Hello, looking for some suggestions for an elderly resident with advanced ischemic disease to lower limbs. One leg has dry eschar from toes to half way up the lower leg. Not a surgical candidate. Wound care plan in place primarily betadine to keep the affected tissue dry. However there is discharge in areas further up the limb near the healthy tissue. No signs of infection thus far. The issue the team is struggling with is keeping the eschar from sticking to the bootie being used to reduce pressure (for comfort) on the affected limb. No suggestions from OT. Need an option that will be non-adherent and non-occlusive. I suggested perhaps a covering for the bootie to allow the tissue to remain open to air, but don't know of any besides trying something DIY.
Obviously he/she has severe arterial disease that will not resolve and is an infection waiting to happen-- especially if the gangrene is wet. From your post it sounds the gangrene is pretty extensive. Any type of non-occlusive dsg (tegaderm) will trap too much moisture and create a soupy mess. I understand your logic in not wanting to use an occlusive dsg, but just plain dry gauze maybe the only way to go-- and use saline to moisten it before removal. I would also make sure the nursing staff is removing the dsg daily to inspect the gangrene to make sure it is not deteriorating. At this point wound care is palliative and the goal is to remain infection-free since the patient is not a surgical candidate.
I suggest petroleum gauze or adaptic dressing and secondary dressing of conforming gauze roll.
Can you get nylon boots so they don't stick to her skin?
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