need suggestions for hypergranulated toe wound

[acompassionatecare]

i have a homecare patient with a hypergranulated, calloused wound to the end of his toe. I have provided wound care to this type of wound in the past with silver nitrate and had great results. it has scant to small amount of serous drainage. the wound has been present 7-8 months with no change. he is unable to go in to the wound care center. his PCP is unfamiliar with wound care and has not ordered treatment beyond TAO. Would it be better to suggest order for silver nitrate or something such as granulex?

[annaedRN, RN]

even though the wound has little drainage, TAO is probably keeping it too moist. I would silver nitrate it then place foam or something absorbent and wrap it - sometimes the less the better.

[mommy.19, MSN, RN, APRN]

Hypergranulation can come from a couple things, including infection, too many proteases in the wound bed(pretty common with chronic wounds), etc. Silver nitrate will temporarily take care of the problem but not correct the cause. Also, the callous surrounding the wound is likely not helping the epithelial tissue migrate across the wound bed. Can he see a podiatrist and have the callous debrided if he can't make it to a wound center? I would use a product with a protease inhibitor if you can afford to (a collagen like promogran or prisma). Can the doc give you an order to do a tissue culture and send it to lab to see if it's infected? Not sure about HH rules, etc. Just curious, is this a diabetic foot ulcer or an ischemic ulcer?