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Discussion

Wound Advice

Need a bit of help.

I have been looking after a wound on a foot for about 4 months. The wound is about 12 months old. It was a pressure sore. The patient is in a wheel chair, has MS and possibly diabetes. She is a large lady. She is in a wheel chair for about 12 hours per day, with legs down on the foot plates.

The wound is not really getting better. When I first started looking after it. It was being dressed twice per week with a product called Iodasorb, jelonet pad and crepe bandage. I'm in australia so don't know if these products are familiar to most. The wound can be odourous and had a fair bit of discharge.

About 2 weeks ago I decided to change the dressing to kaltostat (alginate). The odour has improved, and the discharge has improved. Does anyone have any suggestions for me. I am not a wound specialist by any means. But I have inherrited this patient and I would love to see the wound heal.

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    Hi,,,

    Need to get rid of the patient's edema using a three or four layer wrap.

    For the wound, an enzymatic debrider like Santyl, thick barrier cream to

    periwound, cover with hydrocolloid so that you can loosen the slough and

    clean it out. Once you have granulated tissue, change the hydrocolloid to an

    alignate. If you don't get rid of the edema and the slough, the wound will not heal.

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    I'd also start a back to bed program and have the resident placed in bed after meals with heels elevated to help the edema. Have you checked labs recently for nutrition? How about supplements?

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    First, does she have to be up in a wheelchair for 12 hours per day? How many times is she returned to bed? Elevating those legs would be a big help.

    If she is diabetic, is her blood sugar under control? When was her last HgbA1C?Also, vascular studies might be in order. Diabetics may have calcified vasculature, so use caution with any type of compression wraps. When was the wound last cultured? How is the patient's nutritional status?

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