I am still experiencing problems with this poor woman. PLEASE BEAR WITH ME, this is long, but I have a story.....I am so frustrated. She was actually doing quite well for a while. We stopped any kind of dressing such as aquacel, lyofoam, etc. We started using only the mesh that comes with the profore, then doing the wraps. Previously, we'd just been tossing it, because "oh we never use that". It's like no one even really knew what it was. I'd looked up on the profores website and read a bit and suggested we try it and was totally worried it would backfire.....but she comes in for the next dressing change with dry legs! This did well for a long, long time.
Then she started having problems with her left leg bumping against the side of her wheelchair, and this eventually happened after a shower while her wraps were off. That area became infected, so we went to the aquacel ag again...it made her legs sooooo much worse! Then we tried just lyofoam. Even worse! She began having large macerated areas again. So finally I said we need to go back to the mesh and profore alone, which we did, and again the legs dried out. We then discovered that the woman seemed to have very sensitive skin, and using any kind of lotion on the dry skin ended up with weepy, macerated areas, and wound cleaner made her skin slough off, and soap was a problem too! We went to just plain water in the shower for her legs, and saline on the non shower days. She dried up again.
Then.....the mesh started sticking to the dry areas, as if her skin was a little moist, dried up, then adhered and were hard to take off. No matter how careful we were, even just spraying the mesh off with water, the areas became irritated. So boom, we put xeroform on those areas, as well as the mesh. Soon we were using large amounts of xeroform. Then she was unable to come to the clinic on a Monday and dressings were not changed for 5 days...when we took them off her legs were terribly macerated..again! So back to the aquacel ag under the mesh, then the profores. Legs got worse. So again I talk to our NP and say please, lets try just the mesh again, it has dried her up before.....so we do, and her legs are still macerated. It's awful. No matter how much you try to get her legs dry before applying the mesh and wraps, it's impossible...she drips fluid onto the barrier pad we put on the floor! I am at my wits end. For whatever reason, she has become my "special project". Another co-worker and I have always taken extra interest in her, but she was let go with 'downsizing' and while my other co-workers are caring and competent, they certainly don't worry about her wound care on their days off, lol!
Please, if anyone has any suggestions, I would love to know!