Wound Callus (?) on nonhealing wound

[Lynx25, LPN]

I have a patient with a stage 4 ulcer, that's not making any progress. It's about the size of the top of a Gatoraide bottle, were someone to punch a hole in his thigh with one.

There's some pale pink granulation at the base, but the periwound has a thick, soft white layer that extends down the sides of the wound. The layer extends above the level of the healthy skin.

The previous wound nurse was charting this as eschar, but I was under the impression eschar was a darker color. I would be hesitant to chart it as slough, as it doesn't really resemble it. It's almost like a thick moist callus. (Moist due to moist wound dsgs)

I'm of the opinion he could use a sharp debridement and a vac or graph, but it's not something we do here, and it's like pulling teeth to get a wound clinic appointment.

Could someone with more experience help me out a bit?

[jacks4798]

Could it be hypergranulation?

[mommy.19, MSN, RN, APRN]

Is the wound highly draining? It sounds like you lay be describing laceration, which is tissue damage due to excessive moisture to the periwound. What is the wound being treated with currently? It definitely sounds like you need a wound specialists nurse in there at a minimum.

[deemalt, BSN, RN]

I think you mean maceration, not laceration - which it may be. It could also be epibole if the wound edges are rolled under which would require sharp debridement or silver nitrate.

[mommy.19, MSN, RN, APRN]

I think you mean maceration not laceration - which it may be. It could also be epibole if the wound edges are rolled under which would require sharp debridement or silver nitrate.[/quote']

Yes, my auto correct went mad. Thank you for pointing that out!