Suggested Wound Treatment

I have a patient with stage 3 infected pressure wounds to the right medial heel and left lateral ankle. Both with tunneling. The physician has been prescribing tunnel packing with Dakins soaked nugauze then wound bed covered with Dakins soaked 4x4s followed by dry 4x4 and kerlix. The wounds are showing no signs of improvement over the last 2 months. I have suggested a wound vac but the physician is resistent. Does anyone have any other suggestions to help get these wounds healing?

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Permalink Reply by orlando sanchez on June 18, 2011 at 5:00am

use Iodosore gel from smith&nephew one a day

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Permalink Reply by ANDREW S HARRISON on June 23, 2011 at 7:47pm

Assuming that patient is already on an antiobiotic, might be a good idea to quit attacking the tissue with Dakins (only doing more harm than good at this stage).

Monophasic HVPC Estim (for chronic wounds over > than 30 days duration - evidence rating A),

to decrease bioburden and to stimulate inflammatory components in an attempt to start the healing process again.

30-45 mins 3 x week or daily if inpatient

•Days 1-5 (or until necrosis is removed)

–Negative polarity, 50-80pps, 100-150 volts

•Days 6+ (until closure)

–Positive polarity, 80-100pps, 100-125 volts

try alternating negative / positive electrode in the wound beds if healing plateaus.

Then keep the wound bed moist with aquacel-type silver ointment with duoderm secondary dressing

Fyi: a wound vac is contraindicated in an actively infected wound

Dr. Harrison, PT, DPT

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Permalink Reply by orlando sanchez on June 24, 2011 at 12:40am

Dakins is olny good for 5 days dakins will damage the granulation tissue and iodosore will absorb drainage and prevent infection.Dakins only dries the wound bed and when removing the dressing causes the wound bed to bleed.

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Permalink Reply by Lisa Ramirez, RN, COHN, BSN, CCM on June 27, 2011 at 12:31am

Thank you. I agree the Dankins was way over used here but I could not get the physician to make any changes. Unfortunately the patient is back in the hospital now and will most likely lose one foot.

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Permalink Reply by Beth Culpepper RN, BSN, WCC, CHT on June 29, 2011 at 12:59am

I am sure this patient has moved on to another phase, but I wanted to add something. My first goal is to attack the problem. If pressure is the culprit, that has to be fixed first. Some physicians just skip right over that part. Million dollar treatments are worthless if you don't treat the problem. It sounds like this patient is bed bound and sleeping primarily on the left side. He/she needs pillows under the calves to have the heels of both feet floating in the air. I think the wound VAC is a great idea IF and only IF the infection is being treated. The fact that there is tunneling sounds like there is bone involvement. Osteomyelitis if untreated is also contraindicated for the VAC. If there is undermining as well this person may be suffering with restless leg syndrome and sliding all over the place. Taking care of all the problems is a must. 90% of the time, if you fix the problem, the wound will fix itself. I realize that older patients do have slow senescent cells that are slow to recover and need a jump start sometimes. But for the most part, if it is wet, dry it up. If it is dry, moisten it. If it is infected, treat it. Vascular disease needs a consult. Offload pressure and control edema. Keep blood sugars below 140 and evaluate every patient with a wound for a nutritional deficit no matter what they weigh. It is like MAGIC!!!