gangrene in a very private area.

nola1202 · Aug 10, 2011

not getting any responses, I guess this stuff is not a big deal to WOCN's and WCC's, I'll try the Hospice forum.

TVN2011 · Aug 11, 2011

Has this area become necrotic from pressure? or the patients co morbidity? Is it wet or dry gangrene?

Iodosorb (Smith and Nephew) which is cadexomer iodine would help dry up the area or a simple batadine paint.Also ensure that there is no friction or rubbing from the foley.

The second patient, what is the nature of the wound bed?? maybe a simple foam dressing wrapped around the member may prevent friction.

Hope this helps

alphabetsoup · Aug 11, 2011

Is the scrotal wound due to Forniers gangrene? Cancer? Pressure ulcer? What is the goal of treatment? Comfort only? Drainage control? Odor control? Is it dry gangrene or wet gangrene?

nola1202 · Aug 13, 2011

Is the scrotal wound due to Forniers gangrene? Cancer? Pressure ulcer? What is the goal of treatment? Comfort only? Drainage control? Odor control? Is it dry gangrene or wet gangrene?

thanks for responding it is Forniers Gangrene. The hospital kept him for more debridements. I'm not sure what kind of wound I'll be looking at when he gets to us.

The other wound, is strange. The skin of the member is split from the constant

pressure or traction of the Foley. I guess taking it out isn't a consideration.

The small round (almost a punched out look to it) wound. A gel like dressing

was provided by the hospice nurse to wrap around the member and promote comfort and healing. I checked today and it looks better!

So far as the other gangrene pt, I know comfort care is the goal, but I'm happy the family went with debridement. I've seen some terrible cases of gangrene that just

kept on going, smelling worse and worse, causing pain where the tissue hadn't yet died. I was picturing something like this in my mind. thanks again

jujuseah, RN · Sep 13, 2011

I had a pt who had Fornier's gangrene. It was really bad. But it wasn't a hospice pt.

The wound was very wet, smelly and caused alot of pain to the pain and the gentleman needed to be bed bound because of the pain.

What I remembered doing was using Aquacell AG (blue strip with silver elements) it helped to absorb and eliminate odour and slough with the silver. It was a daily dressing even though it should be changed every two days but the wound was rather bad. I flushed the wound using syringes with normal saline (it is actally the best cleaning agent as according to literatures even with infection wound or unless stated by Drs). and dab it dry. Apply the Aquacell AG and cover it with a primary dressing (PRETTY HARD TO DO THAT but you gotta try)

We left the area open, meaning no pants or diapers. We created a tent using drawsheets tying one end to the right cot side and to the left cot side to protect privacy. And have a fan to blow around him (In Singapore it is very hot)

If he needs to crap, of course we gave him either diapers or bed pan.

I

itthybitthythpider · Sep 13, 2011

Penile Erosion? We have a resident with that developing. We put steristrips around the member where it was splitting, and so it seems to work. Do you know what the name of the gel is that you put on? If that works better, we may try it!

nola1202 · Sep 14, 2011

I'm not sure anymore, something like hydrogel, it was a thin flexible sheet, and felt rubbery and soft kind of like a very thin gel insert for a shoe. I could be cut to the wound shape but needed some sort of dressing to stay in place, we used very fine strips of transparent dressing over that. (just made sure area, (shaft of member was clean and very dry before attempting, took 2 people to get it done easily. This was a clean, scant to none drainage wound. The wound was improving then he pulled out his foley twice more with new trauma to the site.

The second time the MD said leave it out and see how he does. He's up in his W/C and just as mean and nasty as before, but without the foley it seems to be healing with just wound gel/AG with diaper change.