Painful drressing changes

I am the wound nurse in a nursing /rehab facility and take care of an elderly man who has basal cell cancer of the left side of his face and it has slowly advanced into his ear auricle . It has a moist yellow-red wound base with irregular border and extends from just in front of his left ear and up to and just entering his sideburn hairline. Over the past several months it has become increasingly painful when even gentle cleansing with a saline wipe. His current dressing is Xeroform gauze and Mepilex lite , change QOD, but due to drainage and him touching, picking at the dressing it has to be replaced daily. The wound is not painful unless it is touched/cleansed with dressing changes. Does anyone know of a dressing that wound be less painful. Maybe just lidocaine spray prior to dressing change?

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Permalink Reply by Dorothy Jean Steigerwald on July 28, 2010 at 3:44pm

Xeroform {bismuth has mild antimicrobial properties and has been used prophylactically to prevent wound infection. However, bismuth is also cytotoxic to inflammatory cells and may be a sensitizing agent, thais it may case irritation, dermatis, or an icreased inflammatory response, Patients with venous insufficiency ulcers are particularly prone to such responses, Clinicians must weigh these potentially adverse responses against the potential benefits of bismuth's antimicrobial properties. {Taken from Wound Management Principles and Practice 2nd edition by Betsy A. Myers pg 131 and 132};We have had alot of luck with xeroform gauze and the representatives from Santyl ointment recommend that either xeroform gauze or oil Emulsion be used in conjunction with Santyl for the moisture retaining effects. Thanks Dot S.