What type of dressing to use for small leg wound?

[AniSo]

I have a patient with a small leg wound/ulcer r/t his dx bullous pemphigoid (a rare skin condition causing blisters). He was sent home with orders to clean with NS and apply a silicone foam non-bordered dressing (it was adhesive) and to change Q3 days. I don't think the wound is healing. The skin around wound is starting to get macerated and starting to peel superficially around the edges. What are other dressing could I use, definitely something nonadhesive. I was thinking maybe non-adhesive telfa and wrap with kerlix or cohesive wrap? How often do you change a telfa dressing? or maybe i could just use a non-adherent optifoam? The amount of drainage is minimal serosanguineous.

I am not a wound specialist and still am learning about the types of dressings available, so any help or suggestions will help.

[Candogal]

Since you said the wound is getting macerated avoid Telfa that would cause even more damage then the silicone foam dressing. First I would go back to whoever gave the orders and show them the wound for re-assessment. It probably just needs to be changed more frequently like every day or every other day. Other options to maybe consider are using a non-adhering dressing like mepitel or adaptic to allow the drainage to flow through onto the second layer and prevent any dressings sticking to the wound- if the dressings have a tendency to stick to the wounds and then plain gauze, aqaucel, drawtex, or even an abd pad.

[jordan7526]

More information is needed to give better advice. Does this patient have venus insufficiency or arterial (if known), does this patient have Edema a the wound site? Are there more than one wound? I have seen wounds similar to what your explaining (some times there are 7-10 wounds on a leg.)

I would use one of these 3 things and change dressing 3x per week.

Cleanse with wound cleanser or NS, apply (1) aquacel ag, (2) mepilex AG, (3) adaptic cover with non stick/ telfa, 4x4, rolled gauze, tape.

[woundnurse4u]

It wouldn't be cost effective to change that type of dressing (silicone foam, non-bordered) more frequently. Have you considered using a skin barrier film to the periwound skin? One thing that isn't making sense is that a minimally exudative wound typically doesn't have a lot of periwound maceration going on. When we talk about maceration, I think of that tissue as being "white" in color and soft.