Protecting Skin Grafts

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Specializes in LTC.

I tried to ask this on another site- was met by a barrage of "OMG CAN'T DIAGNOSE ON THE INTERNETS!"

Let's see if this does any better.

I have a very obese patient, with split thickness grafts to his entire abdomen. He has a small fistula to one area, that occasionally leaks stool. Someone decided to slap a colostomy bag over the fistula, and now we have a large area of graft missing, because of the fragility of the entire area.

I've also noted that he's acquired several smaller areas of shearing from what I assume is improper handling during care.

The ostomy bag is no more, and I've covered the whole thing with Xeroform and ABD pads after a call to his surgeon, but does anyone have a particular product that you think would be good to stabilize and protect the area? Maybe something to put over the Xeroform and gauze? I really don't have anything large enough to protect the whole area- it's a bit of a loose patchwork.

It's not currently infected. Total graft area, I'd say 2'x1.5' roughly.

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Specializes in Acute Care, Rehab, Palliative.

You should get a wound care order, either from the MD or a wound care specialist.It would be difficult to recommend a dresing without seeing the area.

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Specializes in LTC.

Oh I called the surgeon- he told me to dc the bag and apply xeroform. I just don't have any idea how to secure the whole thing to avoid further trauma. I can't get it through anyone's head that he has to be handled with caution. It's a 15:1 aide ratio- and I think they are going in there doing care by themselves. The treatment isn't my problem- it's protection.

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Specializes in Acute Care, Rehab, Palliative.

Did you ask your wound care specialist?

Where I work the MDs or the wound care nurse write orders for dressings including how to secure it.

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perhaps putting duoderm type stuff around the area, then use Montgomery straps to secure the dressings.. Old fashioned, I know, but then you are not ripping skin off every time you change the dressing, and those things used to hold the dressing on very well.. the Montgomery straps stay on.. just untie the ties to redo the dressings..

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Specializes in LTC.
perhaps putting duoderm type stuff around the area, then use Montgomery straps to secure the dressings.. Old fashioned, I know, but then you are not ripping skin off every time you change the dressing, and those things used to hold the dressing on very well.. the Montgomery straps stay on.. just untie the ties to redo the dressings..

Hey, that might work! I've never seen them used before, but I can get them through Medline. Thanks for the assist.

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Are you putting a dry dsg over the xeroform? What about securing with a bunch of large tegaderms?

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