Abdominal Wounds

[jthenursepug]

In the area where I work we seem to be having a large amount of clients who have abdominal wounds that range in depth from 4-9cm. The wound openings are approximately 0.40cm to .080cm length and width respectively. I am asking for input into different types of dressings that can be done to these, wounds excluding the wound vac, the particular insurance won't pay for the KCI or Smith and Nephew vac. The biggest hurdle that I have run across are the doctors who want to pack these wounds with either: 1. plain nugauze then cover with dsd or 2. pack with iodoform cover with dsd. I am actually a bit frustrated because with all the new and wonderful products out there I can't seem to get some of these doctors to try anything else. The worst part about this whole thing is that these doctors are from our wound care clinics. We have a client who has been on service for over a year with the same wound on his sacrum. This wound was almost healed and now it is worse then when we first admitted him (3.20cm x 8.80cm x 1.30cm) we are doing a 1/4 strength dakins w/d dressing BID. This doctor said that this is the dressing ordered and this is the dressing that we will be doing, end of story. Now I am certain that in my education we learned that if after two weeks if there hasn't been any change in the wound's status we need to try a different method of treatment, but what do I know. Anyway enough of the rant. If anyone out there has any suggestions I would greatly appreciate it.