white skin around wound

[bebop1]

what do you normally do for the white skin around a 'healthy wound'. I have went on call for a different office over the weekend, they are not good for their wound care. this poor patient has been getting daily wound care on this wound forever. wet/dry. I was the one that finally got the wound vac off him two months ago because I told them it was not working. we would change the wound vac every day. he was not but getting maybe 12 hours of 'good suction' everyday...so it was not doing good. now when I say him today, the wound is bigger, and all they are doing is wet/dry with normal saline. they use only a 4x4 to cover it. the whole surrounding skin is white. when I arrived the dressing was soaked. he is a younger guy, he is alone, he is WC bound. if he was bedbound, had people to help him ya the woundvac would maybe work....but it won't. I have used on another patient Biafine before. I had never heard of it before but it was ordered per a wound care hospital then a barrier cream around the wound then an exudry or abd pad. Would this work on this patient? or any other suggestions?

This wound is right by the scrotum, it is 4cmx3.5cmx3cm. And like I have said he lives alone, and needs to transfer from bed/wc/showerchair etc.

any suggestions would be wonderful. and am I correct in saying when the skin right around the wound is white that is from maceration? or too much drainage? or what is that from?

Thanks!!!!!!!

[jnette, ASN, EMT-I]

Wow... poor guy has definately been getting poor wound care.

You are correct in assuming maceration. Evidently, the WTDs have been improperly done. The "wet" should never be "sopping wet", and ONLY the actual wound itself should have the "wet" gauze placed in it. No area outside of the wound bed at ALL should come in contact with th wet gauze, and SEVERAL 4x4s should be placed on top to absorb the moist gauze underneath. If the moist "wet" part of the dsg. comes into contact with teh thealthy, intact skin around the wound bed, it WILL turn "white" and begin to break down !

They should know better!

[Mabel 29]

I have seen Silvasorb packing used with positive outcome on wound similar to this. The antimicrobial properties keeps the bioburden down and promotes healing. The dressing should be changed daily.

[jnette, ASN, EMT-I]

I have seen Silvasorb packing used with positive outcome on wound similar to this. The antimicrobial properties keeps the bioburden down and promotes healing. The dressing should be changed daily.

We use a good bit of Silvasorb as well.. with good outcomes. :)

[annaedRN, RN]

I've used Mesalt on some really nasty draining nonhealing wounds. It really cleaned them up...but it is daily as well.

[gaymac]

My husband has stasis ulcer disease, right now the vascular surgeon has

me putting DuoDerm CGF on the wound ever thress days. We have tried many things NS wet to dry, Domboro wet to dry, silvadene, this has been going on for 4 years. Our primary Dr. promised once he got on medicare she would send him for hyperbaric treatments, but has not done so. These

ulcers are very painful, and I am not real happy with the care he is getting, I am a retired nurse, use sterile technique. But this never gets better you heal one and another comes after months of healing the one. Any suggestions would be appreciated. He does not have diabetes, and his circulation in this leg is sufficient. thanks gmcgann38

[annaedRN, RN]

Can't really give you any specific advice. Stasis ulcers can be SO painful and hard to heal. I did have success using Aquacel AG on one patient - also using compression wraps (after ABI was checked) played into the healing process. It seemed once the bioburden was alleviated and some of the edema managed that her ulcers started to shrink before my eyes ( they were 18cm x 13cm bilaterally). So, check with your MD about something to treat the "bugs" and the edema...sounds like it's worth a shot.

[gaymac]

Thanks he's wearing compression hose 30-40 that were measured for him,he complains of them hurting his toe, they did dopplers for his circulation. The wound has gotten worse since these txs has started, the wound was very dry. now its reddish looking with the white what people used to call proud skin looking flesh all in and around the wound, moist and the wound has incresed in size, When a patient does not feel a Dr. is helping them its difficult to get them to go back, Thanks for your resonse am writing suggestions down.

I have healed many stasis and diabetic ulcers with just wet to dry NS or Dromsboro, but this also didn't work:nurse:

[cookie102]

i have had good luck with Acticoat absorbant,,,first had to change it daily due to increase drainage, now only 1x wk,,,,for the "macerated" skin around the wound,,i use a real cheap antipersperent-just rub it around the perimeter of the wound and helps with "drying" that area.

[gaymac]

This macerated skin is on the wound its self, I wonder if changing the

DuoDerm dressing daily might help, my husband prespires at the least

movement I mean really prespires and I am concerned the wound is getting

too wet inside, the reason its not healing. any ideas ? he is still refusing to go

back to the Dr even when I tell him there are other treatments or he could

lose his leg. He is starting to wear his stockings now ,I got some of that foam

roll stuff for his large toe but am going to have to start checking it 3-4 times

a day because he lets it get creases in it and looks like he's had a rubber band

on the leg. Thanks for any ideas.

[lsyorke, RN]

we would change the wound vac every day. he was not but getting maybe 12 hours of 'good suction' everyday

and all they are doing is wet/dry with normal saline. they use only a 4x4 to cover it. the whole surrounding skin is white. when I arrived the dressing was soaked.

Wow...that's not good wound care at all. Wound vacs should not be changed everyday, way to much trauma to the wound. Why was he only getting 12 hours of suction? And wet to dry is proven to make wounds worse, not better. Offloading the site of the wound is going to be critical. Pressure relieving pads and limited "up" time will help.

There are so many products that will absorb drainage and still keep the wound bed moist....a wound center is probably a good idea for this patient.

[pressurefree]

First off is the wound wet or dry? If wet then you want an absorbent dressing like silvasorb. Then you can add a unna boot. Then after that you can apply ace wraps that will help with the venous return. I have been working as a wound care nurse for the past year and the addage of compresion dressings have helped a great deal.