Help! Stalled wound...

[JulesRN10]

I have a pt who is a relatively healthy paraplegic, about 55 yrs old. He has a non-healing/ stalled wound on the left buttock since October...had cyst removed late October. Wound vac placed with good, although slow, results until March. Wound vac removed, went to wet to dry dressings TID. Stalled again. Went to Dakin's Solution BID. Stalled. Added honey dressings BID. Stalled. Alternate Dakins/Honey dressings, continue BID changes. Dr is considering a muscle flap. My concern is that if we do surgery, with the slow healing we have now, if we have surgery, we'll have a larger wound that is not healing. There is no slough, no s sx of infection. MRI completed, shows bone is free from harm. I am at a loss...anyone know of dressings, additives, something to do to help get this wound headed in the right direction? I've suggested hyperbaric chamber, pt has no way of getting to the closest available for the length of time needed for successful treatment. Help!

[samasiaskipper]

I have a pt who is a relatively healthy paraplegic, about 55 yrs old. He has a non-healing/ stalled wound on the left buttock since October...had cyst removed late October. Wound vac placed with good, although slow, results until March. Wound vac removed, went to wet to dry dressings TID. Stalled again. Went to Dakin's Solution BID. Stalled. Added honey dressings BID. Stalled. Alternate Dakins/Honey dressings, continue BID changes. Dr is considering a muscle flap. My concern is that if we do surgery, with the slow healing we have now, if we have surgery, we'll have a larger wound that is not healing. There is no slough, no s sx of infection. MRI completed, shows bone is free from harm. I am at a loss...anyone know of dressings, additives, something to do to help get this wound headed in the right direction? I've suggested hyperbaric chamber, pt has no way of getting to the closest available for the length of time needed for successful treatment. Help!

Hello have you tried silversorb gel? Vasche wash, and you mentioned honey, was this the medihoney or an organic honey? There are organic honeys with bees from Tea Tree Oil blossoms that work well too. Also the mix of honey and sugar works well too.

[followyourbliss]

Hi,

Has he been offloading? Without the issue of that being addressed the wound will likely stall or break down.

Is he on any immunosuppressants, diabetic, renal issues etc? Any underlying eltiology with systemic issues is paramount.

Being on a high protein diet with supplements to replace the high protein loss from wound fluid; the body has to compensate for fluid loss. Is the patient catheterized?

Chronic Wounds that are heavily colonized with biofilms often do not show the classic signs of infection and often cycle through inflammatory and stalled states until something can facilitate a break over to healing and proliferative.

There is weak evidence and research surrounding honey based dressings as well as using wet to dry dressings which are widely regarded as poor practice, Best Practice protocols and current wound Practice support and endorse Moist Wound Healing.

I encourage you to check out websites such as Wounds International and other Wound care sites that have comprehensive information; also find a Wound Care clinic in your area and get a Dr's order for him to go for an assessment.

Do some reading on anti-microbials such as Iodasorb, Inadine, silver products etc. Going on the websites for wound care products such as Smith and Nephew, Monolyke etc is an excellent place to get informed on what to use for what.

How deep is this wound- does it probe to bone or have sinus or undermining?

Keep us informed! Great to have some chatter on here!

[tyvin, BSN, RN]

Why was the wound vac discontinued?