto Bactigras (2 layers) and impregnate a chux like material with Silvazine, 2 mm thick; cover with pad and tubigrip; change 3 times weekly. The paste provides a hydrocolloid component which draws the body's own wound fluid into the area rather than donating fluid such as a gel. The degree of moisture remains more constant and limited to the area where the paste has been placed. Presumably, the body fluid would also contain growth factors. The hydrocolloid promotes separation of devitalised tissue, promotes granulation tissue formation. The Bactigras and Silvazine component serve as a vehicle for the paste as well as controlling bacterial numbers. Another consideration is to debride the devitalised tissue on the bone. Clearing the bone of eschar also stimulates granulation tissue formation. About 2000 years ago the Greeks discovered that if they drilled into the skull of patients that had been scalped, granulation tissue sprouted from the drill sites. This eventually coverd the area which could then accommodate a graft. I'm not advocating drilling; however, gentle scrapping to lift any devitalised tissue has stimulated granulation tissue and all the deficits have filled and closed without surgical intervention. Hope this helps Rae.

how i treat large ulcers with exposed bone

Re: Bone-structure in an open wound - (Luk De Crom) Date: 2000, Jan 06
From: Adam Leeds

Put the VAC from KCI on. Debride any devitallized tissue (you said it was clean, so I'm assuming there is none). Apply a single layer of xeroform over the bone to protect it, but do not cover the rest of the wound base. Then apply the VAC sponge and 125-150 mm Hg. Change it every 2-3 days until the bone is covered, then switch backt to a more traditional dressing.

New treatment for a decubitus ulcer

Date: 1999, Nov 09
From: <dshaffer at minford.k12.oh.us>

I have a brother who has been a paraplegic for twenty years. He has a stage iv decubitus ulcer on his entire buttocks area. He has had it since 1994. He has had flap surgeries in the past so there is no longer any skin to use. Various treatments have been done including saline, dakins, wet to dry dressings, silvadene, and the new expensive gel treatment. Doctors have suggested amputating his legs but none of us want that to be done. He is anemic and currently his red blood cell count is 8. We need help because we know we will lose him if somebody doesn't do something about his condition. The doctors just keep up with the same regiment of dressing the wound twice a day using soap and water to clean the area and dakins dressing. Please return an answer asap.

nutrition

Re: New treatment for a decubitus ulcer - Date: 1999, Nov 16
From: <redding at kans.com>

I am in no way an expert nor do I know of any new tx's. With your brothers cell count low it may do well to look at things which affect healing. Talk with a registered dietition about a diet that will build up the body so it can heal. Also see about therapies to promote blood flow in that region which can aid in healing.

Para for 22 years has some great advice

Re: New treatment for a decubitus ulcer - Date: 2000, Oct 27
From: sharon

I wanted to share with you my formula for rapid wound healing. I have 22+ years experience in dealing with wound care and skin problems and infection.I DO NOT have any medical degrees...just a lifetime of personal experience to draw from....and 22+ years of hospitals, doctors and nurses. I start with cleaning a wound with anti-bacterial liquid soap and water. Then I take a blowdryer and use the "cool" air setting and blow the wound dry for 3-5 minutes. Next I take PURE vitamin E oil and apply it generously to the wound. Then leave the wound open to the air. I repeat this several times a day if needed (especially if the wound is weepy)...2 times a day otherwise. Then after I do the wound care I drink a mixture of 2 tablespoons of protein powder mixed with 1 packet of Carnation Instant Breakfast and 1 1/2 cups of 2% milk. I then take 1 Multi-vitamin and 500mg of vitamin C. I repeat the drink again in the evening. This has worked so well for me that I can see changes in a wound within 24 hours and have healed a wound the size of a nickle in just 13 days. I would suggest that you try this! E-mail me at this address tcarcich at turbonet.com if you want to talk further. Good luck, Sharon

LPN

Re: New treatment for a decubitus ulcer - Date: 2003, Sep 17
From: Linda

I would not use Dakins solution due to the fact that it is very destructive to the good tissue. Try a calcium alginate if you haven't yet.

Slow to heal burn wound

Date: 1999, Nov 19
From: Linda Bray

Please can anyone advise me on an appropriate dressing to encourage the epithelialisation stage of a burn. The wound is very friable and bleeds easily,site - upper arm,size approx 5cms x 10cms have tried Lyofoam and recently Mepitel which has resulted in hypergranulation. Many thanks

Untitled

Re: Slow to heal burn wound - (Linda Bray) Date: 1999, Nov 19
From: brispark

As you are probably aware Hypergranulation is where the cappillary loops have gone into "overdrive" it is a common problem in burns Two questions need to be asked
1 When was the injury sustained
2 how was it treated
The treatment depends on these answers as if it is a full thickness burns which has become hypergranulated it may need a scrap under GA or Graft (It is unusual but recently I have seen several. The hypergranulation can form a "false granular layer".
Anecdotal evidence suggests the use of terra cortril ointment. Dont ask me how it works at present no one in burns and plastics knows but it does i hope to do research in the near future.
This can be secured on a small area with hydrocolloid such as duoderm.
if over two weeks suggest patient needs to be seen in burns unit for exert advice.

Slow Healing Burn Wound

Re: Untitled - Date: 1999, Nov 22
From: Amanda Woodcock

Wound Care Knowledge Survey

Date: 1999, Nov 20
From: Diane

We are developing a survey tool to assess the knowledge of wound care within our agency and would appreciate any information on similar survey tools or research papers dealing with same. Thanks

wound care survey - copy please

Re: Wound Care Knowledge Survey - (Diane) Date: 2000, Feb 25
From: lynn

We are also formulatting a wound care survey tool, and would be very grateful for a copy of yours. e.Mail; a reply and I will send you fax number. Many thanks

pressure ulcers and turning patients

Date: 1999, Nov 20
From: janet barclay

Has anyone got any information regarding turning terminal patients with first stage pressure ulcers? Do you think that there is any point in turning when it could be painful or distressing for a terminal patient, even when pressure area care could be compromised? Should we still carry out pressure area care even in the end stages of terminal care? I have had a query from a Sister of a Nursing Home in Edinburgh, Scotland and I am stuck, so if anyone has any thoughts. thanks janet

Pressure Ulcers and turning patients

Re: pressure ulcers and turning patients - (janet barclay) Date: 1999, Dec 02
From: Amanda

Hello
I too am wondering about the necessity of two hourly turning for dying /terminally ill patients. I work in a hospice and as a general rule we nurse patients on high risk matresses and limit turning depending on the patient. We argue that patient comfort is more important and often use pillows to position and do leg massages, touch etc, rather than strict two hourly turns. However, I have no research evidence for this and our physiotherapist said to me last week that we could be ethically wrong in not doing strict two hourly turns and should we not place patients on ordinary matresses (which she feels are easier for moving and handling) and then employ strict two hourly turns for dying patients. I am very much against this but I would be interested to hear anyones views

TURNING PATIENTS

Re: Pressure Ulcers and turning patients - (Amanda) Date: 2000, Mar 08
From: carol mcquillian

Hi well we use 30 degree turns for all our patients which actually eliminates turning two hourly.When you position the patient in a 30 degree tilt by positioning pillows under the limbs and at their back when you remove them you are altering their position without turning them.I would be happy to provide the references if anyone is interested carol

30 degree tilt

Re: TURNING PATIENTS - (carol mcquillian) Date: 2001, Apr 10
From: Vicky

We currently use 30 degree tilt on the intensive care unit where I work. I am carrying out some teaching sessions and would like some references and pictures preferably. thank you Vicky

Untitled

Re: Pressure Ulcers and turning patients - (Amanda) Date: 2000, Dec 22
From: Dirk De Wolf

Hi, In Belgium there is published a rapport about this issue by Tom Defloor (isbn:90 804088 5 9). At the end of his book he writes that when the patient is on a visco-elastic foammatras, You may turn this patient every 4hours instead of every 2 hours. There is not significant diffrence between 2 and 3 hours turning. In Our unit we use Alpha-X-Cell matrasses. They are from Huntleigh. But htey are very expensive. There is however another matras who is a lot sheaper but even better than the alpha-x- cell.You can find more info about this matras at http://www.talleymedical.co.uk or email at: sales at talleymedical.co.uk greetings, dirk.de.wolf@advalvas.be

Untitled

Re: Pressure Ulcers and turning patients - (Amanda) Date: 2000, Dec 22
From: Dirk De Wolf

Hi, In Belgium there is published a rapport about this issue by Tom Defloor (isbn:90 804088 5 9). At the end of his book he writes that when the patient is on a visco-elastic foammatras, You may turn this patient every 4hours instead of every 2 hours. There is not significant diffrence between 2 and 3 hours turning. In Our unit we use Alpha-X-Cell matrasses. They are from Huntleigh. But they are very expensive. There is however another matras who is a lot sheaper but even better than the alpha-x- cell.You can find more info about this matras at http://www.talleymedical.co.uk or email at: sales at talleymedical.co.uk greetings, dirk.de.wolf@advalvas.be

pressure ulcers on terminal patients

Re: pressure ulcers and turning patients - (janet barclay) Date: 2004, Mar 08
From: medical_lady00

ok heres what i think on this issue,i am a c.n.a at a nursing home and we have had a few people from hospice come to our place and they have stage2 or stage4 pressure sores and we use the two hour turn rule for ones at risk because even if they are dying comfort is still an issue and those sores are very painful so even if someone is dying you should still give them the dignity and respect and give that comfort or at least try to heal it even so thanks.

information

Re: pressure ulcers and turning patients - (janet barclay) Date: 2004, Apr 09
From: may johnston

I am looking for a copy of the article 'The effect of different turning intervals on the development of pressure ulcers' By Defloor T 1996. can any one help??

Jelonet evidence for use

Date: 1999, Nov 22
From: Katie Smith

Hello Is there any evidence for the use of Jelonet? It has been banned from a local hospital formulary because it tends to dry out very quickly and new tissue tends to grow up through the gauze and when the dressing is removed the new tissue is pulled away. Are there any situations where Jelonet is the dressing of choice or is prefered to something else? Any information gratefully received. Thank you

Jelonet

Re: Jelonet evidence for use - (Katie Smith) Date: 1999, Nov 22
From: Amanda Woodcock

Hi Katie, Some centres have reported a reduced tendency of Jelonet to dry out when multiple layers of the dressing are used over each other. The manufacturer also produces dressings with different quantities of paraffin (loading). Please consult the manufacturer for further details (Smith & Nephew).
There are several publications outlining the comparative disadvantages of this type of dressing as a primary contact layer in different wound types. Jelonet has been used as the comparator in several Mepitel evaluations (copies on request). Drying out and resultant trauma are the commonest problems. The dressing is inexpensive, although this should be fully weighed against the cost of any resultant clinical consequences.
Kind regards
Amanda Woodcock, Clinical Research Manager Molnlycke Health Care UK

article request

Re: Jelonet - (Amanda Woodcock) Date: 1999, Nov 23
From: Sue Dunn

I would be interested in knowing where the comparison article can be found. Thank you

Untitled

Re: Jelonet evidence for use - (Katie Smith) Date: 1999, Nov 24
From: <Anonymous>

Jelonet is a basic and primerily cheap dressing, it is used in burns a lot due to its cost and general effectiveness. I would only recommend it as a secondary dressing over a cream such as flammercerium (ie in burns only) and even then there is a wealth of better (more useable and effective) dressings on the market that may cost more initially but with better healing times and patient compliance are cheaper in the long run.
Yes we do come across it sticking to newly formed epithial tissue and have to soak it off
hope this helps
simon

jelonet

Re: Jelonet evidence for use - (Katie Smith) Date: 1999, Dec 01
From: jenny thomas

Please could i have a copy of articles for jelonet use and those against. We are having big battles between nurses and doctors re its use.

jelonet

Re: Jelonet evidence for use - (Katie Smith) Date: 1999, Dec 10
From: janet barclay

hi there I have used jelonet frequently in the past and find that granulating tissue does tend to stick to the dressing once it has dried out and this can cause the wound to bleed, putting it back into the inflammatory phase which sets it back. I used na ultra instead, made by johnson and johnson, get in touch with your local rep and i am sure she will be pleased to help you out with clinical papers etc hope this helps janet

Jelonet

Re: jelonet - (janet barclay) Date: 2000, Jan 29
From: Jan Horn

I am having the same arguement at work, re the tissue damage caused by Jelonet, and would be grateful for some references to back up my point

Jelonet and burns

Re: Jelonet - (Jan Horn) Date: 2000, Jan 30
From: Wendy Furness

Hi, we use jelonet for virtually anything in our A&E department, and my mission is to find evidence for alternatives, especially in burns dressings. I would be grateful if anyone has any references which would point us in the right direction! Thanks Wendy

jelonet vs mepitel

Re: Jelonet evidence for use - (Katie Smith) Date: 2001, Jan 17
From: Jodie

Hi, I am a fourth year nursing student and at the moment I am doing an evidence based project for my dissertation. I am looking into whether mepitel or jelonet is better in the initial treatment of burns. If anyone knows of any references or has any suggestions about any helpful resources then I would be grateful. I am particularly looking for pieces of research that compare the two types of dressings. Thanks.

jelonet vs opsite in burns.

Re: jelonet vs mepitel - (Jodie) Date: 2001, Apr 17
From: ldente

jodie,
hi my name is linda and i work at the QEH emergency department and i hate using opsite on burns especially partial thickness burns.
It does not heal the burn and usually the patient returns for a redress, as it smells or is producing exudate and not healing.
I am wondering if you have found any evidence into which is more effective in burns jelonet or opsite and let me know this would be most appreciated.
thanks
linda.

evidence for the use of jelonet

Re: Jelonet evidence for use - (Katie Smith) Date: 2003, Nov 13
From: juliet newson

I am a plastic surgery nurse at exeter hospital and at present am trying to evidence base a wound care protocol for use in the hospital and to go to P.C.T's. this protocol is for plastic surgery patient's specifically. I am struggling to find evidence for the use of jelonet as a skin graft dressing and for burns and would be grateful of any relevent references.

HELP!Vascular Ulcer Pic's?

Date: 1999, Nov 23
From: Mark Zamora, StudentPT

Hi. I am giving an inservice at a local hospital to a group of physical therapist staff members on the differential diagnosis and treatment of vascular wounds including venous and arterial wounds of the lower extremities. If anyone has pictures suitable for a small group(~15 people), please send! Mark Zamora 1400 Barton Rd. #902 Redlands, CA 92373

need info on obesity and wound management

Date: 1999, Nov 23
From: s.morcom

HELP ME PLEASE, I AM WRITING AN ESSAY ON PROBLEMATIC WOUNDS AND THE PROBLEM PATIENT I HAVE CHOSEN HAS PROVEN TO BE A BIG PROBLEM!!!! THE FOCUS OF MY ESSAY IS WOUND MANAGEMENT IN THE OBESE PATIENT AND I CAN NOT FIND ANY SPECIFIC INFO ON THIS, CAN ANYONE HELP ME OR POINT ME IN THE RIGHT DIRECTION??? I WOULD BE MOST GRATEFUL, THANKS.

Obesity

Re: need info on obesity and wound management - (s.morcom) Date: 1999, Nov 25
From: Amanda Woodcock

Hi there:
Try Carol Dealy's new edition of "The Care of Wounds" or Madeleine Flanagan's "Wound Management", in fact - any good all round wound care book. Many of the factors which can affect wound healing are interlinked with obesity:
Diet, Personal Cleansing / Hygiene, Mobility, Psychological Status, Medical Conditions (e.g. Type II Diabetes), Medications etc etc
There should be plenty to get started on. Then try an internet literature review for relevant research articles. By using a suitable search engine you can pick your area quite specifically.
Kind regards, Amanda Woodcock, Clinical Research Manager Molnlycke Health Care UK

tracheostomy occulsion dressings

Date: 1999, Nov 24
From: Linda

I am looking at dressings used, when a tracheostomy tube is removed. I would like to find out what is used in your area. There seems to be little researched evidence to show wich dressings are the best for this purpose. Some areas tend to use sleek. I believe there is a much better dressing out there. That is kind to the skin and can provide an air tight seal. Can you help.Thanks for taking the time to read this message and I look forward to your reply.

Fungating wounds

Date: 1999, Dec 02
From: Amanda

Has any one heard of Urea pads for treating odour in fungating wounds? A relative of a patient said she found such information on the internet, but I have been unable to do so.

pain relief when dressing wounds

Re: Fungating wounds - (Amanda) Date: 2001, Aug 18
From: sue

Has anybody out there ever used morphine soaked dressings as a way of dressing fungating wounds, and providing adequate pain relief. common sense tells me that it would give localised analgesic relief but I cant find any studies documenting this. I would also like to be able to use this for dressings with epidermiolysis bullosa and leg ulcers. Thanks

diabetic foot ulcers

Date: 1999, Dec 02
From: <donnasalata at yahoo.com>

hello again, i am looking for clinical guidelines for treating diabetic foot ulcers. any suggestions? thank you!

A good starting point

Re: diabetic foot ulcers - Date: 2001, Jan 21
From: Ted Yeoman

Try this book I found it useful Managing The Diabetic Foot, Michael E Edmonds & Alethea VM Foster (Blackwell Science). A nice easy read full of useful information for all non specialists.�

Why do community dressing packs contain cotton wool balls?

Date: 1999, Dec 11
From: Deborah

Does anyone know why community dressing packs contain cotton wool when we are not supposed to use it on wounds? Wouldn't it be sensible to have an alternative dressing pack without the cotton wool and save money? Has anyone looked at this before?

Untitled

Re: Why do community dressing packs contain cotton wool balls? - (Deborah) Date: 1999, Dec 21
From: <Anonymous>

To annoy us and waste already limited resources.

DoH Again

Re: Why do community dressing packs contain cotton wool balls? - (Deborah) Date: 1999, Dec 21
From: Ted Yeoman

Simply because the Drug Tarrif Spec says they must & it is not a priority to change it, 4 Layer Bandages, Carbon Dressings etc, etc, The real rip off is what the Chemist pays in relation to the price they are reimbursed at!!

Untitled

Re: Why do community dressing packs contain cotton wool balls? - (Deborah) Date: 2001, Feb 13
From: <Anonymous>

scars

Date: 1999, Dec 16
From: V�ctor

I have read that there are some efficient dressings to improve hypertrophic scars like Cica-care. Is it suitable to raise depressed scars?. If not,is there any other kind of dressing or gel with that purpose?. Thank you.

Foot Ulcer Infected

Date: 1999, Dec 17
From: Barb

My father is 72 and has a sore that is now called an ulcer on his foot. He has had this for at least 6 months and it has continued to get worse despite going to wound care specialists. Currently he is in the hospital because of a staph infection. He is curently receiving whirlpool daily plus debridement. One of his doctors wants to put him under and completely debreed the whole ulcer. Another one wants him to only have about 10% debreeded daily. Any one have any suggestions? Thank you. Barb

Re: Infected foot ulcer

Re: Foot Ulcer Infected - (Barb) Date: 2000, Jan 12
From: Jeff Watt

Dear Barb My Father is 71, has suffered the aftermath of a massive stroke 6 years ago and has also suffered from a pressure sore on his paralysed side ankle for about the same period. To cut a long story short, he contracted osteomyelitus(sic) via the pressure sore, which was first noticed about 3 months ago. Further complications are that he suffers from non insulin dependant diabetes and contracted a chest infection during his last period of respite care. Even with being on three different antibiotics through an IV and everything else, the doctors are now talking about amputation above the knee. The point to all this is that I got this news last night and have found out more information today about woundcare on the internet than 6 years interaction with health professionals dealing with my father. I am very angry about the quality of his care and the end result. Whenever my mother made progress with his wound care, my father inevitably ended up back in respite care for his 2 week out of 8 cycle. Guess what, the wound was usually worse after being with the professionals. I suggest you do a bit more research on sites like this one and start asking awkward questions of the white coats and especially GP's, who to my rather tainted view are not as clued up as they should be. Nurses I have found are pretty clued up but are sometimes not listened to. The person who out of all this I am most angry with is myself. I did not complain enough, soon enough, which is a pretty poor epitaph. Yours sincerely Jeff Watt

Hibiclens and MRSA

Date: 1999, Dec 23
From: <eetrn at aol.com>

A young quad was admitted with a huge, gaping pressure wound of the ischial tuberosity, which was treated with our institues protocol. However, the wound did not improve, and the infection spread into the femoral head. During surgery, MRSA was cultured. Hibiclens flushes were ordered, and the ortho surgeon is asking if I can site references for success using Hibiclens for eradicating MRSA. Of course, the patient is on IV antibiotics too. Can anyone help?

Hibiclens V MRSA

Re: Hibiclens and MRSA - Date: 2000, Jan 09
From: Ted Yeoman

Ref McLure & Gordon J Hosp Inf 1992 21,291-299. tested Povidone Iodine (betadine) and CHX (Hibiscub) against33 strains of MRSA, While Betadine killed all 33 strains, Chlorhexadine (Hibiscub Therefofe Hibclens) killed just 3. A clinicallly significant difference. Maybe not the best clinical ( but a wide spread) policy to use Chlorhexidine for the control of MRSA.

Stasis Dermatitis in Venous Stasis Ulcers

Date: 2000, Jan 06
From: Adam Leeds

Some of my venous leg ulcer patients develop itching around the wound. In two of my patients, this itching has spread over the entire body. Biopsy results have returned "stasis Dermatitis." The venous ulcers with stasis dermatitis have, in my experience, been the hardest to heal. I have another patient who had varicose veins, and an itchy, scaly area which the doctor biopsied. The results again, stasis dermatitis. Unfortunately, the biopsy site never healed, and the ulcer in that area is now 8x6cm. I have tried hydrocortisone, midlevel steroid creams, NSAIDS, and even prednisone. I achieved temporary results with prednisone, but the condition returned as soon as the medication was discontinued.
Any ideas about how to treat this itchy condition? Our standard treatments for stasis ulcers include topical management of the wound plus compression. NON-elastic compression for ambulatory patients (Circ-Aid or low stretch bandaging), and elastic compression for patients without a functioning calf pump (SurePress). In difficult edema, Manual Lymphatic Drainage is applied by a certified Vodder Therapist. Our results are ususlly great unless this itching starts.

Stasis eczema

Re: Stasis Dermatitis in Venous Stasis Ulcers - (Adam Leeds) Date: 2000, Mar 19
From: Ian

Venous stasis eczema should be reversable with compression. Have you tried Multilayer compression?ie3-4layer compression.The problem with venous eczema is that the skin is susceptible to contact dermatitis, due to the primary dressing products that you may be using. Similarly check the topical products do they contain potential allergens eg lanolin,parabens,antibiotics,dyes,perfumes,antiseptics. In fact any product that is in direct contact with the skin can be a potential cause of dermatitis even the primary dressing eg hydrocolloid,adhesive dressings etc.Dermatological referral is advisable for patch testing to eliminate common allergens.

Stasis eczema.

Re: Stasis eczema - (Ian) Date: 2001, Apr 06
From: Mary

I have a problem with the return circulation in legs especially the left. for about three months at the end of last year I had a scayly rash which started around the ankle of the left leg worked its way up the shin with some spots on upper leg....it also appeared on the right leg.....much worse on the left..... I also suffer from psoriasis on knees and elbows when i am stressed......i naturally thought the rash i had was psoriasis but now after browsing your sight.....i am wondering if it is not stasis eczema. i treated it with psoriasis cream......and eventually found a QV wash and soap (not real soap) worked best. eventually going on holidays and doing lots of walking and surfing helped and it is completely gone. i still get some swelling. Have you any thoughts on oxygen exercise machines.....the ones where you wiggle like a fish.......supposed to help circulation........ also what are the long term affects if you are put on fluid tablets to relieve the swelling......is it best to use natural methods first. Mary

venous stasis dermatitis

Re: Stasis Dermatitis in Venous Stasis Ulcers - (Adam Leeds) Date: 2000, Jul 07
From: lori killingsworth

I have been having excellent results treating venous stasis dermatitis using a product called Cloderm. Cloderm is made just for this problem and is produced by Healthpoint. I use it in conjuction with compression therapy such as unnaboots or coban wraps. My patients report immediate relief from the itching.

venous stassis with an ulcer

Re: Stasis Dermatitis in Venous Stasis Ulcers - (Adam Leeds) Date: 2004, Jan 05
From: Orji .G.Ezikpe

Sir,
You have just been recommended tome as one of the most competent hospitals in the USA that could help me solve my problem of debilitating illness. I am a patient with vascular problem of the left leg with an ulcer, that needs a venous bye pass. Would you therefore please confirm possibility of said treatment in your hospital, giving me the break down as to what is required. This ailment has been disturbing me for sometime now and I would like to get it over with once and for all. Would you therefore please furnish me with the requisite letter of an invitation with which to start processing my documents for my eventual departure for the said treatment.
Thanks ,
Yours Very truly,
Orji Ezikpe

Ms.

Date: 2000, Jan 07
From: Lynne

I need to find information on causes, effects and treatments of hypergranulation. I have nothing so far. Any references would be appreciated.

onset of gangrene

Date: 2000, Jan 08
From: Catherine

Elderly patient, primary dx-dementia. Poor nutritional intake, immobile. In terminal phase. No other significant underlying medical problems. Presents suddenly with ischemia to one foot. Foot is cold, pulseless, cyanotic and within several days toes are deep purplish/almost black. Medical dx "probable small thrombi". According to wishes of family and treating physician - no medical treatment other than comfort measures, receiving codeine for pain. A H2O pillow has been installed to relieve pressure to foot and provide comfort. My questions are: he has developed 2 very small wounds on foot which at present are dry - is it best to leave foot exposed at present or to cover with a dry dressing. As foot continues to deteriorate, what is the best type of dressing to use a}on dry gangrene and b} on wet gangrenous lesions? How effective is codeine for this type of pain versus morphine? Thanks in advance for any replies.

ENT Nursing

Date: 2000, Jan 08
From: Linda

Are thre any ENT nurses out there that are interested in identifying the best dressings to use after removal of tracheostomy tubes. If so what do you think provides the best air seal and optimum wound healing. I would be greatful for your help as there is very little in the litrature to suggest why certain dressings are used and I am trying to do some research on this subject. Thanks.

TransCyte

Date: 2000, Jan 11
From: jane

we have been using TransCyte for a year or two now on major burn cases with varying success. Could anyone help me with dressing regimes. When do you first look at the TC post application? What do you do if and when collections of ? purulent ooze are observed beneathe the TC? Any other hints on its use? Thanks

pressure sores and the social implications

Date: 2000, Jan 12
From: jack

Someone plaese help! I'm trying to locate literature regarding economical, technological, social and political factors relating to pressure sores and pressure sore prevention. I'm really struggling to find work on the social aspect, any suggestions will be most welcome. This is an assignment I am currently working on, I'm a third year student nurse in Wales. Thankyou, love Jack xxx

maybe this will help

Re: pressure sores and the social implications - (jack) Date: 2000, Jan 15
From: <jipbarclay at hotmail.com>

Hiya jack try and get in touch with your pressure area care nurse, or tissue viability nurse. I work for huntleigh healthcare who make pressure area care products, like the nimbus mattress, we also do a lot of educational work on the development of pressure sores etc. have a look at our website www.huntleighhealthcare.com ( i think!) good luck janet

Are nurses responsible for causing pressure sores

Re: pressure sores and the social implications - (jack) Date: 2003, Nov 14
From: rita guy

Hi need some evidence to support my theory that nurses are not a main factor of causing pressure sores. help, thank you!

Yes and no!!!!

Re: Are nurses responsible for causing pressure sores - (rita guy) Date: 2004, Apr 20
From: Danielle

A pressure sore occurs when someone is in bed for to long without being turned. Residents/patients should be turned every two hours and thei hygeine needs should be met. If they are not turned every two hours then their skin will rub on the bed at first this may go un-noticed as it just looks like a little red mark, so the carers and nurses think its alright to leave them for a little bit longer, maybe three, four hours maybe even more. Many carers and nurses may have realised that most pressure sores occur on the bottom, this is usually bacuse if the patient is incontenent and is wet, and had not been changed the acid in the urine can burn the skin causing it to peel and eventually blister, then when the patient hasnt been turned for more than two hours it turns into a pressure sore. so in my opinon is yes nurses are to blame for the increse in pressure sores. to prevent them the residents/patients should have all their hygein needs met and turned evry two hours maybe even evry hour.
Danielle Daly (care assistant)

Disinfection of Scissors used to cut dressings in the community setting

Date: 2000, Jan 15
From: Linda

I am looking for opinions or preferably research, on the practice in my area, of community nurses, to disinfect clean scissors with alcohol prior to cutting gauge packing, jellonet, sofratulle, mesalt, aquacel, telfa, etc. to fit a wound. Wound care in the home is considered a clean procedure as apposed to a sterile one and boiling scissors causes them to rust very quickly and becomes a cost to the client who must repurchase them for care, however, is there expert opinion or documentation to support this practice? Any comments?

scissors

Re: Disinfection of Scissors used to cut dressings in the community setting - (Linda) Date: 2000, Jan 17
From: Sue Dunn

We us sterile scissors from our CSSD dept, and send them back for re-sterilisation. We do re-use scissors if just cutting tape. Hope that's some help.

scissors

Re: Disinfection of Scissors used to cut dressings in the community setting - (Linda) Date: 2000, Apr 25
From: kim

I was trained by a nurse to clean my friends wound. She cleaned scissors prior to use by soaking in alcohol (3/4 up the blades). I use a sterile piece of guaze soaked in alcohol and wipe the scissors down.

Use of Carica papaya (Papaya) for debribement of leg ulcers

Date: 2000, Jan 18
From: Danae

Hello Could anyone give us information on the use of Carica papaya (Papaya) for debribement of leg ulcers? This is a recognised natural remedy currently being used by New Zealand hospitals Any information on this practice or the properties of Papaya would be appreciated D. Etches Waitara Library email: danae at sun.nppl.govt.nz

Papaya in wound care

Re: Use of Carica papaya (Papaya) for debribement of leg ulcers - (Danae) Date: 2000, Jan 18
From: Wayne Naylor

Hi there
I have not used Papain (enzyme extracted from Papaya) in wound care before but have seen it mentioned on a number of american discussion forums. They seem to use it quite a lot for wound debridement. One of the products they use is called Accuzyme, info on it can be found at these sites:

http://woundcare.org/newsvol1n2/n2zc.htm http://woundcare.org/newsvol2n4/ar6.htm http://www2.kumc.edu/druginfo/pharmkey/PharmKeyJul99.html

General information on Papain is available from these sites:

http://www.worthington-biochem.com/manual/P/PAP.html http://www.agroindia.org/world/ace/papain.htm

Try doing an internet search using the Dogpile search engine to find more sites. (http://www.dogpile.com).
I hope this is helpful
Wayne :-) (London and Hokitika)

raw papaya for ulcer

Re: Papaya in wound care - (Wayne Naylor) Date: 2002, Apr 20
From: rakesh

i am using raw papaya as such for ulcer dressing of a diabetic lady.any problems.

Biosurgery Documentary

Date: 2000, Jan 18
From: <getzels.gordon at btinternet.com>

We are film producers who make science documentaries for channels like BBC, C4 (UK), TLC, Discovery etc. We are currently working on a film about Biosurgery and would like to hear from anyone who has had an extraordinary experience in helping to heal what seemed an insurmountable wound; we would also like to hear from any patients who are interested in telling their experience. This is a very early stage of research so information and direction from health care professionals is welcome. Getzels/Gordon

Date: 2000, Jan 18
From: <Anonymous>

Help please, for student investigating wound evolution

Date: 2000, Jan 20
From: gary

I am a student investigating wound care and would be most helpfull to anyone who can help me with the following do you think that the evolution of wound care has helped with the transition to community care and peoples preference to be cared for at home if possible. please contact me with any information or questions you may have. My email is srmp@email.com">srmp@email.com or Untitled

Re: Help please, for student investigating wound evolution - (gary ) Date: 2000, Jan 23
From: <donnasalata at yahoo.com>

hello, i believe that the advancements in wound care have allowed for the patient to be cared for easier at home. fewer wounds need sharp debridement, or sharp debridement can be done in the physicians office and then the wound can be cared for at home. we are finding here that once a wound has reached a certain stage in healing that it is better to do less rather than more such as changing the dressing once or twice a week as drainage allows once infection has been resolved. just my opinion and experience, hope this helps. donna

Wound care at home

Re: Help please, for student investigating wound evolution - (gary ) Date: 2000, Jan 26
From: Ann

Hello Gary I am a wheelchair user and I have a pressure sore at the moment and became really ill with infection. My GP had to fight really hard to get me admitted into hospital for some intravenous antibiotics. As soon as I had had these, I was sent home under the care of the community nurses. Then it had to be decided whether I should be treated by the practice nurse or district nurse and which of these should give me dressings. My main problem now is getting prescriptions for dressings. My wound is very deep and anyone would think I ate the dressings!!!. In my experience, I feel care for people with pressure sores has deteriated. I last had a sore some 14-15 years ago. I was then immediately taken into hospital, given blood, put on a healthy protein diet and on a clinitron bed. The nursing care was exceptional. I have now resorted to going to see my old plastic surgeon on a private basis, as I am getting nowhere with the NHS plastic surgeon. I find this really sad, given disabled people are supposed to have rights these days!!! I hope this helps in your research!

Help, wound pictures for a conference

Date: 2000, Jan 21
From: <ialen at prw.net>

Hi! I'm a pharmacist student, and I'm assigned to do a presentation about skin care in the elderly (products available for wound care). If anyone can suggest me sites in which I can find wound photos, it will be really appreciated. Thanks, Islen :-) islenrx at prw.net

Untitled

Re: Help, wound pictures for a conference - Date: 2000, Jan 27
From: <donnasalata at yahoo.com>

FYI: there have been other requests for photo on this forum. see number 25 for example. hope this helps. donna

Iodine dressing use for diabetics

Date: 2000, Jan 26
From: Linda

Help ! I am looking for a reference about the adverse effects of the prolongued use of iodine impregnated dressings on wounds on diabetic patients. Can anyone recall such a referrence. Thankyou

Wound Management in Cancer Patients

Date: 2000, Jan 27
From: Wayne Naylor

Hi,
I have recently taken up a newly created post as Wound Management Research Nurse at a major cancer centre in London. I would like to make contact with Tissue Viability/Wound Care Nurses working in oncology or who have a lot of contact with cancer patients with a view to setting up an informal network.
Wound management in cancer patients has a variety of challenges that are different to other areas of wound care and I would like to be able to contact other nurses for advice and support in this area.
Please either reply on this forum or e-mail me on the address above.
Thank you and I look forward to hearing from you.
Wayne :-)

Poviderm (UK Drug Tariff)

Date: 2000, Feb 03
From: David Morgan

Poviderm has been added to the Drug Tariff in the UK. Does anybody know the manufacturer?

Untitled

Re: Poviderm (UK Drug Tariff) - (David Morgan) Date: 2000, Feb 07
From: carol mcquillian

I believe it is smith and nephew however to check if you go onto the nursing times job site im sure they have an advert for it
carol

Untitled

Re: Poviderm (UK Drug Tariff) - (David Morgan) Date: 2000, Mar 17
From: Mike Watkins

Poviderm is manufactured by SSL International (formerly Seton Scholl).
Poviderm is a 'knitted viscose primary dressing BP impregnated with povidone iodine ointment 10%w/w.
It is indicated for the topical treatment of infection in minor cuts and abrasions and small areas of burns, including treatment of infection in decubitous and venous ulcers.
Mike Watkins, Senior Product Manager, SSL International.

Date: 2000, Feb 03
From: <Anonymous>

Date: 2000, Feb 03
From: <Anonymous>

Open abdominal wounds

Date: 2000, Feb 06
From: Cath Pearson Bsc RN

Does anyone have an assessment tool for large open abdominal wounds or have any experience conducting research involving such wounds

wound assessment for dressing change

Date: 2000, Feb 06
From: carol mcquillian

I would be interested if anyone has a wound assessment tool which could be used to assess postoperative wounds. thanks in anticipation carol
carolm at currantbun.com

RE:ASSESSMENT TOOL

Re: wound assessment for dressing change - (carol mcquillian) Date: 2000, Feb 08
From: CATH PEARSON

FOR A PARTICULAR TYPE OF WOUND OR JUST GENERAL WOUNDS?

Untitled

Re: RE:ASSESSMENT TOOL - (CATH PEARSON) Date: 2000, Feb 08
From: carol mcquillian

The wounds im particularily interested in is following orthopaedic surgery such as elective hips or knees. thanking you in anticipation carol

Opsite Postoperative dressing

Date: 2000, Feb 06
From: carol mcquillian

Has anyone any experience of using opsite postoperative dressings or been involved in any trials or studies comparing postoperative dressings? I mean the composite opsite dressing and not the occlusive type thankyou in anticipation carol
carol at currantbun.com

Showering and wounds

Date: 2000, Feb 08
From: Bev Davis

I am a 7 year surgical R.N. I have irrigated and packed 100's of wounds. Recently, a friend had a breast biopsy which dehisced completely leaving quite a cavity in her breast. Initially, the edges were brought back together with steristrips - boy, I knew that was a mistake. It wasn't long before there was copious amounts of drainage and it was obviously infected. Another physician decided to debride and pack with iodoform packing. After 3 days this was completely removed with instructions to have the wound irrigated daily. The drainage decreased very little. Finally, I told her to get in the shower and give the wound a good cleaning out with the shower head and nice, warm water. She told me "oodles and oodles of cottage cheese" came out of the wound. Once the water came back clear she stopped. She continued her daily irrigations with a nightly "wound shower". It was only 2 days before a very significant difference was seen in the closing of the wound. I truly believe a good cleaning (now not full force of the shower head, but a gentle continuous clean) with warm water does more than all the irrigations with cold saline. The proof was in the healing of this wound. I have seen similar results in the hospital setting. No muss, no fuss - just keep it clean.

Untitled

Re: Showering and wounds - (Bev Davis) Date: 2000, Feb 11
From: Simon Booth

I quite agree,
there have been several studies suggesting tap water from the domestic supply is as effective in cleaning the wound and does not cause any significant delay or complications.
In in our burns unit with major dressing covering large areas we use both shower plinths and immersion to remove dressings and clean wounds causing minimal pain
This technique should continue with out a doubt

re: showering with wounds

Re: Untitled - (Simon Booth) Date: 2000, Feb 24
From: cyndi

I agree wholeheartedly. I work with a vascular doctor and our treatment is very very simple.. cleanse out the wound gently either by whirpool or by shower head. Then adaptic or telfa dressing, kerlix, and tape on the kerlix.. We have about a 95% success rate right now..The only time we ever ever use any ointment is regranax to encourage cellular growth. At NO other time do we use any ointments. People forget that sometimes the simple procedures are best when it comes to wound care.

?us of 40% dakins solution

Date: 2000, Feb 11
From: Dianne

I am looking for any information using a very new concentration of 40% dakins for a wet to wet dressing. Please forward any information to the above email.

Tapeless Dressings

Date: 2000, Feb 15
From: Ray Norris

I am A community Nurse and would be pleased to hear of any experiences with tapeless dressing products

Vacuum Assisted Closure

Date: 2000, Feb 15
From: Ray Norris

I wish to receive information about the efficacy and cost effectiveness of this form of system in the community setting.
An Email adress or URL for KCI in the UK would helpful for a start.

SN

Date: 2000, Feb 17
From: Martin

Greetings from Pennsylvania, USA ...Can anyone refer me to a site where I can see illustrations for discharge wound care teaching? Creating a pamphlet and would like to possibly "borrow" some illustrations for easy patient understanding.

Paddington cup apparatus

Date: 2000, Feb 17
From: Tomasz Popek

I am looking for any information about producers of the 'Paddingtn cup apparats' and for apparatus suitable for testing the conformability of dressings such as hydrocolloids. Thanks in advance for information. Tom

Paddington Cups

Re: Paddington cup apparatus - (Tomasz Popek) Date: 2000, Aug 01
From: Mike Waring

Tomasz
Paddington cups are available from
Dr Brian Midcalf Pharmacy Department St James's University Hospital Beckett Street Leeds LS9 7TF U.K.
Mike

5th european wound conference

Date: 2000, Feb 19
From: carol mcquillian

aparently opsite wound postop dressing was presented at the 5th european wound conference does any one have any info on it was any one present at this conference

Fungating Breast Dressings

Date: 2000, Feb 22
From: Nicky Perkins

Does anyone have any ideas as to a comfortable maybe washable secondary dressing for patients with a fungating breast? It is the one area of wound care that i feel is not addressed. Maybe because the prognosis is poor. I have tried tubifast, cut up netelast knickers, nothing seems to keep the dressings in place or helps my patients dignity in the final stages of this horrible disease. Any suggestions?

re: Fungating Breast Lesion

Re: Fungating Breast Dressings - (Nicky Perkins) Date: 2000, Feb 23
From: Mary

Have you tried disposable baby diapers(nappies) over the primary dressing and secured by a bra? If the breasts are different cup sizes buy 2 bras and cut them in the middle then sew them back with the appropriate bra cups in place. Or try panty hose (knickers) with the legs cut off to just leave the panty section to act as a tube top to stretch over the dressing to secure it in place.

Untitled

Re: Fungating Breast Dressings - (Nicky Perkins) Date: 2000, Feb 24
From: Wayne Naylor

Have you tried the tapeless retention dressings from Mediplus? (e-mail: help at mediplus.co.uk) These dressing come in a range of sizes and there are some especially designed for breasts. Also you could try sports or maternity bras (there are some with zip fronts that may be quite good).
You could try a different dressing system as well to reduce leakage of exudate. The 2 piece system of Mepitel and Mesorb from Molyncke (http://www.wm.molnlyckehc.com/) is good as you can leave the Mepital on the wound for up to 7 days and just change the outer absorbent dressing (Mesorb) when necessary. They are also developing a new range of foam backed dressings (Mepilex) that may be useful for fungating wounds.
I hope this is helpful.

fungating breast dressings

Re: Fungating Breast Dressings - (Nicky Perkins) Date: 2000, Feb 28
From: raynorris

I have successfully used Mepitel as a wound contact layer, an absorbant dressing of choice dependent on exudate levels and held in place by a tapeless dressing product for that body area.

opsite dressing trial

Date: 2000, Feb 25
From: carol mcquillian

I am trying to trace anyone who participated in any health care setting in an evaluation of a postoperative trial between mepore and opsite postop dressing. I intend carrying out this trial but would appreciate if anyone out there has any experience using these dressings to give me their feedback. thanking everybody in anticipation carol

Opsite post op dressings

Re: opsite dressing trial - (carol mcquillian) Date: 2000, Feb 26
From: Jill

I have not personally used this dressing, but have received a sample of the smallest size. I was disappointed to find that the wound contact layer does not appear to be non-adherant, making it an unlikely first choice for wounds in the community. Although Mepore also does not have a very good wound contact layer, I expected a 'new' product to offer a solution to this short coming. Before choosing Opsite Post Op I would need further information on research and comparative prices as well as more adequate samples from the suppliers.

opsite post op dressing

Re: Opsite post op dressings - (Jill) Date: 2000, Feb 26
From: carol mcquillian

Dear Jill thanks for your feedback. There was a trial done in nottingham at the park hospital however have had no joy obtaining full study.I will let you know how the trial goes however if you would like a poster which gives results of trial smith and nephew will oblige also they are happy to give samples.As you say mepore is not satisfactory either i am hoping that opsite post op gives more favourable results however will need to wait and see.
best wishes carol

hydrogen peroxide, Dakin's, acetic acid

Date: 2000, Feb 26
From: John smitthers

I'm looking information regarding when to use these, the ttypes of wound, the %, and for how long.

Untitled

Re: hydrogen peroxide, Dakin's, acetic acid - (John smitthers) Date: 2000, Feb 29
From: <donnasalata at yahoo.com>

We almost always use the recommendations in the U.S. Department of Health and Human Services AHCPR #15 "Treatment of Pressure Ulcers" to guide us in this. There is a toxicity index on page 51. Hope this is helpful.

H2O2, Dakin's, Acetic acid

Re: hydrogen peroxide, Dakin's, acetic acid - (John smitthers) Date: 2000, Mar 06
From: Wayne Naylor

Hi John, the following is taken from a booklet supplied by ConvaTec in the UK.
Morgan D.A. (1997) Formulary of Wound Management Products 7th edition. A Guide for Health Care Staff. Euromed Communications Ltd, Haslemere, Surrey, UK.
HYDROGEN PEROXIDE: -Usual strength of solution is 10 vol (3%). -Caustic effect on wounds in concentrations above 20 vol(6%). -Used to clean dirty, infected, necrotic, sloughy wounds but not recommended on clean wounds. -Contamination with organic material results in loss of effectiveness. -Has an antiseptic effect due to its release of oxygen when applied to tissues-1ml of hydrogen peroxide 3% (10 vol) will release 10ml oxygen (oxidising agent). -Reacts with catalase causing frothing which helps to lift out foreign matter from the wound. -Beware chemical interactions with other agents. -Irrigation of hydrogen peroxide solution under pressure or into enclosed body cavities may have serious consequences such as oxygen embolus and surgical emphysema. A patient died due to air embolism attributed to hydrogen peroxide. -May be caustic to surrounding skin and wound. -At low concentrations may stimulate fibroblast proliferation. At concentrations recommended for wound cleansing, it produced 100% killing of all cell types. Hydrogen peroxide fibroblast toxicity exceeds bacterial toxicity. In an in-vitro study, at concentrations that preserve fibroblast function, 0.003% hydrogen peroxide failed to reduce any bacterial counts.
DAKIN'S SOLUTION: -A solution of chlorinated lime, sodium carbonate and boric acid containing 0.5% w/v available chlorine with a pH of 9.5. -First introduced for topical use in open wounds during World War One by Nobel Prize winner Alexis Carrel. -Needs to be freshly prepared as it is only stable for two to three weeks. -Not recommended
ACETIC ACID: -Topical antiseptic -2-5% solution. -Apply twice daily as a wet to dry dressing. -Can cause quite severe stinging. -Specifically effective against Pseudomonas aeruginosa but little effect on other organisms whose numbers may increase -Effectiveness is short lived -The activity of this relatively weak acid may be the result of changing the pH of the wound environment, thus inhibiting the organism's growth, rather than direct bactericidal effect.
Morgan goes on to say that topical antiseptics should be used judiciously and sparingly in preference to topical antibiotics and that irrigation with topical antiseptics has very little effect. He also suggests that topical antiseptics may be damaging to tissues and delays the healing process.
Chlorinated solutions such as Dakin's are not recommended for routine use in wound management due to their toxicity on normal tissues. These toxicities include: toxic to fibroblasts, reduces basal cell activity, delays collagen production, prolongs inflammatory response, impairs epithelial migration and causes cessation of blood flow. Some authors recommend these solutions as desloughing agents for three to four days only. Hydrogen peroxide should only be used to clean 'contaminated' wounds, for example those that may be seen in an emergency department.
I personally would avoid the use of these three products in wound management in preference for a safer, and probably more reliable, modern alternative.
I hope this information is helpful, I am not sure if the formulary is available outside of the UK, however there are a number of journal articles available on the use of topical antiseptics etc.

Info. on article about alginate fibres

Date: 2000, Mar 09
From: pat holman

Does anyone know of an article published by Patricia Grocott about Alginate fibres in fungating wounds, could I have a reference please

Topical Vitamin A

Date: 2000, Mar 09
From: Mike Sellers

I am looking for information regarding the use of Vitamin A topically for steroid-dependent wound care patients. Thank you.
Mike Sellers San Antonio, Texas

on-line documentation using imaging

Date: 2000, Mar 10
From: Gail Hawley Knowles

We are planning to implement an on-line wound managememt process which includes photographs (stored and viewed on-line) of wounds from onset-the population will be Oncology patients in both in patient and out patient settings. This will enable staff to visualize results of treatments used or chemotherapy response. Has anone done this before? Do you have a policy?

about MEDISKIN

Date: 2000, Mar 14
From: �Ŧ]

somebody know something about MEDISKIN(a fresh porcine skin with pore, be a coverage in full-thickness wound) tell me about it(where can buy and more information) thanks

Developments in Japan

Date: 2000, Mar 16
From: <wsegal at technomics.com>

Anyone have any news on what's happening in wound care in Japan? They should have some interesting biotech products coming out of there. Anyone know of someone I can contact?

Ringers as wound cleanser

Date: 2000, Mar 17
From: Nico Small

Does someone perhaps have any information or references regarding the use of Ringers solution as a wound cleanser - advantages/disadvantages or any relevant research results. Regards, Nico (South Africa)

Information on surgical wound haematoma and dehiscence

Date: 2000, Mar 22
From: Suzy Narroway

I am currently studying for the ENB N49 Principles of Wound Management course, and I have chosen a surgical wound which had healed and then developed a haematoma and became dehisced, as a focus for my care study. I am having great difficulty finding any relevant research or journal articles/information on this subject, and wondered if anyone could assist. I would be grateful to hear from anyone with some insight, knowledge, or detailed info on this. Many thanks. Suzy

re Haematoma

Re: Information on surgical wound haematoma and dehiscence - (Suzy Narroway) Date: 2000, Mar 24
From: Ian

The problem with a haematoma developing in any area of the body is that if it's not removed or drained promptly this space occupying lesion can give rise to a number of problems. firstly as the haematoma increases in size the pressure it exerts on the internal structures can cause pressure necrosis with consequent tissue damage.Also as the haematoma develops in the tissue layers it can prevent the vascular supply from reaching the opposite side of the wound as vessals cannot penetrate the haematoma resulting in avascular necrosis.the haematoma is also a foci for infection an ideal medium for the growth of pathogenic bacteria

Alternatives to acetic acid

Date: 2000, Mar 30
From: Mike Sellers

My facility currently uses 0.25% acetic acid solution topically for wounds with obvious pseudomonas. I am aware of acetic acid's cellular toxicity component and am interested in any alternatives that you may be able to offer. I investigated a triple antiboitic soln.(0.1% gentamycin, 0.1% clindamycin, and 0.05% polymixin B)recently, but it didn't prove to be cost effective. Thank you.

alternative to acetic acid

Re: Alternatives to acetic acid - (Mike Sellers) Date: 2000, Apr 11
From: Adam Leeds

Acetic acid is usually a poor choice to reduce bacteria in a wound. Daily cleansing with saline would be a better approach. However, if an antiseptic agent must be used, Dakins .025% (2ml of bleach per liter) has a much higher bacteria kill rate, and a much lower cellular toxicity. Bear in mind that while this diluted solution (a 20 fold dilution of full strength dakins) has a lower toxicity, it does stop cell migration. In other words, the cells are alive, but not doing thier job. Limit the amount of time this dressing is used -- usually 3-5 days. Using it longer doesn't usually help because no topical solution can penetrate blow the surface of the wound.

yiuhiuhuihyu

Re: alternative to acetic acid - (Adam Leeds) Date: 2001, Apr 17
From: compaq

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Looking for reference on clinical assesment of wound infection and references on photography in wound assessment

Date: 2000, Apr 03
From: Debray

I'm working on photography in wound assessment. I'm looking for references on: 1. Clinical assesment of wound infection 2. Photography in wound assesment: especially this article: K. Bellamy; Photography in wound assesment: a guide to some pf the principales and techniques of medical photography; Journal of wound care-vol 4 n�7,313-16, July 1995
It's very difficult to find "Journal of wound care" in France, if anybody could send me a copy, I'd be very pleased Dr Matthieu DEBRAY Pavillon Elis�e Chatin (service du Pr Franco) D�partement Hospitalo-Universitaire de M�decine Communautaire , CHU de Grenoble 38043 GRENOBLE Cedex France Fone 33(0)476765541 /Fax 33(0)476765576

Lux flakes to soak leg???

Date: 2000, Apr 15
From: Sue Dunn

One of my District Nurse colleagues has been requested to soak a gentleman's leg in Lux flakes. He has a mixed aetiology leg ulcer, ABPI 0.6. She has also been requested to put on daily Flamazine for 4 weeks to the ulcer, a steroid cream to the surrounding skin which we don't think has any eczema, an alginate, and straight Tubigrip. The team are struggling with all of this:- 1- the use of Lux flakes anyway, plus the leg already tends to be dry, 2- we have always used Flamazine for a total of 2 weeks not 4, 3- straight Tubigrip we never use as it gives uneven compression, plus his APBI is only 0.6. help.

Pressure Risk Assessment

Date: 2000, Apr 17
From: Will Blake

Hi there, I am looking for pressure risk assessment tools. I have Waterlow and Norton but am looking for others. Anyone out there point me in the right direction or know of resources on the web. I am particularly interested in simple pro forma which provide a score to judge the risk of a patient developing a sore.
Email me at willford at i.am

What happened to WoundDoc from the Wound Clinic?

Date: 2000, Apr 17
From: <performing at dca.net>

Two years ago I found a web site by the Wound Clinic for a software called WoundDoc, I can't find it. Can anyone tell me what happened to it?

pathways in wound care

Date: 2000, Apr 19
From: Elizabeth Reed

I am a member of a wound care group set up by District Nurses. We would be interested to hear fellow professionals experiences using wound care pathways or guidelines.

Pathway

Re: pathways in wound care - (Elizabeth Reed) Date: 2000, Apr 21
From: Mike Sellers

My facility does not currently use a wound care pathway. I do know, however, that the staff at the Southeast Texas Center for Wound Care and Hyperbaric Medicine uses one. Their website is woundcarehbo.com. Hope this can be of help.
Mike

Wound Pathway

Re: Pathway - (Mike Sellers) Date: 2000, May 03
From: K. Clark RN CETN

I have experimented with development of wound pathways. The main problem is giving a nurse, without any formal training in woundcare, a "map" that requires them to make decisions based on questions that they may not properly answer. Protocols are another means to address certain wounds. If you have any further questions or would like to discuss this further feel free to contact me per e-mail. sailneck at mindspring.com

non-healing wound

Re: pathways in wound care - (Elizabeth Reed) Date: 2000, Nov 16
From: christine

I have a non-healing wound on my left ankle. I've had it for 3 yrs. I've been to wound care centers, plastic surgeons. I've had a by-pass in my leg because an artery wass 100% blocked.Vascular Institute in Albany. I thought after the by-pass it would finally heal. It didn't. It is very painful.Any new treatments for non-healing wounds. it was last grafted 11/6/00. it lasted days & sloughed off. I'd be appreciative for any advice ie;suggstions. Desperate: Christine

Platelet rich plasma or fibrin glue

Date: 2000, Apr 20
From: David

Platelet rich Plasma. A few years ago I heard alot of discussion about the use of platelet rich plasma in wound healing. Online searches show no recent articles for this use. Does anyone have any experience using this technique also known as fibrin glue?

Untitled

Re: Platelet rich plasma or fibrin glue - (David ) Date: 2000, Dec 11
From: Robin

I was recently interviewing a company out of Monroe Louisiana that performs the platelet dressings for a patient of mine who has been a quad for 21 years and has a stage 4 coccyx ulcer. The dressings are applied every two weeks to the ulcer site by a physician in the hospital. the patient is released home and a family member is trained to remove the dressings after 7 days of application. Supposively, they can heal a stage 4 pressure ulcer within 30-90 days. There is a website for the company who makes the dressings. Unfortunately, I have misplaced the article i was given by the company. The concept in theory makes sense. The patient's blood is taken via venipuncture. the plasma and red blood cells are returned and the platelets are placed in a vitamin enriched plasma dressing and applied to the wound. hence the non- rejection factor. medicare pays for the treatment. My patient was rejected due to tunneling and recent venous bleed. In future searches, I recommend typing in Platelet enriched dressings as your key words. Good luck in your search and if I can retrieve the information from my employer I will forward the website to this forum.

Fibrin Glue

Re: Platelet rich plasma or fibrin glue - (David ) Date: 2001, Jan 19
From: Melicov Peter

How do you do dear colleagues,
My name is Melicov Peter, i'm from Russia, Nizhniy Novgorod. I work in firm on manufacture of preparations of blood- Imbio. For our surgeons in Russia fibrin glue very expensive, because in our clinics not used Fibrin sealing. Therefore we are creating domestic (Russian) fibrin glue. Now we have two components fibrin glue- fibrinogen and trombin. We have research on the animal- rabbits and have made hystological analysis. But to doit it is very difficult. We require the information about prepare fibrin glue and yours fibrin glues for comparison of efficiency.
If you can help with our request it will very well. Please E-mail me: nn9226 at nnov.sitek.net

Advice on fibrin sealant

Re: Platelet rich plasma or fibrin glue - (David ) Date: 2001, Apr 13
From: <Ginette.Nye at ukgateway.net>

I have recently had a large soft-tissue sarcoma removed from my buttock. It has left a large cavity which keeps filling up with fluid, causing a seroma. The doctor has suggested trying a fibrin sealant. What would this do and what are the dangers? Does anyone think it might work? Also there seem to be different ways of making the sealant. Are there any that are safer/riskier?
Please e-mail me if you have any advice to offer.
Ginette.Nye at ukgateway.net

courses wound care & stoma therapy

Date: 2000, Apr 21
From: Denise Hibbert

I am a new member and live and work in Saudi Arabia. I would be very interested in any information regarding distance learning oppertunities related to, wound care or stoma therapy. Thankyou Denise.

Long distance courses

Re: courses wound care & stoma therapy - (Denise Hibbert) Date: 2000, May 20
From: <isabelle_lg at yahoo.com>

I also worked in Saudi Arabia and did complete some long distance program while I was there. Maybe you want to check the following:
- U.K.Nursing Time Magazine, there is courses advertised in it.
- You can also check with the post graduate center or the Nurse Educator department of your hospital they also have sometime block mail of distance learning course.
- You can also try contacting the ENB careers section (UK)and ask for your specific request. They give information on local programs but they may be aware of long distance one: 011 44 207 391-6254, 6200, 6205
Good search,
Enjoy Saudi Arabia, I miss it a lot,
Isabelle Gagnon Montr�al

MR

Re: Long distance courses - Date: 2001, Apr 10
From: JUDE CHUKWURAH

I am a Nigerian living in Germany.I would be delighted if you can give me informations where i can get the web site and postal addresses about Universities round the world that offer long distance courses in Masters in Business Administration. Thanks.

distance wound care courses

Re: courses wound care & stoma therapy - (Denise Hibbert) Date: 2000, Sep 26
From: glynis

Hi Have you tried contacting wound healing research unit at the university of Wales, Cardiff. They run an excellant masters course on Wound healing and Tissue Repair. They may do the course totally as a distance learning package I,m not sure. On another note, one of the staff nurses in my unit wondered are you the Denise Hibbert who worked in jeddah on the surgical ward in approx 1992.

DISTANCE LEARNING COURSES IN WOUND CARE

Re: distance wound care courses - (glynis) Date: 2000, Oct 04
From: JANINE MICHAELIDES

I am about to commence a Diploma in Wound Care [distance learning]with THAMES VALLEY UNIVERSITY.You can find details of this course on their web site. Hope this helps.

Canadian Certificate Wound Care Course

Re: DISTANCE LEARNING COURSES IN WOUND CARE - (JANINE MICHAELIDES) Date: 2000, Oct 22
From: Diane

University of Toronto , Ontario, Canada offers a certificate course in Wound Care entitled Interdisciplinary Wound Care Course. It consists of two resident week ends, one at the beginning of the course and one at the end with 8 months of self directed learning in between. The course is offered to doctors, nurses, ETs, physios, corporate reps. etc. Dr. Gary Sibbald and Dr.Diane Krasner are two of the major forces behind the course and the course is affiliated with Dr.Keith Harding in Cardiff, Wales. Check it out on the internet through Continuing Education on the University of Toronto web site.

Distance learning wound modules

Re: DISTANCE LEARNING COURSES IN WOUND CARE - (JANINE MICHAELIDES) Date: 2000, Nov 16
From: Katie Eves

I am presently studying a wound module with University of Dundee.
It is very good. I am doing it as part of my degree but you can do stand alone module. check out the university web site for more details

Wound care facilities in California Bayarea

Date: 2000, Apr 22
From: JR Henderson

I am interested in locating a wound care facility in the California Bayarea. My mother has under gone surgical removal of dead tissue on her back due to several bed sores. She has a rather large ulcer now and I would like suggestions on the best way to treat this ulcer.

John Muir

Re: Wound care facilities in California Bayarea - (JR Henderson) Date: 2000, May 09
From: sue Etter

I am a Para. I have had two pressure sores. John Muir in Walnut Creek. They have a wound care. Best in Northern California. 925-945-6644. Good Luck.

jargon about woundcare

Date: 2000, Apr 27
From: nele

For my script I'm looking for jargon about woundcare. Does someone knows some articles or books, were I can find some information?

Use of Epanutin in wounds?

Date: 2000, May 04
From: Ian

About to receive a patient in the community with trache wound and a non healing sinus around the stoma.Wound to be treated with Epanutin powder. Has anybody heard of this treatment. Is there any robust evidence to back it up.Thanks:-) ian

radiation burns

Date: 2000, May 07
From: Sue

Can anyone give me suggestions on treatments/dressings for a cancer patient with radiation burns? The wounds are dry with yellow crusty base. They are located on inner upper thighs bilaterally and are further irritated by rubbing against each other.

radiotherapy skin reactions

Re: radiation burns - (Sue) Date: 2000, May 08
From: Wayne Naylor

Hi Sue
Firstly it is not appropriate to call these wounds 'burns'. They are the result of radiotherapy affecting the cells in the skin that divide to form new skin (Basal cells). Because these cells do not divide as normal, when the skin flakes of in the normal process of wear and tear they are not replaced leading to the wound your patient now has. If the radiotherapy is finished the wounds should heal quite quickly as the cells will return to thier normal function.
To encourage healing, and promote comfort, you could try hydrogel sheets (geliperm, Novogel, Spenco Second Skin etc) or an amorphous hydrogel (Granugel, Intrasite etc). If the radiotherapy is finished then hydrocolloid sheets (Granuflex, Duoderm etc) would probably be best, they have been shown to improve healing in radiotherapy skin reactions post treatment and would also prevent them rubbing. The hydocolloid can be left in place for 3-4 days depending on how much exudate there is.
Once the wounds are healed and not weeping, then the patient should be encouraged to use a simple, perfume free moisturiser on the skin to keep it supple.
I hope this is helpful
kind regards
Wayne

Untitled

Re: radiotherapy skin reactions - (Wayne Naylor) Date: 2000, May 18
From: Simon Booth

I disagree I have seen burns caused directly by radiotherapy treatment however i agree a thin hydrocolloid wafer should ease any discomfort and minimise chaffing

What worked?

Re: radiation burns - (Sue) Date: 2001, Apr 29
From: Mark Goldman

My wife recently received radiation in the region at the top of the femur. She now has a "burn" at the top of her inner thigh, similar to the area described in the question. Which treatment to alleviate the symptoms worked? The burn did not appear until the end of the 2 week treatment. Aloha

?hyperfix as primary dressing on burns

Date: 2000, May 12
From: theresa

Has anyone got research/reference on the use of hyperfix as primary/only dressing on burns? Does anyone use this method? If so what results/criteria for use?

Untitled

Re: ?hyperfix as primary dressing on burns - (theresa) Date: 2000, May 18
From: Simon Booth

HI
Royal Perth Hospital AUS used mefix/hyperfi for dressing scalds initially in 1997
we have used it on small donor areas, I am aware that several burns units around the country are now using it however i remain a little sceptical.
We are currently doing a randomised trial into it use as a primary dressing
John Radcliffe, Oxford have recently published results of a large trial in its use on donors, Ankur Pandaya was one of the surgeons involved
send me your email adress and i will forward our draft protocol

hyperfix response

Re: Untitled - (Simon Booth) Date: 2000, May 23
From: Tracey

I have seen hyperfix work when my daughter sustained a burn to her neck. The results were nothing short of miraculous. As a wound care clinician myself I believe that more research is necessary before I would be prepared to use it.

Wound care regarding Beta hemolytic strep. A

Date: 2000, May 12
From: isab

I would like to have informations (references) regarding the wound care/ dressing on the initial assessment and following fasciotomy for strep.A infection (flesh eating desease)
Many thanks

Fiberglass fibers in skin

Date: 2000, May 13
From: Mark Long

Yes, I got fiberglass fibers in my fingers and have spread them to my genital area. I've tried scrubing,and picking the fibers with tweezers repetedly and the still keep appearing.....please help...Thanks, Mark Long

fibers in finger

Re: Fiberglass fibers in skin - (Mark Long) Date: May 05, 10:16
From: Lynette

I am replying to the man named Markolong@hotmail.com and his message above. I also have fibers in my right index finger and I cannot get rid of them, I have been to 3 doctors and they do not know what it is. I was hoping to see if this man finally found out what he had. He was on your sight under Fiberglass fibers in skin. Thanks

Sharp Debridement

Date: 2000, May 13
From: BridgetG

I am a clinical specialist in tissue viability working in the UK. I have been practicing sharp debridement for many years having been taught informally by a varied range of different professionals over the years. I wound like to consolidate my skills and am interested to know how others in a similar role deal with this issue and if any formal courses are available, either at home or abroad (I am aware of the forthcoming 'Masterclass' in Nottingham).

debridement/leg ulcers

Re: Sharp Debridement - Date: 2000, Oct 30
From: ann smith

I am in desperate need of information pertaining to this subject - my brother, 49years, is hopsitalized for numerous leg ulcers - please give me some info. about this procedure - debridement - the dr. did this procedure and said that if it doesn't work, he'll take off the leg. please help me.

Sharp Debridement in Physical Therapy

Re: Sharp Debridement - Date: 2000, Nov 27
From: Melissa

I'm a graduate physical therapy student doing a debate on the use of sharp debridement in physical therapist practice. Recently there has been much debate on whether this procedure is appropriate to be done by PTs, since it is a surgical procedure. If anyone can offer input, pro or con, please email me as soon as possible- stiglianom2@uofs.edu">stiglianom2@uofs.edu or Telemedicine for Wound Care

Date: 2000, May 14
From: Richard Johnston

We are looking for beta sites to test our new Internet based program for doing telmedicine for wound care. There is no special software to purchase and beta sites who continue using the system after the beta period receive a discount. Please contact me at johnston at cvtv.net or 888-575-7408 for more information

turning

Date: 2000, May 15
From: Sue

I am interested in obtaining a copy of the European study re positioning based on the stress response. In this, they prioritized rest above positioning and noted that sleep deprived individuals had an increased cortisol level affecting their immune system and leading to the potential for skin breakdown. I aminterested in this view that the positioning schedule is not always to be enforced if rest is an important goal

MRSA and antiseptics

Date: 2000, May 19
From: Amanda

Should povidone iodine (i.e. inadine) be used routinely on MRSA infected wounds? We currently treat MRSA infected wounds with occlusive dressings only. Any ideas and references will be gratefully accepted.

MRSA infected wounds

Re: MRSA and antiseptics - (Amanda) Date: 2000, May 20
From: Sue

Povidone Iodine should never be used routinely in any wound. Very toxic. The only topical antibacterial effective against MRSA is Bactroban (Mupirocin). Severe infection should be treated systemically with a strong antibiotic such as Vancomycin.

Snr Product Manager - SSL International

Re: MRSA infected wounds - Date: 2000, May 22
From: Mike Watkins

In response to the message from Sue I feel obliged to make some comments regarding chat forums as vehicles for dispensing advice. A couple of Sue's comments as well as being unsubstantiated are also inaccurate and could thus lead to poor management of a MRSA infected wound. I would suggest that all advice posted on these pages is viewed as hearsay unless substantiated with references - EVIDENCE BASED!!!!
In reference to povidone iodine being very toxic I qoute the abstract of Mayer & Tsapogas, Povidone iodine and wound healing a critical review, 1993. "Although there may be an initial delay in wound healing associate with the use of PVP-I solution, overall time to complete wound healing appears unaffected by this initial delay. There appears to be no evidence that any of the PVP-I preparations reviewed, other than detergent containing preparations, are detrimental to overall wound healing. Newer vehicles such as PVP-I ointment and cream may actually enhance the healing process".
Sue's statement that only Bactroban is effective versus MRSA doesn't stand up to scrutiny either. There are a number of papers which demonstrate the efficacy of PVP-I versus MRSA, 'In vitro efficacy of povidone-iodine solution and cream against MRSA - Goldenheim 1993. Postgrad Med J 69(Supp 3) S62-S65'. 'In vitro evaluation of povidone iodine and chlorhexidine against MRSA - McClure & Gordon 1992, J of Hosp. Infection 21, 291-299.
McClure and Gordon found that PVP-I killed all 33 isolates of MRSA tested. Goldenheim found that the PVP-I cream (Betadine) killed all 5 MRSA isolates tested.
On the basis of the results of these papers I would suggest that Bactroban is not the only topical treatment effective versus MRSA and PVP-I is also effective. Furthermore there are concerns regarding low level resistance of MRSA to Bactroban because of its widespread use.
However all infected wounds should be assessed and treated accordingly which may or may not include topical treatment plus systemic antibiotics. Where topical treatments are used perhaps a rotational product policy should be adopted to reduce the chances of resistance building up.

povidone iodine toxicity

Re: Snr Product Manager - SSL International - (Mike Watkins) Date: 2000, Jun 23
From: Sue

Please refer to #16 of this forum (especially comments 2 and 6) regarding Povidone iodine toxicity.

Untitled

Re: MRSA and antiseptics - (Amanda) Date: 2000, Jun 03
From: a j

We see MRSA as a normal commensal in burn wounds,
VERY RARELY IS IT PATHOGENIC. in fact even when found in blood cultures it has shown very little pathogenicity
We do not treat it with anything other bugs are much more dangerous Acinitobacter, enteroccocus strep etc
povidone iodine is effective in removing many bugs however simply due to the nature of a wound you will never get rid of all the bugs , they are mostly colinisers not infectors

MRSA

Re: MRSA and antiseptics - (Amanda) Date: 2001, Feb 16
From: <Anonymous>

In Britain the best and only cure for MRSA I have been told, is Tea Tree Oil!

MRSA - The use of Manuka Honey

Re: MRSA and antiseptics - (Amanda) Date: 2001, Mar 03
From: Greg King

We have had some very successful cases where people with MRSA infected wounds have used Active Manuka Honey in their treatment. This honey has a very powerful antibacterial property which is as yet not fully understood by the scientists (most research is carried out at the Honey Research Unit at the University of Waikato in New Zealand - links to their website can be found at www.manukahoney.co.uk/researcharticles.html).
Some MRSA sufferers who we have come into contact with have used the honey as a dressing on their wound. The antibacterial action is known to kill the MRSA bacteria and is actually more effective than a number of antibiotics in killing a wide variety of bacteria (there is no known bacteria as yet which is known to resist it).
Others have been advised by their doctor against using it since many health care professionals still are uninformed of the use of Active Manuka Honey in medical treatment. Because of this these people have eaten the honey regularly and have observed the rapid healing of their MRSA wound. There is evidence that the antibacterial property is strong and resilient enough to have systemic use - it fights the MRSA from within the body.
Manuka Honey therefore offers an effective, low risk natural weapon against MRSA without the risk of toxicity. Please read the research and information about Active Manuka Honey at www.manukahoney.co.uk for full details.
Gregory King

commen help for M.R.S.A, but often ignored

Re: MRSA and antiseptics - (Amanda) Date: 2001, Mar 27
From: Rob UK

I have suffered with M.R.S.A ever since I was in an accident which needed hospital treatment. I was involved in an RTA which nearly took my life, after the surgery, I was then allowed home after 11 days, then the medical staff looking after me noticed a small red swelling, I was sent back to hospital for swabs to be taken. It came back positive and I was started on all different anti_biotics, but they all failed to treat me, I then had my plate removed from my leg (non union had taken place) and then I started to read about the healing power of tea tree oil against M.R.S.A and I was so impressed with what I read that I gave it a go, just as a skin wash in a small bottle, just like a moisturiser rubbed it into my skin. still taking anti-biotics I got a clear swab, then another clear two after. now I am not saying its the "super bug cure" , but after suffering with the bug for nearly two years, then to try something "new", I got a clear result and then others after, bells started to ring about what I had been doing, so I asked my doctor about it ang got a suprise answer,"tea tree oil is still very much unknown and it may hold the answers to a lot of bug problems known today", reading more on the stuff, I have to agree with him. I would not tell anyone to stop taking the prescribed medication, but to try this as a "helper" with the tablets given. Ask your doctor about the healing propertys of tea tree oil, and they will tell you of the antiseptic qualitys of the oil and the strenghs ir grades (austrailian grade or hospital grades are far better then the others and are marked on the bottles). what can I say, it did not improve my spelling, but I got a clear result after using it.

alternative to Mesalt dressing

Date: 2000, May 21
From: mark

at the hospital in which I work, we've run out of Mesalt and I was informed of a national backup on orders...my question is...what would be a suitable alternative dressing for a stage III wound at lateral aspect of ankle...wound moist,pink,with clear tan drainage( question at this point is whether wound is contaminated),,,wound is draining moderate amount of fluid and the edges of wound and tissue around wound is macerated...any input is greatly appreciated.

Urgent Help needed

Date: 2000, May 24
From: Sean Henning

I am looking into recording wound healing by calculating wound surface area on a weekly basis. Some investigators have outlined the wound on a clear plastic sheet that is then entered into a computer program that measures the surface area . I have not found a usable system. Do you have any suggestions? Any help is appreciated very much.

sounds like a job to me

Re: Urgent Help needed - (Sean Henning) Date: 2000, Jun 26
From: James

Does it really have to be that accurate. I think the good old counting the grid boxes works even though I am a complete computer buff and would love to see a vaste amount of nursing gumph computerised, but you can take things a bit far. Just a suggestion, no offence. Please do reply though if you are persivering and I might come up with a cost effective idea with a bit more thought.

Accepted method of warming bottles of Normal Saline?

Date: 2000, May 24
From: Lis Gilmour

We are having a discussion in the ward about what is currently accepted practice for warming 100ml and 500ml bottles of normal saline before use in wound dressing. We have been using a microwave up until now, but have been directed to stop using it on "Infection Control" grounds. If we can not use a microwave, what are alternative methods? Please quote sources if available. Lis Gilmour CNC

Untitled

Re: Accepted method of warming bottles of Normal Saline? - (Lis Gilmour) Date: 2000, Nov 17
From: <Anonymous>

I am trying to imagine what size wounds you are dressing to use that volume of fluid. Many wounds do not actually need cleaning anyway, because if there is not visible, movable debris you are really only rearranging the bacteria. There has been research to this effect, but I am not able to access it at pressent. Volumes of 100 to 500 ml tend to suggest 'multiple patient use' which would certainly be inappropriate. If these volumes are appropriate, you need to find out the principle behind the infection control objection to the microwave before a viable alternative can be found. - are the containers new and unused? My objection would be the very real risk of over heating and consequent tissue damage.

Guidelines for use of scissors for cutting wound product.

Date: 2000, May 24
From: Mitch McGregor

I work in an Infectious Isolation Ward, and there are proposed changes to practices that seem very expensive, and not necessarily effective from a cost, infection control or environmental viewpoint. Can someone advise me whether 1. is it necessary (from an Infection Control viewpoint) to use sterile / disposable scissors rather than simply 'clean' scissors (washed with soap and water / disinfectant) to cut wound product for dressings 2. whether plastic / disposable aprons are necessary rather than re-usable (washed and re-used that is) gowns? If there are any references / studies that you can refer me to, that would be much appreciated. Thanks

Perianal Sinus not healing

Date: 2000, May 30
From: John.kavanagh

Hi
I had my rectum removed in 1997 due to Ulcerative Colitis. Since then I have had a wound (sinus) that will not heal. I had more surgery in March this year to core out the sinus but it failed now I have been referred to a plastic surgeon. Any advice would be appreciated.
John

Untitled

Re: Perianal Sinus not healing - (John.kavanagh) Date: 2002, Feb 07
From: Amy

Wound vac would be an option maybe. I am currently using the vac on a lady that had a 10.5cm sinus tract on her rt. buttocks from a failed flap - now the tract is measuring 1.7cm within a month and a half time. Good luck!

Manuka honey in infected ulcers

Date: 2000, Jun 02
From: Belinda Ihaka

Help, need some good evidence that Manuka honey works on infected pressure ulcers. The current dressing is manuka honey, and comfeel. I only debride the lesion every seven days as requested by a nurse. It has been present for over 6 months and the lady in turning 105 in August. She has full sensation and her vascular system seems o.k. When I get a chance, I use an alginate dressing (keltostat) and apply duoderm as a secondary dressing. Please advise.

reply

Re: Manuka honey in infected ulcers - (Belinda Ihaka) Date: 2000, Aug 19
From: Dawn

Try looking at http://communities.msn.com/MEDIMANUKA.com
Dawn

Active Manuka Honey - research

Re: Manuka honey in infected ulcers - (Belinda Ihaka) Date: 2001, Mar 02
From: Gregory King

There is a lot of research documented at www.manukahoney.co.uk. Our company has had a number of wound care professionals have success using active manuka honey on bacterial infected wounds. If you read some of the research articles you will see the importance of using active honey as opposed to ordinary honey due to the strong anti-bacterial properties of it

opsite trial begins

Date: 2000, Jun 02
From: carol mcquillian

I will be commencing a trial over a four month period to evaluate mepore/airstrip to opsite postoperative dressings.I would be grateful if anyone has any information of previous studies on any of these dressings.Thankyou all in anticipation.

glass in my foot for 3 months

Date: 2000, Jun 03
From: <trixie at prysm.net>

help i have glass in the bottom of my foot and cannot get it out i have tried and tried and cant see it to get it out is there something i can put on it to draw it out thanks. when i leave it alone it just calluous over and hurt to walk on it .

Free grant for telemedicine

Date: 2000, Jun 03
From: Richard Johnston

We are looking for wound specialists world-wide who would be interested in testing our new Internet based program for doing telmedicine for wound care. There is no special software to buy or maintain and all that is needed is a computer and access to the Internet. Either a digital camera or camera/scanner combo is required so that photos of the patient's wounds can be attached to their records. After the 6 week testing period, wound specialists can continue using the program at a discounted rate or stop using it with no furter commitment. Please contact me via email or toll free 888-575-7408 Fax 361-572-3894 for more information.

Non healing perineal wound

Date: 2000, Jun 09
From: Denise Hibbert

I have a patient, post AP resection for CA rectum and post radio therapy. He was readmitted with pseudomonas in his perineal wound which is now a large cavity, with slough over the roof, which the Drs. are reluctant to debride due to the close proximity to the small bowel, and over bone which is visible. He has had treatment with IV antibiotics and topical antibiotics ( flamazine ) He now has 4 organisms in his wound but only one + of leucocytes his WBC is normal the surrounding tissue is neither swollen or inflammed and he has no fever. We have tried for the last few weeks intrasite gel with Kaltostat and covering with duoderm but ther is so much exudate it only lasts about 16 hours. The gentleman also has a mental disorder and puts his fingers in the wound if it isn't occluded. We live in Saudi Arabia so we don't have an abundant amount of different wound supplies. I would be grateful for any surgestions. Thankyou

Wound Care Link in Saudi.

Re: Non healing perineal wound - (Denise Hibbert) Date: 2000, Jun 10
From: <Anonymous>

Dear Denise, I am also a Wound Care Nurse here in Riyadh Saudi Arabia. My post is new so perhaps we could liase with each other. I have been in my current hospital for 5 years so know the Reps & local resources well. Perhaps we could make contact with ourselves & others re Study Days , swapping info, & sharing wound care problems here in saudi? Linda Primmer CLINICAL RESOURCE NURSE SKIN & WOUND CARE.

Untitled

Re: Non healing perineal wound - (Denise Hibbert) Date: 2000, Jun 13
From: <Anonymous>

Denise- It seems as though your use of kaltostat would be appropriate according to how you have described the wound. However, I'm not clear as to the reason for using Intrasite gel in combination with the Kaltostat. Intrasite gel is not indicated with highly exuding wounds and may possibly be at least partially absorbed by the Kaltostat, so it may not be the best use of resources at this point. Also, use caution with the Duoderm in regards to breakdown of periwound tissue secondary to the frequent dressing changes and the strong adhesive qualities of the dressing. Would the patient be sufficiently deterred from putting his fingers in the wound by a snug fitting Depends instead? In regards to the removal of the slough, we have had good luck with a product called as Mesalt which is a crystalline sodium chloride impregnated gauze that creates an isotonic environment and helps loosen necrotic tissue, you may, however, notice even more exudate when using this product. Due to the delicate nature of the internal structures in the wound, perhaps the physicians you are dealing with would be more open to using an enzymatic debriding agent, such as Santyl or Panafil. I know your resources are limited, but is the use of V.A.C. (vacuum assisted closure) an option? You may want to investigate this possibility as well. Good luck with this obviously challenging case.

Coding of Wounds

Re: Untitled - Date: 2000, Nov 08
From: Kathe McCool, CCS

Help!! I didn't see anything about coding of the diagnosis of wounds for reimbursement, I hope this question is ok. A person comes to wound care with an abscess and it is debrided . On the first visit it would be an abscess, now on any returning visits would you consider it still an abscess, or would you call it an nonhealing wound??? I would appreciate any help.. Thanks

Honey or Sugar Paste May Help

Re: Non healing perineal wound - (Denise Hibbert) Date: 2000, Jun 28
From: Wayne Naylor

Just thought you may be able to try either honey or sugar paste for this difficult wound. They are both readily available and quite cheap as well. Honey has been used for vulvectomy wounds where it prevented infection and promoted healing so it should have a similar effect on a perineal wound.
The highly osmotic nature of honey and sugar paste competes for water in the wound leaving none for bacterial growth. In honey the presence of hydrogen peroxide, which is slowly released by the honey as it becomes diluted in the wound, is also highly bacteriocidal. Several honeys have also been found to contain plant derived antibacterial agents.
Both honey and sugar paste provide a moist wound environment and are non-adherent causing no trauma to the wound on removal. They also promotes debridement of the wound and help to eliminate wound malodour. Honey also has an anti-inflammatory effect that may be attributed to the presence of antioxidants in the honey.
The presence of hydrogen peroxide in the honey is thought to stimulate the formation of granulation tissue and re-epithelialisation of the wound, and honey also produces an acidic environment that promotes wound healing. Honey contains amino acids, vitamins, trace elements and sugars which provide a ready source of nutrients to the healing tissues that may also contribute to increased healing rates.
Honey has been shown to be effective against antibiotic resistant bacteria including MRSA. It is also effective against 20 different strains of Pseudomonas. Further it has no harmful effects on healing tissues and no allergic reactions have been reported. Honey used in wound care should be sterilised by gamma irradiation as there is the possibility of clostridium spores being present in the honey that could cause wound botulism. It is preferable to use a honey specifically manufactured for use in wounds.
The most commonly recommended, and most studied, honey is Manuka honey produced in New Zealand and obtainable commercially as wound dressings. It is available by mail order from a number of companies who also have web sites.

http://www.honeynz.co.nz/goldline.htm http://www.manukahoney.co.nz/ http://www.naturalharvest.co.nz/actimel1.html

The amount of honey used on the wound will depend on the level of exudate and infection present. Usually 30 mls of honey is used per 10 centimetre square of dressing pad.
For more information see this site as well http://honey.bio.waikato.ac.nz/
For more information on sugar paste there is a good article in the Dressing Times on this Web site at
http://www.smtl.co.uk/WMPRC/DressingsTimes/vol3.2.txt
which includes the recipe for making it up as thick or thin paste. The thick paste would probably be better as it can be molded into the shape of the cavity.
I hope this information is helpful, goo luck.
Wayne
PS it will also taste nicer if he sticks his finger in it!!

Piercing Aftercare

Date: 2000, Jun 10
From: <Pysche at sprintmail.com>

The latest discussion in a piercing mailing list that I am subscribed to is the question of aftercare. Currently, people use a variety of treatments such as: bactine, saline soaks, cleaning with dial soap, cleaning with another antibacterial soap, and finally, using tea tree or lavender oil. Since there seems to be no general consenus on which product or method is best to use, I was wondering if anyone had an opinion on a better method of treatment or an opinion on any of the products that I listed above that are used to heal piercings. Thank you very much.

Perianal Cavities

Date: 2000, Jun 13
From: <Kerstie.Metcalf at btinternet.com>

I need some up to date research on types of dressings to use post perianal surgery-can anyone help?!

Infected or not infected?

Date: 2000, Jun 15
From: Belinda Ihaka

I debride an ulcer for a lady in a rest home who's dressings (when I'm not in charge) consist of comfeet and dabs of manuka honey. I am not sure whether or not it is pure, but when I get a chance to assess the lesion, a yellowish almost pus like ooze drains out with a distinctive smell. Unfortunately, I am not able to take bacterial swabs, and the visiting doctor does not seem interested. Is this a typical presentation of this type of therapy?

MRSA and Normal Saline

Date: 2000, Jun 16
From: Emma

Can anybody help? I am writing an assignment on the use of normal saline in wound cleansing, I am looking for some articles that contra-indicate the use of normal saline in MRSA infected wounds.

Untitled

Re: MRSA and Normal Saline - (Emma) Date: 2000, Nov 18
From: <Anonymous>

I don't have the references here, but have been told that East Berks Community Trust policy states that MRSA and N Saline don't mix, so they should be able to help.

pressure area risk assessment tools

Date: 2000, Jun 19
From: steve holt

can anyone please help, im a student nurse trying to find info on pressure area assessment tool such as waterlow, norton and braden scales, can anyone direct me to sites with info about these ??

Pressure area risk assessment tools

Re: pressure area risk assessment tools - (steve holt) Date: 2000, Jun 23
From: <Anonymous>

Steve, try doing a literature search in the ENB website, this will give you a number of articles on risk assessment tools.

waterlow

Re: pressure area risk assessment tools - (steve holt) Date: 2004, Mar 02
From: charmaine

i just saw you web page and was hoping that you may be ablr to help my i am currently writting an essay on pressure sore i am studying waterlow and was hoping that you may have some information that i could use. please could you send anyinformation you have to cn22 at cant.ac.uk thank you look forward to your reply

Untitled

Re: pressure area risk assessment tools - (steve holt) Date: Jul 12, 19:45
From: michelle

please can someone give me some information on the waterlow assessment why each question is asked and things like why weight is important to pressure sores and mobility and also why males score 1 where females score to etc... on all of the questions please.I am a student nurse currently doing some work on the waterlow assessment and would be very grateful for any help its on planning and implementing and evaluating care of a neck of femur fracture patient.pleased could you email me to michelleraybone at hotmail.com. I would like medical theory behind the reasons and points of each question.thankyou

leg ulcer self infection

Date: 2000, Jun 22
From: Pat

I am trying to find any literature or research on the use of buckets or bowls used to soak leg ulcers with and self cross infection from the patients foot back to the ulcer itself.
Any advice or directions would be gratefully accepted. Thanks

Untitled

Re: leg ulcer self infection - (Pat) Date: 2000, Nov 30
From: <Anonymous>

I have no research, but in homes with questionable hygiene and no bleach etc, I line the bowl / bin / bucket with disposable bin liner bags

Soaking ulcers

Re: leg ulcer self infection - (Pat) Date: 2001, Feb 16
From: Josi

This is something that concerned me, too, when this practice was used on my leg at the ulcer clinic. No attempt was made to disinfect the foot beforehand and tap water was used also. There are an enormous amount of bugs in hot water tanks and I find this a dangerous method to use. This is why, I think, that my ulcer has been infected now for about two years with the same bug. Antibiotics do not work.I attend to my own four layer dressings now.

Amputee pressure sores

Date: 2000, Jun 28
From: Ciaron Byrne

To whom it may concern, I am 25 year old male Caucasian living in Botswana. When I was 16, I was involved in a cycling accident which after 10 years resulted in a below knee amputation. However, I underwent 25 operations in an attempt to save my lower right leg. As a result the muscles and skin were taken from my thigh and back in an attempt to re-graft muscle and skin tissue. However, since my amputation I have struggled with my prosthesis as a result of defective skin. Despite wearing a sophisticated gel liner to protect my stump, I am constantly suffering from pressure sores and friction related blisters. The problem is that in order to allow time for these sores to heal, I am obligated to refrain from using the prosthesis. Once again, due to such poor skin quality and bad blood circulation, the resulting 1cm x 1cm inch wide and .3 cm deep sore can take up to four months to heal. I have been advised that the only remedy which would provide me with better continuity would be a above knee amputation. This course of action is unacceptable as it requires the loss of a fully functional knee I have for a long time used Vitamin E cream to try a speed up the process, however it still takes to long. Please could you advise on any products that might be available that could do the following:- An ointment or such that could be applied when I am not using the prothesis e.g. before I go to bed. Ideally this product would need to both toughen the skin for when the prosthesis is being used and nourish the skin when not. An ointment that could be applied in the event of pressure/friction sores developing. An ointment that when applied on the sores would encourage rapid regrowth of skin over the affected area. I appreciate that the above is very broad, never the less such specialised products are hard to find in Southern Africa. Also please keep in mind that summer temperatures in Botswana reach as high as 50 degrees Celsius. I look forward to hearing from you, Ciaron Byrne. Botswana.

You may want to give this a try

Re: Amputee pressure sores - (Ciaron Byrne) Date: 2000, Jul 27
From: Janelle Dees CWOCN

I have found that for friction/shear wounds on active amputee's using an alginate with a thin film as a cover dressing works well to alleviate the problem. My personal favorites would be sorbsan/tegaderm. This dressing is waterproof and can stay on for up to 4 days depending on the amount of drainage. When you skin is healed and a wound dressing is no longer needed, tegaderm by itself will work, but will get expensive. I am not aware of any cream to toughen the skin, but if I come across anything I will let you know. Janelle RN BSN CWOCN

Below the knee pressure sores

Re: You may want to give this a try - (Janelle Dees CWOCN) Date: 2004, Apr 09
From: morrigan3

My mother is a below the knee amputee as well, and has tried many things over the years. For prevention, washing with phisoderm daily, 3 times daily when the sores begin. But a few things helped even more, bag balm (or similiar ointment), applied generously to the stub, between the stub & gel cushion. Bag balm is an ointment originally used on dairy cow's teats and bag, to help cracks/infection in the skin to heal. (You have to remove the bag balm every night, wipe it off the stub & gel cushion, well with a clean paper towel. I don't recall how often she cleans the gel cushion. The stub should also be clean when you apply the bag balm.) Also, 3 months of Super Lysine Plus by Quantum, helped decrease the incidence of the sores. (She probably caught staph from the hospital, not uncommon, but antibiotics and the like have never fully gotten rid of it, and she's also gotten boils alot, since the surgery, til she began supporting her immune system with proper nutrition, vitamins, and the Super Lysine Plus.) You may also wish to get your thyroid checked. Supporting your body and its immune system is important in fighting these infections off. The above ideas helped my mom decrease the incident of infections ALOT, but aren't a "cure". Also, properly fitting prothesis makes a huge difference! Any improper rubbing is just opening for infection.
I have chosen to keep my email addy private, for reasons of spam, but I will check back on your post a few times in case you have any questions. I am not a medical expert in anyway, this is just what helped my mom, after 20-some odd years of torture.

Neonatal and paediatric wound management (The mine field!!!)

Date: 2000, Jun 30
From: <Anonymous>

I am gearing myself up to write a paediatric and neonatal wound formulary-to you have any useful references to guide me in the right direction. I would be eternally grateful for anything other than tegaderm and intrasite gel!

Post Op vulvectomy dressings

Date: 2000, Jul 01
From: Linda Primmer, C.R.N. Skin & Wound Care

In the very near future we have a patient needing a vulvectomy & groin lymph dissection. We are looking for the best dressing for this lady post op. The Obs & Gynae nurses tell the lady will require a dressing 2 hourly post op. Does anyone have any experience with such a wound & can they suggest alternative dressings? Thankyou for any help recieved.

where can i find research on benefits of eosin?

Date: 2000, Jul 03
From: fiona morrison

Eosin has been recommended as a drying and antimicrobial agent to be applied to wet areas of skin surrounding wounds. does anyone know of any research that exists to prove this or any protocols for it's use? thanks

Use of digital cameras

Date: 2000, Jul 05
From: Grace Spinner

I would like some advice on types of digital cameras available for wound care. Thanks

Date: 2000, Jul 05
From: Grace Spinner

Honey for wounds - Availability in UK

Date: 2000, Jul 06
From: Wayne Naylor

Does anyone know if there is an importer of medical grade honey for use in wound management in the UK?
I am aware of some mail order companies in Australia and New Zealand but a UK distributor would be easier.
Thanks
Wayne :-)

honey

Re: Honey for wounds - Availability in UK - (Wayne Naylor) Date: 2001, Jan 24
From: dawn

Dear Wayne, I have tried to find a local supplier myself and been unsuccessful. Good Luck. Dawn

BRITISH HONEY

Re: Honey for wounds - Availability in UK - (Wayne Naylor) Date: 2001, Feb 16
From: Josi

Find yourself a local beekeeper. (Try www.kentbee.com to find a local one via their links.) Ask him to supply the 'first cappings'of the honey frame which are naturally totally sterile. The bees manage this with the use of the Propolis which they obtain from trees.A beehive is the most sterile environment on the planet. Propolis tincture, Propolis gum dissolved in pure alchohol, applied to a small wound will heal it whilst you watch. It does sting for about five seconds but it's very effective. Honey from a beehive found within a radius of five miles from your home will cure pollen based hay fever. A teaspoonful eaten at the first sign of sneezing or itchy eyes will usually do the trick. Honey from the supermarket is useless. You can also search Google typing "bees UK" in the box Good luck! Josi

Active Manuka Honey - availability in the UK

Re: Honey for wounds - Availability in UK - (Wayne Naylor) Date: 2001, Feb 28
From: Greg King

The term you use "medical grade honey" can mean one of two things. Academic opinion and research demonstrates that Active Manuka Honey, with a verified UMF rating of 10 or more, is suitable for medical therapeutic use due to its unique antibacterial properties. It is used to clear bacterial infected wounds and treat stomach (peptic) ulcers.
The other meaning of the phrase could refer to whether the honey is sterilised or not. Nature's Nectar Limited in the UK (my company) imports Active Manuka Honey with a superior UMF rating of 16 into the UK (it is tested at the University of Waikato and given its rating there). We also are able to supply active manuka honey that has been sterilised using radiation.
Please visit www.manukahoney.co.uk for research articles about the use of active manuka honey for wound and digestive treatment. For details about the supply of honey in the UK please contact either :
paulwood@manukahoney.co.uk
or
chriswood@manukahoney.co.uk
Regards
Greg King
Manuka Honey Limited and Nature's Nectar Limited

Algisite M

Date: 2000, Jul 12
From: Andrew

Does anyone out there have any experience with Algisite M, particularly in a hospital setting and how it compares to other alginates, eg. Sorbsan or Kaltostat.
Many thanks,
Andrew

laparostomy

Date: 2000, Jul 18
From: Felice Apicella

what about dressing laparostomy?

Hydrocolloids and Infected Wounds?

Date: 2000, Jul 27
From: Janelle Dees CWOCN

I am looking for any information or studies on using hydrocolloids with infected (not just colonized/contaminated) pressure/venous wounds. I have found this to be in many protocols at places that I have contracts with. I am not comfortable with this practice and would like to know of others experience. Thank you. Janelle RN BSN CWOCN

Need help with leg ulcer

Date: 2000, Jul 28
From: Janice Celania

My mother is 88 yrs. old, lives in Keokuk, Ia. and has an open wound(ulcer) since last Nov. It is located about 6 in. above the ankle on the front of the leg near the large bone. She "thinks" she hit it on an open drawer.
I have taken her to her family Dr. (Davis,Int. Med.). He referred her to a dermatologist in Keokuk in March. It started out being approx. 1/2 cm. around and is now about 5 cm and oval shaped. The dermatologist in Keokuk put her in a whirpool and dug it out several times as it was scabbing over. That was very painful. He had her on antibiotics and treating it w/ an antibiotic cream. We felt like we were getting nowhere so we started taking her to the Univ. Hospital in Ia. City, Dermatology Dept. in April. They had her clean it w/ a vinegar solution and use polysporin and a Tegaderm wrap and wrap it with an Ace bandage and leave it alone for 3 days. She was to keep her feet up as much as possible. It became extremely painful and quite red around the area. She was having so much trouble sleeping that they prescribed Ibuprofin. A month ago we were to start cleaning it with a hydrogen peroxide sol. every day and use wet soaks on it to remove the sloughy, apply polysporin, and wrap it. The pain in it is like a drawing pain and every time I would put her through this or she would change elevations, it would pain so bad, she would cry. They now have her back on the Tegaderm patches every 3 days and cleaning it then w/ the peroxide sol. and wet soaks etc. I cannot see that we are getting anywhere. It is still very red around the area and still a lot of sloughy. There is some red coming underneath which they say is part of the healing process. They also have prescribed Darviset for pain.
Being 88 yrs. old, she has become quite confused and forgetful and this has increased since she has had this ulcer. They tell me that these nonhealing wounds are quite common in elderly people and that it is quite common for them to take a year or more to heal. I just wish we would see more improvement in this amount of time. Do you have any suggestions for me or could your center do anything to help us? I would appreciate any advice. Thank you, jlcelani at interl.net

leg ulcer help

Re: Need help with leg ulcer - (Janice Celania) Date: 2000, Jul 31
From: <nicky.perkins at cwc.net>

It sounds as if your mother needs a doppler examination to determine if the ulcer is caused by arterial insufficiency or venous return insufficiency. If it is arterial she may need to see a vascular surgeon. If Venous, compression therapy is the treatment of choice and has very good results. In my experience gauze soak are detrimental to the wound healing process and should not be uses for desloughing wounds,a hydrogel is much nicer for the patient.

Leg ulcer

Re: Need help with leg ulcer - (Janice Celania) Date: 2000, Aug 05
From: Mike Sellers

I agree with the above posting. Another study that may be of help might be a transcutaneous oxygen study. These are performed at hyperbaric oxygen facilities. A lack of oxygen may be part of the problem. Oxygen is essential in wound healing. I suggest that you stop cleansing the wound with peroxide, it is toxic to any new tissue that may be forming. A sterile normal saline rinse would be much better. I have seen chronic wounds begin to heal by just stopping the use of peroxide. Monitor the site closely for reddness, swelling, or other signs and symptoms of infection also. Best of luck.

Help and New Hope for Leg Ulcers

Re: Need help with leg ulcer - (Janice Celania) Date: 2000, Nov 07
From: Thomas A. Sharon, R.N., M.P.H.

Your mothers problem is not uncommon. I can offer some hope. There is a little known but very effective wound healing technology called "The Diapulse Wound Treatment System". It delivers a non-invasive pulsed electromagnetic energy and is safe and painless. I have used it on hundreds of patients and their chronic wounds healed completely. It is available in only a few areas around the U.S.A. (New York, Chicago, California, South Florida, North Carolina, etc.) and a physician's prescription is required. Information is available at the following sites: http://nursetom.healthcareforums.com and http://www.diapulse.com You can also locate The manufacturer as follows: Diapulse Corporation of America 321 East Shore Road Great Neck, N.Y. 11023 Telephone: 516-466-3030 Fax: 516-829-8069 I hope this will help you. Thomas A. Sharon, R.N., M.P.H.

To irrigate or not?

Date: 2000, Jul 31
From: Nicky Perkins

Can anyone give me the correct procedure for taking a wound swab following a course of bactroban for treating MRSA? Do you irrigate first or swab the wound bed with debris insitu?

Protein loss from pressure sores

Date: 2000, Aug 03
From: Graham Hall

I am seeking a rough estimate of typical protein losses from pressure sores. Thank you

Use of Telfa Clear as a burns dressing

Date: 2000, Aug 06
From: mark hardman

My burns unit is thinking of changing our standard burns dressing from paraffin-tulle and gauze to Telfa Clear and Kerlix gauze. However I cannot find any published research on this combination. Have any readers any experience of using Telfa Clear dressing, or know of any published studies on this subject

New Non-Healing ulcer on 25 yr.old old scar

Date: 2000, Aug 07
From: Eve

Please help me i don't know who to turn to: I had an accident 25 years ago where I have extensive scar tissue on the entire front of my ankle. This area is fibrous and had been skin grafted using my own skin 24 years ago. Last December I wore a new pair of boots and rubbed an ulcer into the scar close to the ankle bone and a ligament. Needless to say the wound is not healing despite Oasis Grafts and Aplegrafts. They keep debriding the wound and it has gotten bigger, from 2 cm x 1cm to 5 cm x 3.5 cm. I have also battled many staff and strep infections. Plastic Surgeons cannot help me due to the location and fibrous tissue. They also said the area should not be debrided. However the wound care center doctor I am going to continues to debride.
My questions are 1) Should an ulcer be debrided if the surrounding area consists of all scar tissue???
2) After an Aplegraft is applied, they change the dressing only once a week for several weeks in secession....Is that common practice
3) Will electroregenesis work for my situation.
3) What can be done about the endless itching on the surrounding healthy tissue?
Please Help: I'm at my wits end and don't want to lose my foot. I don't know where to turn.

Above posting should be a question icon

Re: Untitled - Date: 2000, Aug 10
From: <Anonymous>

Date: 2000, Aug 07
From: <Anonymous>

See above

Date: 2000, Aug 07
From: Pam V. Trone, PT, Manager- Phys. Med. Wound Care Center

Does anyone have information on obtaining tissue cultures for quantative bacterial content in wounds from the tissue. Proper techniques. Etc. Our medical director- a vascular surgery MD - has requested this procedure on some of his patients.

alternative to proflavine for vaginal packing/

Date: 2000, Aug 10
From: SHONA MCCULLOCH.

I HAVE A PATIENT WITH AN ULCERATED PROCIDENTIA. MANUFACTURERS ARE NO LONGER PRODUCING PROFLAVINE WHICH WE NORMALLY USE. COULD AN ALTERNATIVE PLEASE BE SUGGESTED.

Untitled

Re: alternative to proflavine for vaginal packing/ - (SHONA MCCULLOCH.) Date: 2000, Sep 28
From: <Anonymous>

There is a product on the market called intrasite conformable. This provides a primary layer of hydrogel that stays in place and provides moist environment, it may help your patient with the ulceration. Proflavine seems a bit harsh

PRESSURE REDUCING DEVICES FOR TX. OF HEEL ULCERS

Date: 2000, Aug 15
From: CATHI

NEED HELP WITH OFF LOADING PRESSURE FROM HEEL ULCERS OTHER THAN FLOATING HEELS ON PILLOWS, SPENCO BOOTS AND FOOT ELEVATORS. ANY HELP WOULD BE GREATLY APPRECIATED. THANKS, CATHI

pressure relieving devices

Re: PRESSURE REDUCING DEVICES FOR TX. OF HEEL ULCERS - (CATHI) Date: 2000, Aug 15
From: carol mcquillian

TRY REPOSE SPLINTS WILL CHECK SUPP;IER TOMMORROW FOR YOU IF YOU WISH ANY FURTHER DETAILS DONT HESITATE TO E MAIL ME REGARDS CAROL

pressure reducing pads

Re: PRESSURE REDUCING DEVICES FOR TX. OF HEEL ULCERS - (CATHI) Date: 2000, Aug 25
From: andrea cresswell

why not try spenko gel pads, which are more effective than the boots. They are great for placing in plaster casts and back slabs, can be cut to size and used as a secondary dressing. great on elbows too. secure with tape or bandage. have also used effectively on spinal pressure sores.

Any info on Mepilex?

Date: 2000, Aug 15
From: <margaret at mfox40.freeserve.co.uk>

Anyone got any info on Mepilex by Tendra? We have found some patients are allergic to ALLEVYN and wish to know if Mepilex would be of use in these cases.

Re: "Any info on Mepilex?"

Re: Any info on Mepilex? - Date: 2000, Aug 20
From: Catherine

Here is a link to the manufacturer -
http://www.tendra.com/products/products_exudate.html

mepilex-use it daily

Re: Any info on Mepilex? - Date: Aug 08, 00:47
From: geraldine mackinnon

Ive been using it on hard to heal wounds that my son has after a large burn. It has been most useful and has allowed some very presistent wounds to heal while protecting the skin from the pressure garments he must wear.

flaps and specialist mattresses

Date: 2000, Aug 16
From: andrea cresswell

Following the failure of a free flap to lower leg of one of my patients, I was reading that positioning is extremely important to prevent damage to the anastomosis. We were nursing this patient on an alternating pressure mattress. Could this in some way have added to the failure of the flap.I can find no literature on freeflaps and alternating pressure mattresses. I would appreciate some help with my burning question??

flaps and beds

Re: flaps and specialist mattresses - (andrea cresswell) Date: 2000, Aug 21
From: Wayne Naylor

I am not sure of any evidence but I think that potentially an alternating cell mattress could cause problems with the anastomosis in a free flap. If an individual cell was inflating at the site of the anastomosis while the cells either side deflated it could put pressure on the anastomosis and cut of the blood supply to the flap.
I would suggest using a low air-loss bed instead so that pressure is reduced over the whole body rather than alternate areas.
Wayne :-)

Protocols and flaps

Date: 2000, Aug 25
From: andrea cresswell

As a nurse within a plastic surgery environment, I am currently attempting to write a protocol for flap care, monitoring and intervention. Does anybody have any information they could send, or know of suitable sites that would help. Thankyou

Infected venous leg ulcers

Date: 2000, Aug 25
From: Maureen

It has always been my practice, when treating a patient with a venous leg ulcer which has become infected, displaying fairly widespread inflammation and severe pain to discontinue compression therapy for a short period until systemic antibiotic treatment controlled the very distressing symptoms. I cannot bring to mind any theory to support this treatment, which has rently been questioned. Since my access to search facilities is limited by both time and access can anyone support my thinking? My main reason for suspending compression has been purely humane. The pain of an acutely infected wound is sufficient in itself without the added burden of pressure on the wound site. With correct systemic treatment the infection is quickly resolved and the patient happily resumes treatment with compression therapy, having suffered as little pain/discomfort as possible during the painful, infected period. Please, if there is theory to support my practice would someone direct me to it?

RN

Re: Infected venous leg ulcers - (Maureen) Date: 2000, Oct 11
From: Amy

Maureen: I am RN at a Wound Care Center. It is the practice at our facility to do just what you described. The compression bandage is d/c'd until the infection is under control. We typically use a topical antibiotic solution called GCP solution. It is specially mixed by a local pharmacy which includes Gentamycin, Clindamycin and Polymyxin B. With our patients that have been having a great amount of pain, with infection, this topical solution is just what the doctor ordered. After about 3-4 weeks of daily application, the wound is re-cultured and the compression wrap is re-applied. If you would like more information on the GCP solution, contact me. Amy RN

any information on the identification of infection in granulating wounds by registered nurses

Date: 2000, Sep 04
From: <htkaren at aol.com>

Information required on the identification of infection in granulating wounds by registered nurses

Classification system

Date: 2000, Sep 07
From: Belinda Ihaka

Can anyone post to me via email a classification system including most common sites on the lower limbs, differential diagnoses of ulcers?

History of wound care in PT

Date: 2000, Sep 13
From: Dr. Sonia Dumit-Minkel

i am in urgent need of information regarding the historical role of physical therapists (physiotherapists) in wound management. as of yet i have been unable to locate any information. thankyou in advance!!!

Hydrocolloids and exposed tendons

Date: 2000, Sep 18
From: Andrew Jull

I was recently asked whether hydrocolloids were contraindicated when a wound contained exposed tendons as well as granulating tissue. I have been unable to find any data on this, other than advice that when a wound contains exposed tendon it requires plastic surgery to cover the tendon (I am unsure of what evidence this advice is based upon). Can anybody provide a cogent response to the above question? Many thanks.
Andrew Jull Clinical Nurse Consultant Auckland Hospital New Zealand

Ultrasound for wound healing

Date: 2000, Sep 19
From: Dennis

Has anyone had positive results using therapeutic ultrasound for the treatment of soft tissue wounds. Please contact me with any comments on technique, success etc. ddavey at prodigy.net

Legal issues and innovations in wound care management A Study Day in Bath

Date: 2000, Sep 20
From: Sue Butts

Interested in this study day due to be held at the Royal National Hospital for Rheumatic Diseases, Bath on Friday 6th October? Keynote Speaker Professor Brigid Dimond Emeritus Professor, University of Glamorgan �55 (including all refreashmnets and lunch) Contact for further details: Sister Sue Butts RNHRD Upper Borough Walls, Bath BA1 1RL 01225-465941 Ext 209 Email: buttss at rnhrd-tr.sewst.nhs.uk

Untitled

Date: 2000, Sep 26
From: mary ann

Please give me any information about fistulas that are about to form and enlarge in a loop of exposed bowel- I have a pt. with a small bowel loop with a pin point opening in an open abdominal wound in the LLQ of the abd. THis opening is still pin point yet secreting clear liquid at this point.Pt has a Higher-Up fistula closer to the duodenum. Pt. is being fed clear liquid which immediately excrete thru the proximal fistula.Yet with food stimulus I suspect that peristalsis is stimulated down to the distal non-comunicating fistula and will possibly cause this fistula to open further. Another question is how does the surgeon secure the LLQ open bowel wound and give it support-can he mesh the wound, and cauterize the pinpoint fistula??? Can thesurgeon give the abdomen any support to prevent the fistula and bowel from exiting the abdomen.? Does peristalsis effect the entire GI tract even though you have a proximal fistula and no food is getting to th lower fistula bowel.

A & E risk assessment for pressure sores

Date: 2000, Oct 08
From: angela cave

Doas anyone know of any good pressure sore risk assessment tools for A & E?

Untitled

Re: A & E risk assessment for pressure sores - (angela cave) Date: 2000, Oct 10
From: <Anonymous>

Waterlow scale tends to highlight most at risk patients although for a&e i would reccommend combining this with a nutritional risk score.

rheumatoid arthritis and wounds

Date: 2000, Oct 11
From: Amy

Does anyone have any info. regarding wound infection related to rheumatoid arthritis? Is there a connection somehow with the immune system of a RA patient and infection in an open wound? We have a patient with RA and seems her wound is constantly getting infected, more than what is expected. Any info would be appreciated. Amy RN

wounds - infected w/RA patient

Re: rheumatoid arthritis and wounds - (Amy) Date: 2000, Nov 16
From: Christine

I also have RA and a non-healing wound, have had vscular by-pass surgery numerous grafts (3 yrs. duration) will contact you if it heals.

NEW PRODUCT TO ERADICATE WOUND ODOURS

Date: 2000, Oct 16
From: <r.mc at btclick.com>

PRODUCT JUST LAUNCHED - HAS BEEN WELL RECEIVED BY WOUND CARE SPECIALISTS AT RECENT CONFERENCES - PLSE E MAIL FOR FULL DETAILS

Painful Vasculitic Lesions due to Cryoglobulinaemia

Date: 2000, Oct 17
From: Wayne Naylor

I have been asked for advice on the management of painful ulcerative vasculitic lesions on a patient's feet and lower legs. The ulcers are due to cryoglobulinaemia and he only suffers from them in cold weather. The patient cannot leave his house during cold weather as this exacerbates his condition.
Has anyone had any experience in managing this type of wound? Basically he needs a dressing that will protect the ulcers but is non-adherent as his skin is quite fragile. I have thought of Mepitel or some of the foam dressings but these could be difficult to keep in place as the ulcers affect the sole of his feet as well.
Any suggestions would be greatfully recieved.
Thanks.
Wayne :-)

Sterile gauze vs. Non-sterile gauze use

Date: 2000, Oct 18
From: Kristie

I am looking for info on use of Non-sterile gauze (for cleansing with Saf-clens, or other wound cleanser) vs. sterile gauze use......
Can anyone help? It would be greatly appreciated.
Kristie

Procuren

Date: 2000, Oct 22
From: Diane

Has anyone ever heard of or used a product called Procuren and if so who makes it and how do I find out more about it. Thanks

renewing surgical wound dressings

Date: 2000, Oct 23
From: glynis

Does anyone know of any papers which indicate the optimum time post surgery for changing the first dressing. There is some debate in my organisation, between those who want the dressing changed within 24-48 hrs and those who want the dressing left in situ despite being soiled.

Renewing Surgical Dressings

Re: renewing surgical wound dressings - (glynis) Date: 2003, Nov 12
From: Susan

Chrintz H et al. Department of Surgery Kalundborg Hospital, Denmark, carried out research that suggested that after the first post-operative day or 24 hrs there was evidence to suggest the benefits of removing the dressings alltogether. Also as a nursing student, I can't get past recommending Athens as a valuable source of evidence based research! PLease do not take my word for it, you can check out Chrintz's paper on Pub Med. Hope this has been of some use.
Susan x

Potassium permanganate

Date: 2000, Oct 24
From: Judy

It's that age old question again I'm afraid (sorry). I know experience says it is effective when used on leg ulcers, but is there any research available to support this? Any replies are appreciated!!!

Please help me!

Re: Potassium permanganate - (Judy) Date: 2002, Mar 21
From: <bobthebeetle at hotmail.com>

I am second year degree nursing student and i am hoping to research the effects of potassium permaganate on leg ulcers for my dissertation. Any information around this topic i would be very intersted in.

RN, BSN

Re: Potassium permanganate - (Judy) Date: 2003, Nov 20
From: Amy Schelin

I am responding to this message a little late... but am wondering if you have learned anything else about Potassium Permanganate. I am a nurse in Cambodia w/ limited resources to take care of people's wounds. Well, we have a visiting dermatologist who is now retired and had a lot of experience w/ KMnO4 in the past, like in the 50's or so. He states that it is useful mostly on epidermal wounds and nothing that goes deeper than the dermis. So, a diabetic foot ulcer most likely would not be a good candidate for using this solution since most are much deeper than the dermis and go into tendon, bone, or at least the subcutaneous tissue... So, I have only seen him use it on a Steven Johnson's syndrome pt. at this time and it worked wonderfully.... Good luck. would love to hear what else you learned and if you have had any experience using it. Thanks

Alternative to povidone iodine

Date: 2000, Oct 26
From: M Wider

I have developed and applied for a patent covering use in wound treatment for an antiseptic that is nonoxidizing, has very broad antimicrobial activity, is made from GRAS substances approved for direct addition to food and has an MIC against MRSA and VRE of 32 to 64 ug/ml. It does not lead to the development of resistant strains after 30 passes at suboptimal concentrations. It is active against bacteria, spore forms, fungi and viruses and antibiotic resistant organisms causing a 5 log reduction in 30 sec at 23o C.
The product is active at a pH of 3.5 to 4.5 and can be applied copiously and repeatedly with no adverse effects due to the total lack of toxicity. Oral ingestion of the product has been evaluated in clinical trials for gastrointestinal uses and there were no adverse side effects reported. It causes no irritation of the epidermis and has been injected intraperitoneally in rats with no evidence of irritation and no hyperemia of the viscera or fluid collection in the abdomen. It is colorless and causes no tissue staining.
I am looking for anyone interested in evaluating the product for wound sterilization either clinically or in animals.
Michael Wider, PhD mwider at home.com

A Totally Nontoxic and Nonirritating Product for Wound Sterilization

Date: 2000, Oct 26
From: Mike Wider

I have developed and applied for a patent covering use in wound treatment for an antiseptic that is nonoxidizing, has very broad antimicrobial activity, is made from GRAS substances approved for direct addition to food and has an MIC against MRSA and VRE of 32 to 64 ug/ml. It does not lead to the development of resistant strains after 30 passes at subopti