What is the worst wound you have ever treated?
Please take a moment to share with the group your experience and how the wound was treated.
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Replies to This Discussion
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Permalink Reply by Janice Findlay on -
The worst wound I ever cared for was when I was a Coordinator on a Medical Unit. There was a pt with a type of an extremely aggressive necrotizing disease. She was difficult to position her because she was grossly obese and had a spinal infarct. Therefore she could not move herself at all. She had a large pendulous abdomen , which if you looked at it nothing remarkable would appear before you. However, the suprise came when you lifted the abdomen. It was split in two with tendons showing in addition to tremendous amounts of slough and necrotic tissue. Her whole abdomen was the wound bed. Furthermore, the smell of necrotic tissue was so bad that it reminded me of when I had to take families to the morgue when bodies were a number of days old. That smell just stayed with you all day.
The surgeon had odered saline soaked gauze packing which was a major task and of no benefit to the pt. I was sure it would only be a matter of time befrore this pt would become septic. Once a week the pt would be taken to the whirlpool and the surgeon would debride aggressively. She would come back smelling better , but the cycle would star again. I notice a reddened area over the trochanter and we put a pad over this and kept her off of the prominence. We assessed it every day. Within the course of a week the area was opened with the depth almost to the trochantor. In view of the situation I spoke to her Doctor and we met with the pt and family to discuss the current condition and future goals. After this, we focused on pt comfort, basic care and doing whatever could keep her clean and dry and minimize the smell. She was on pt controlled analgesia (Morphine)and we made sure she took some good boostswhen she was in pain. The whirlpool was so draining to her that we encouragd the Drs to stop this and let us deal with the wounds at the bedside. The pt died two weeks later,peacefully, with no pain and her family nearby. Jan Findlay
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Permalink Reply by Tracey Judkins on -
42 y/o patient with lymphoma. radiation burn to the upper body of sternum 12cm x 11cm with 2 cm depth. With each dressing change pieces of his sternum and small ribs wound fall out a little at a time. I used products from smith and nephew. I gently dabbed the area with wound cleanser and sut to fit an allevyn moisture control. I placed it in the cavity.
I then placed a non adhesive allevyn over the area and lightly taped with small pieced of hypafix tape. I then applied and allevyn adhesive 9 x 9 over the dressing and surrounding areas. This was changed 3 x week and sometimes only 2. Of course this wound did not heal (pt on hospice) However it did manage the exudate, as well as help with his disturbed body image.He wanted to take a trip to disneyland and after teaching him he was able to do this with minimal leakage. When he was first taken to our in patient unit, he would not let anyone touch his dressing. He requested me to come, the charge nurse called me and I went to see him and teach them the dressing which he was use to and liked. When I entered his room with supplies he said " You came, I am so glad you came, I was praying you would. He died without pain 5 weeks later in our inpatient unit. I was honored to help this young man.
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Permalink Reply by Laurie Swezey RN, BSN, CWS,CWOCN on -
You did an amazing job. I am sure that the help and support you provided to this patient meant more to him then you can ever imagine. As wound nurses, we are able to touch lives in ways that no one else can. Great job!
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Permalink Reply by Tracey Judkins on
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Thank you Laurie, that means alot to me. I am not certified yet because I am trying to gather funds for the exam and class, I am a single parent and have a teenage daughter. However I have every intention of becoming certified. I work for a not for profit organiztion in hospice. I love wound care and the staff and MD's all call me for wounds.
I have many patients and continously look at them and not the wound, I also include them in the treatment due to longevity, but most importantly work with them to what they are comfortable with.
Thank you so much :)
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Permalink Reply by Janet Wolfson on
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I am not certain that this is the worst but it was certainly challenging due to the other issues that arose through co-morbidities.
The client was a nearly 80 y/o southern woman- very independent, responsible and well connected in the large city we live in. She was referred to us with edema and lower extremity ulcers. The physician diagnosed her at the wound clinic with lymphedema. She had been self treating her dry scaly skin with bag balm. The scaliness was actually papilomas that often occur with lymphedema. they were literally hundreds of them that were circumferential around both calves. The bag balm was imbedded between the growths and the odor offensive. The client was unable to clean between the growths and so kept applying more balm. Thus her inability to complete personal hygiene was evident.
We initiated treatment by soaking her legs with betadine for ten minutes to decrease bacterial load. This was followed with pulse lavage to remove debris. Wounds (small and scattered) were dressed with absorbent silver products, and compression wraps applied.
Through the course of treatment the patients underlying dementia became more evident as she either forgot to keep the wraps on, arrived with wraps intact but soiled with urine, forgot appointments or related getting lost driving to familiar sites. This is where increased family involvement was sought.
The wounds did improve and the papilomas were deflated and actually dried up with the compression. The remaining scale was thick but easily removed with blunt debridement using a tongue blade.
In selecting a definitive compression garment we had to consider her mobility, dementia and independence. She could not apply compression stockings herself nor remove them if they became soiled. We ultimately went successfully with a velcro inelastic garment and a referral to an incontinence clinic.
Client was discharged from the clinic with leg ulcers and edema resolved. She also required a higher level of supervision than her family had previously believed to make the entire treatment successful.
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Permalink Reply by Gail A Sabo on
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Calciphyllaxis
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Permalink Reply by Joey Moss on
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One of my worst wounds involved a 50 Y/O female with a dehised total mastectomy, which the surrounding tissue with radiated as well. We placed Silver Calcium Algisite to the periwound on any exposed radiated part, to ensure the adhesive would not disrupt the tissue & allow the VAC drape to adhere over it, and give absorption properties through a semi permeable dressing . We used silver sponge wound vac on the wound bed and secured with drape.
This wound proressed well and was 40% smaller in 25 days of admission to our LTAC.
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Permalink Reply by leath v charles on
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My biggest fear for this gangarenous wound of this ex-soilder was that a fly would have a change to lay on this wound during procedure there were often so many around the house.
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Permalink Reply by Phyllis Walker RN,ADN,WCC on -
It would have been better to apply maggots to the wound. They would clean out the gangrenous tissue and promote healing by debridment by the maggots. This is an excellent solution as the patient is free of pain and only the necrotic tissue itself is removed. The odor is much decreased and with the necrotic tissue gone the wound will start healing. You must use specially bred sterile medical grade maggots and when they grow large they must be washed out, and a new dressing applied after new maggots are placed in the wound. You will see one of God's miracles and the reason for flies in this world in the healing of an exceptionally difficult painful wound.
Don't say YUK and avoid this, It has been accidentally effective for thousands of years, including in Egypt (on purpuse) in the First Kingdom. The Egyptians had excellent Physicians.
Sincerely,
An Old Gerontological Nurse.
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Permalink Reply by Nancy J Geerdts on
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Hi Phyllis;
Would you be able to give me insight into how you get the maggots - where do you order them from and does your institution have a policy on them? I agree that in all my readings I have only heard of positive results and it's so basic! Thank you for your time, Nancy
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Permalink Reply by lauri ordway on
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when i searched for maggot wound care, i found this:
http://www.monarchlabs.com/
Monarch Labs is the exclusive supplier of Medical Maggots™ (disinfected Phaenicia sericata larvae) for maggot debridement therapy.
Medical Maggots™ are indicated for use in the care and treatment of chronic wounds ("wound care") of humans or other animals for the following indications:
For debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic or post surgical wounds.
Medical Maggots™ are used to clean ("debride") and manage wounds in a procedure known as "maggot therapy." Sometimes wound debridement using maggots is also called "maggot debridement therapy," "MDT," "larva therapy," "larval therapy," "larva debridement therapy," or "biodebridement."
In the United States, Medical Maggots™ are regulated by the Food and Drug Administration as a prescription only medical device used in the care and treatment of wounds. They can not be released without a prescription or an order to do so by an appropriately licensed health care provider.
For more information about Monarch Labs, Medical Maggots or their use, select the appropriate entrance to our site:
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Permalink Reply by Nancy J Geerdts on
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The worst wound I have ever treated was a dehissance of an abdominal insision on a morbidly obese woman who had a staging surgery for a gyn cancer. The surgeon was bent on wet to dry dressings, very rude to the patient at times and refused to listen to recommendations for wound vac. The patient eventually did get a wound vac, her primary physician agreed to start her on an antidepressant, the dietician assisted with a good protein balanced diet and she did heal but it took a LONG time as she was also started on chemo during this process.
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