Removing Triad from wound

[Turtle in scrubs]

I have a pt with a pretty bad skin tear. I was able to place flap over approx 70% of wound although its long term viability is questionable. I had smothered the whole wound with Coloplast triad. 1 week later the flap is adhered but looking rather dark. But she bruises easily and is on anticoagulants. I cleaned the wound gently as to not mess up the flap. Much of the triad stayed in the wound. For those who have worked much with triad, how do you clean the wound without causing trauma to the wound bed? If the wound bed were necrotic I wouldn't mind getting a bit rough, but I don't want to disrupt the flap, or any granulation tissue. Is it alright to leave the triad that remains after gentle cleaning, and just apply new layer? Any thoughts?

[FallingInPlace, ADN, BSN, RN]

I have never used Triad on a skin tear, but think it would be a good choice. As far as removing it, have you tried mineral oil? It should make removing the Triad much less traumatic, although leaving a thin layer after cleansing should cause no problems to the healing process.

[Turtle in scrubs]

Thanks. I haven't tried mineral oil, but I haven't really tried very hard to get it off either. I was more comfortable leaving a thin layer in the wound after cleansing than I was risking causing any more trauma to the wound. I think next I will have her shower with the dressing off, just letting soapy water run over it.

[rkitty198, BSN, RN]

you just moisten gauze with NS and let sit over top and then gently wipe off. Did you put a petroleum non adherent gauze over triad and cover so it didn't dry out? It might have just gotten too dry. The wound bed is too dry for that product. Needs a moister environment for better viability. Coloplast recommends you use a secondary dressing over triad, not by itself, just in case. Good thought to use it, didn't think about that for a skin tear. Makes sense.

[Turtle in scrubs]

Yes, using foam dressing for cover dressing. Her skin is way too fragile to be left uncovered while it heals. And it was pretty exudative in the beginning. I've had her shower twice now with her dressing off, about a week between each dressing change, and it is going well. The flap I placed back was approx 70% viable and the other 30% went necrotic and is clearing away with cleaning. I didn't have much hope with the flap being viable in the beginning because it was so bruised, but I thought it was worth trying to save, and turns out it was a good choice. Interestingly, after her shower the triad was still on. It is a thin, scattered, layer, but still there. Of course she was instructed not to scrub it, only gently let warm soapy water flow over and sort of rub it in the direction the flap was going. So, I've stayed the course with the Triad, having her reapply another layer and cover with mepilex. I've not used Triad much, and never with a skin tear before, but so far I'm happy with it. I wanted something that I could dress and leave undisturbed for several days between dressing changes. The only drawback is wanting to completely clean the Triad off and not being able to. It just made it a bit tricky to assess the wound.

[rkitty198, BSN, RN]

Yes, using foam dressing for cover dressing. Her skin is way too fragile to be left uncovered while it heals. And it was pretty exudative in the beginning. I've had her shower twice now with her dressing off, about a week between each dressing change, and it is going well. The flap I placed back was approx 70% viable and the other 30% went necrotic and is clearing away with cleaning. I didn't have much hope with the flap being viable in the beginning because it was so bruised, but I thought it was worth trying to save, and turns out it was a good choice. Interestingly, after her shower the triad was still on. It is a thin, scattered, layer, but still there. Of course she was instructed not to scrub it, only gently let warm soapy water flow over and sort of rub it in the direction the flap was going. So, I've stayed the course with the Triad, having her reapply another layer and cover with mepilex. I've not used Triad much, and never with a skin tear before, but so far I'm happy with it. I wanted something that I could dress and leave undisturbed for several days between dressing changes. The only drawback is wanting to completely clean the Triad off and not being able to. It just made it a bit tricky to assess the wound.

Interesting, very cool! Have you thought to try a layer of adaptic or hydrogel to keep it moist under the mepilex? Sounds like you are getting good wound stability. I would think that if something bad were to happen to the flap it would have come off already? Or maybe it is acting as a barrier for new growth underneath? I would love to hear how progress is going on the tear! We have a large elderly population at our hospital and see many skin tears. I would love some new ideas to bring to the team!

[Mistyrose123]

from what I understand triad is to be applied, gently cleaned and what is left on the skin remains and apply new layer over it. Have not used this a lot. polymem works well for skin tears, apply, check daily for break through drainage and change every 7 days, there are silicone contact layers also that work well,

[Wound Nurse - Sales]

Triad works well for skin tears. Here is another trick I have learned that also works well with elderly skin.

Cleanse wound as normal

Re-approximate edges as well as possible, if skin is rolled up soak w/ NSaline use qtip to unroll

Apply collagen powder ( I LOVE Stimulen powder) to wound bed

Apply Skin prep to INTACT skin only

Apply steri-strips (leave in place until they fall off)

Protective padding as needed (silicone foam for drainage or contact layer for non draining) wrap to secure

Change foam or contact Q 3-7 days ( per mfg recommendations) depending on infection control protocols, cover may be lifted to visualize wound and re-wrapped

Thoughts ??

[carrie276]

To remove the hardened Triad, try soaking it with saline to soften it and then use adhesive remover