Chronic non healing wound

[Pdrn72]

I've been treating a chronic, coccyx wound approx 2.8x2.4x2.0cm of a completely immobile patient. I've been using a wound vac and although it started at approx 9x9x7.8cm, progress has been stagnant. My settings are 125continuous and I have tried varied. I'm at a loss what I can do to get this area clised. It's been almost a year!

[KatieMI, BSN, MSN, RN]

Do you have a physician to consult with, preferably one specializing in plastics/wound surgery?

Did the patient have bone scan done to exclude pelvic osteomyelitis? Was any debridement done?

What is the general condition of the patient (circulation, oxygenation, nutrition status)? Any chronic conditions, diabetes, anemia, are they under good control? When the last nutrition scan (iron studies, prealbumine, vit. D3, calcium, lipid profile, serum copper, serum zinc (the last two only if patient is on TPN, even partially) was done?

And... last but actually the most important... is the turning schedule followed like the Lord's commandments?

Where I work, such wounds are common things and they can be brought under control, if not healed totally, in like 85% of cases (not 100%), but it takes a lot of work from everyone, including wound care nurse and our amazing CENAs. The patient needs to be "medically optimized", osteomyelitis either excluded or treated and wounds pretty often got debrided repeatedly.

[Mom2boysRN]

Yes, infection can make a wound stop healing so maybe do a culture.

With wound vacs sometimes it's beneficial to do a "holiday" from them, 3-4 days off the vac and doing a wet to dry bid. Then try the vac again sometimes it will start healing again.

My last thought is doing an albumin and prealbumin level to see if the patient has adequate levels to heal a wound.