fungating facial wound

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    I have a pt with a large, deep fungating wound which basically encompasses the entire right side of her face (eye swollen shut for months now). There is an area of tunneling which extends from beside her nose, probably into her sinus cavity, and draining into her oral cavity. Presently the trmt is silvidene impregnated guaze packing/adaptic dressing. Of course, presently we are just trying to maintain comfort, as its a nonhealing wound. Any better ideas for dressing material? And, the pt has severe pain anytime the dressing is changed .... even with morphine prior. I remember from a wound clinic, there being an aerosol spray you could spray to the wound bed to numb the area when changing the drag or debriding the wound bed. Anybody know what that spray is ... or another which would do the same job? Thanks in advance....
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  3. 15 Comments so far...

  4. 0
    its something like the numbing agent used in the perianal area after an episiotomy.
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    Our pharmacy compounds a lidocaine/ acetaminophen /ketamine spray which really seems to help for many things, the main one being wounds.
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    are you thinking of Dermaplast?
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    I don't think its dermaplast.....this wound is deep with several areas if bone exposed. Stage IV
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    Hi I saw your post.... I work in LTACHs and have seen several very challanging cranial patients get very good results with an autologous biologic. I am not sure how it could be used in regard to palliative care but I can send a study if you like... Good Luck...
    Last edit by charles501 on Dec 19, '12 : Reason: spelling errors
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    Yes please send to me....because I'm not familiar with it. Thanks so much!
  10. 0
    We often put lidocaine on the painful wound margins...
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    Could you use a topical opioid? I have used these in the past with very good results.
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    I did consider a topical opioid.....however, my patient is a resident of an ALF, so keeping up with a gel or spray opioid would be difficult (narcotic count). Of course, they wouldn't be able to use an injectable topically. Currently, I go daily and change dressing. Its horrible. The tunneling has basically just opened into a hole beside her nose. There's educate draining from her nose and mouth almost constantly. ... so sad. I'm using regenecare 2% lidocaine and flagyl gel (mixed) impregnated guaze to pack, covered with adaptic and foam drsg. My newest problem is the packing is sticking to good tissue...making it a tedious task to remove...even with NS. IMits very painful too. I ordered hurricane spray to use when removing old packing but I'm scared to use thinking it wk born and cause more pain. The packing isn't drying out...don't know why it's sticking so bad....any ideas?


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