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Discussion

Wound Care question

I need some help! We just completed a wound care assignment a couple weeks ago and now I find myself in a weird (undesirable) place. Our assignment focused on a patient with a stage III pressure ulcer. We were required to say what we would expect to see, their score on a brayden scale, dressing type and factors that would affect the overall picture. We didn't look beyond the dressing types into the healing process (I would have but I was told to cut my assignment short).

Now here is my current scenario:

My husband is a (non-compliant) diabetic and has had issues with furuncles in the past - most of the time resolving on their own - one of them had to be lanced. He had a new one start a couple weeks ago but pride and a medical emergency with our son got in the way of him having it looked at early on despite my pleas to do so. He waited until it was seriously infected before he sought out any medical attention for it (other than putting Fucidin ointment on it)!! Several days and several dressing changes later, he had to go see a surgeon earlier this week and go to the OR to have the furuncle turned abscess surgically treated.

He had his initial dressing change done by the surgeon yesterday and now I'm doing them home. These are the surgeon's dressing orders: I am to take the dressing off, packing out (Iodoform) and he is to get into the shower for me to lightly irrigate the wound. After he soaks it, he has the Iodoform strip packed in place again, I cover it with a sterile 3x3 gauze pad, put an abdominal pad over it and secure it with Hypafix tape.

Now my question:

How do I know that what I'm seeing is healing or not healing? This is a rather deep wound (I don't need forceps or anything to put the packing in place... the surgeon made an incision about 1 1/2 inches long and it is probably as deep as your first knuckle on your index finger... sorry for being so descriptive). How do I know that what I'm seeing is as it should be? The idea is to keep the wound open and to allow it to heal by second (or possibly third) intention.

Thank you in advance for your help in satisfying my curiousity as a refresher student but also as a wife/caregiver.

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    I would ask a mod to move your thread to general nursing. You'd be likely to get more (and better) responses there. This "student assistance" board gets a fraction of the traffic it does.

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    From what I remember about wound healing, as long as there is dark red granulation and obvious signs of perfusion it should be on the right track. Deep tissue injury takes months to heal from the bottom up and fill in with epithelial tissue.

    You'll know if it's not healing if by 3 weeks or so it's still lightly colored without much visual change. Keep a close eye on on signs for infection like purulent drainage.

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    Several trips back and forth to see the surgeon for follow up, it's all coming together for me.

    The surgeon was going to take my husband back into the OR on Friday to debride the necrotic and infected tissue that was still present. I asked him if we could try packing it with Iodosorb and Intra-site gel for the weekend (he wasn't overly familiar with those treatments) but he reluctantly agreed to try it "I'll try anything at this point".

    When we returned this morning for the follow up appointment, we went up half expecting my husband would be going in for more surgery to clean up the necrotic tissue. We took the dressing off and the surgeon was amazed at how well it had worked on the weekend "I admit, I didn't think it was going to work"!! He was able to debride the necrotic tissue without requiring the OR to do it and so we will continue to fill/pack it as I have been for the weekend and go back next Monday for another assessment. There is lots of new tissue growth now that wasn't present even on Friday.

    When I completed my assignment a couple weeks ago, I covered what you would see with a stage III ulcer and the dressings you would use to promote healing but I didn't look beyond at the actual healing process (because I was told to cut it short). While this is an undesirable position for me to be in, it's neat at the same time to see my assignment coming to life.

    Thank you for answering my question... much appreciated

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