Need help from experts

[Kir]

I am caring for a morbidly obese (500 lb +) gal who has two open areas on her gluteal fold/peri/so hard to really tell area. They appear to be shear injuries as they re-open when she transfers from the bed to the w/c. I think they may heal if we can just protect them from reinjury. What do you suggest as far as a dressing? Everything I have tried thus far rolls up when she transfers. I am worried about further injury from the dressing itself. She also has extreme lymphedema in her LE and scratches and picks until she bleeds. I am doing home visits with her PCP and we are at a loss as what to do now. We have convinced her that her diet of fig newtons, Hawaiian Punch and goldfish do nothing for her wound healing and have gotten her to at least start taking a MVI. Thanks so much for all of your help.

[cschuess]

personally, i would use non-sting skin prep and completely cover the areas that keep opening. i would follow this with a little barrier cream after the skin prep dries. this will help to protect these areas...have pt re-assess for transfers. there is no way to keep a dressing on those areas and to try is only compromising the skin more by having dressings roll off the skin.

try it...it's worked for me countless times. we also do this for superficial stage 2's and they heal in no time.