gangrene in a very private area.
- 0Aug 9, '11 by nola1202Need help, this one kinda scares me. There is a pt with gangrene to the um...scrotum.
I was wondering what would be a good approach to careing for this. I'm leaning toward
the old fashioned but effective Venitan Voilet, but am open to new products or techniques.
thanks for your help in advance.
Also one that has a round hole in the skin of the penis after he has been pulling at his foley.
both of these people are Hospice oriented patients who do not want much more than comfort care.
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- 1Aug 11, '11 by TVN2011Has this area become necrotic from pressure? or the patients co morbidity? Is it wet or dry gangrene?
Iodosorb (Smith and Nephew) which is cadexomer iodine would help dry up the area or a simple batadine paint.Also ensure that there is no friction or rubbing from the foley.
The second patient, what is the nature of the wound bed?? maybe a simple foam dressing wrapped around the penis may prevent friction.
Hope this helps
- 0Aug 12, '11 by nola1202Quote from alphabetsoupthanks for responding it is Forniers Gangrene. The hospital kept him for more debridements. I'm not sure what kind of wound I'll be looking at when he gets to us.Is the scrotal wound due to Forniers gangrene? Cancer? Pressure ulcer? What is the goal of treatment? Comfort only? Drainage control? Odor control? Is it dry gangrene or wet gangrene?
The other wound, is strange. The skin of the penis is split from the constant
pressure or traction of the Foley. I guess taking it out isn't a consideration.
The small round (almost a punched out look to it) wound. A gel like dressing
was provided by the hospice nurse to wrap around the penis and promote comfort and healing. I checked today and it looks better!
So far as the other gangrene pt, I know comfort care is the goal, but I'm happy the family went with debridement. I've seen some terrible cases of gangrene that just
kept on going, smelling worse and worse, causing pain where the tissue hadn't yet died. I was picturing something like this in my mind. thanks again
- 1Sep 12, '11 by jujuseahI had a pt who had Fornier's gangrene. It was really bad. But it wasn't a hospice pt.
The wound was very wet, smelly and caused alot of pain to the pain and the gentleman needed to be bed bound because of the pain.
What I remembered doing was using Aquacell AG (blue strip with silver elements) it helped to absorb and eliminate odour and slough with the silver. It was a daily dressing even though it should be changed every two days but the wound was rather bad. I flushed the wound using syringes with normal saline (it is actally the best cleaning agent as according to literatures even with infection wound or unless stated by Drs). and dab it dry. Apply the Aquacell AG and cover it with a primary dressing (PRETTY HARD TO DO THAT but you gotta try)
We left the area open, meaning no pants or diapers. We created a tent using drawsheets tying one end to the right cot side and to the left cot side to protect privacy. And have a fan to blow around him (In Singapore it is very hot)
If he needs to crap, of course we gave him either diapers or bed pan.
- 0Sep 13, '11 by nola1202I'm not sure anymore, something like hydrogel, it was a thin flexible sheet, and felt rubbery and soft kind of like a very thin gel insert for a shoe. I could be cut to the wound shape but needed some sort of dressing to stay in place, we used very fine strips of transparent dressing over that. (just made sure area, (shaft of penis was clean and very dry before attempting, took 2 people to get it done easily. This was a clean, scant to none drainage wound. The wound was improving then he pulled out his foley twice more with new trauma to the site.
The second time the MD said leave it out and see how he does. He's up in his W/C and just as mean and nasty as before, but without the foley it seems to be healing with just wound gel/AG with diaper change.