Wound Care Wound Care ––GeriatricsGeriatrics

Geriatric Lecture Series July 2007Geriatric Lecture Series July 2007Marcia Spear, APRNMarcia Spear, APRN--BC, CWS, CPSNBC, CWS, CPSN

Amanda Bailey, APRNAmanda Bailey, APRN--BC, CWS, BC, CWS, CRRNCRRN

OBJECTIVEOBJECTIVE

Consider NutritionConsider NutritionReview Pressure Reduction DevicesReview Pressure Reduction DevicesAccurately Describe The WoundAccurately Describe The WoundSelect Dressing Options Select Dressing Options Describe Staging and DepthDescribe Staging and Depth

Reference MaterialReference Material

WebsitesWebsiteswww.medicaledu.comwww.medicaledu.comwww.wound.comwww.wound.comwww.woundcaresociety.orgwww.woundcaresociety.orgwww.woundcare.orgwww.woundcare.orgwww.aawcone.comwww.aawcone.com

JournalsJournalswww.journalofwoundcare.comwww.journalofwoundcare.comwww.aswcjournal.comwww.aswcjournal.comwww.owww.o--wm.comwm.com

Nutritional ConsiderationsNutritional ConsiderationsEncourage adequate food and fluid intakeEncourage adequate food and fluid intakeVitamin TherapyVitamin Therapy

Vit C 500 mg po bid Vit C 500 mg po bid –– essential for collagen essential for collagen formationformationMVI one po daily MVI one po daily –– adequate nutrition insuranceadequate nutrition insuranceVit A 10,000 units po daily x 21 days; up to Vit A 10,000 units po daily x 21 days; up to 25,000 units in the immunocompromised 25,000 units in the immunocompromised ––protects wound cells from senescence protects wound cells from senescence Zinc 220 mg po daily x 21 days Zinc 220 mg po daily x 21 days –– nutrient in cell nutrient in cell formationformation

Protein and CaloriesProtein and CaloriesBoost, Ensure, Boost, Ensure, NutrashakeNutrashake

Needs increase with open woundsNeeds increase with open wounds

Review Reduction DevicesReview Reduction Devices

BedsBedsFoam Foam Dynamic Air Dynamic Air Low Air LossLow Air LossAir Air –– FluidizedFluidized

SeatingSeatingFoamFoamAir CushionAir CushionGelGelSpecialized Specialized -- RohoRoho

DON’T FORGET

** TURN Q2 HOUR IN ALL BEDS

** UP IN CHAIR PRESSURE RELIEF Q30 MINUTE ON ALL CUSHIONS

Module 4 - 6

Pressure Points in AdultsPressure Points in Adults

Occiput 1%

Scapula 0.5%

Spine 1% Sacrum 23% Heel 8%

Elbow 3%Trochanter 15%

Knee 6% Malleolus 7%

SUPINE POSITION

LATERAL POSITION

SITTING POSITION

Ischium 24%

Elbow 3%

Preparation for ExaminationPreparation for Examination

Supplies:Supplies:GauzeGauzeBottle NS or NS Bottle NS or NS respiratory respiratory ““bulletsbullets””QQ--tipstips

Patient Position:Patient Position:To enhance examTo enhance examLimit strain on examinerLimit strain on examinerOptimize photographyOptimize photography

Wound Description Phrase Wound Description Phrase ––putting it all togetherputting it all together

There is a (size) wound on the (location) with There is a (size) wound on the (location) with

(undermining cm) at (time) o(undermining cm) at (time) o’’clock and clock and

(tunneling cm) at (time) o(tunneling cm) at (time) o’’clock that has a clock that has a

(wound be color %) with (exudate amount, (wound be color %) with (exudate amount,

color, and odor) and the surrounding skin is color, and odor) and the surrounding skin is

(visual and/or temperature description).(visual and/or temperature description).

Wound Description Phrase Wound Description Phrase ––putting it all togetherputting it all together

LocationLocation

SizeSize

UnderminingUndermining

TunnelingTunneling

ExudateExudate

PeriwoundPeriwound

Wound Description Phrase Wound Description Phrase ––putting it all togetherputting it all together

LocationLocation

SizeSize

UnderminingUndermining

TunnelingTunneling

ExudateExudate

PeriwoundPeriwound

Location

Exudate

Tunneling

Periwound

Undermining

Size

LET PUS

Pressure Ulcer StagingPressure Ulcer Staging

Suspected Deep Tissue InjurySuspected Deep Tissue InjuryNew classification in 2007New classification in 2007Purple/maroon discolored skin that is intact Purple/maroon discolored skin that is intact or has blood filled blisteror has blood filled blisterTissue before appearance of discoloration Tissue before appearance of discoloration may be boggy, mushy, unusually firm, may be boggy, mushy, unusually firm, painful, warmer or cooler compared to painful, warmer or cooler compared to surrounding skinsurrounding skinWound may continue to progress even Wound may continue to progress even with optimal treatmentwith optimal treatment

Pressure Ulcer StagingPressure Ulcer StagingStage IStage I

Intact skin with blanchable redness; darkly Intact skin with blanchable redness; darkly pigmented skin may not blanch but be darker than pigmented skin may not blanch but be darker than surrounding tissuesurrounding tissue

Stage IIStage IIPartial thickness loss of dermis with a red/pink Partial thickness loss of dermis with a red/pink wound bedwound bedNo slough, no necrotic materialNo slough, no necrotic materialHeals by epithelialization from the hair follicleHeals by epithelialization from the hair follicleDo not use to describe skin tears, tape burns, Do not use to describe skin tears, tape burns, perineal dermatitis, maceration or excoriationperineal dermatitis, maceration or excoriation

Stage I

Stage II

Pressure Ulcer StagingPressure Ulcer Staging

Stage IIIStage IIIFull thickness tissue loss with Full thickness tissue loss with subcutaneous fat presentsubcutaneous fat presentSlough or necrotic tissue may be present Slough or necrotic tissue may be present but does not obscure depth of woundbut does not obscure depth of woundNO exposed muscle, bone or tendonNO exposed muscle, bone or tendon

Stage IVStage IVFull thickness tissue loss with exposure of Full thickness tissue loss with exposure of muscle, bone or tendonmuscle, bone or tendon

Stage III

Stage IV

Pressure Ulcer StagingPressure Ulcer StagingUnable to StageUnable to Stage

Full thickness tissue lossFull thickness tissue lossBase of wound covered by slough (yellow, tan, Base of wound covered by slough (yellow, tan, grey, green, brown) or eschar (tan, brown, black)grey, green, brown) or eschar (tan, brown, black)Until base of wound is exposed, true depth, or Until base of wound is exposed, true depth, or stage can not be determinedstage can not be determinedStable eschar (dry, adherent, intact without Stable eschar (dry, adherent, intact without erythema or fluctuance) on the heels should not erythema or fluctuance) on the heels should not be removed and are considered the bodybe removed and are considered the body’’s natural s natural ““biologicalbiological”” coveringcovering

Arterial, Venous, and Surgical Arterial, Venous, and Surgical ThicknessThickness

Partial Thickness Partial Thickness -- involving epidermis, dermis, or involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow center (Same as Stage an abrasion, blister, or shallow center (Same as Stage II).II).Full Thickness Full Thickness -- skin loss with extensive destruction, skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be present Undermining and sinus tracts also may be present (Same as Stage IV).(Same as Stage IV).Magnitude of depth can best be described by naming Magnitude of depth can best be described by naming visible structures in woundvisible structures in wound

Diabetic Grading SystemDiabetic Grading SystemTable 1: Wagner's Table 1: Wagner's Classification For Foot Classification For Foot UlcersUlcersGrade 0Grade 0 -- PrePre--ulcerative ulcerative lesion, healed ulcers, lesion, healed ulcers, presence of bony presence of bony deformity deformity Grade IGrade I -- Superficial ulcer Superficial ulcer without subcutaneous without subcutaneous tissue involvement tissue involvement Grade 2Grade 2 -- Penetration Penetration through the subcutaneous through the subcutaneous tissue (may expose bone, tissue (may expose bone, tendon, ligament or joint tendon, ligament or joint capsule) capsule)

Grade 3Grade 3 -- Osteitis, Osteitis, abscess, or abscess, or osteomyelitis osteomyelitis Grade 4Grade 4 -- Gangrene of Gangrene of the forefoot the forefoot Grade 5Grade 5 -- Gangrene of Gangrene of the entire foot the entire foot

Dressing TypesDressing TypesBasicBasic

HydrogelHydrogelTransparent DressingTransparent DressingHydrocolloidHydrocolloidAcrylicAcrylicFoamFoamCalcium AlginateCalcium AlginateHydrofiberHydrofiberZinc Based CreamZinc Based CreamBetadineBetadineXenaderm (Balsam of Xenaderm (Balsam of Peru, Trypsin, Castor Peru, Trypsin, Castor Oil)Oil)

Specialty DressingsSpecialty DressingsSilver impregnatedSilver impregnatedSkin substitutesSkin substitutesPlatelet derivedPlatelet derivedNegative Pressure TherapyNegative Pressure TherapyHyperbaric TreatmentsHyperbaric TreatmentsDebridement OintmentsDebridement OintmentsCompressionCompressionCopper Chlorophyllin Copper Chlorophyllin ComplexComplexCollagen DressingCollagen DressingCadexomer IodineCadexomer IodineIntegra Integra –– bovine collagen bovine collagen with shark cartilage and with shark cartilage and silicone barriersilicone barrier

Dressing Types Dressing Types -- TransparentTransparent

Goal . . .Goal . . .Protection of skin tears, Protection of skin tears, maintain moisturemaintain moisture

Wound Bed is . . .Wound Bed is . . .ShallowShallowSkin TearSkin TearLittle to NO drainageLittle to NO drainageSmall < 6cm roundSmall < 6cm roundBest used on the Best used on the extremities or trunk; extremities or trunk; avoid the sacrumavoid the sacrum

Cover entire wound Cover entire wound surface including 2 surface including 2 cm around wound cm around wound with dressing with dressing Change every 7 Change every 7 daysdays

Dressing Types Dressing Types –– HydrogelHydrogel

Goal . . .Goal . . .Keep wound bed moist, Keep wound bed moist, add moisture or assist add moisture or assist with autolytic with autolytic debridementdebridement

Wound Bed Is . . .Wound Bed Is . . .DryDryBarely MoistBarely MoistLittle DrainageLittle DrainageRed = Granulation BedRed = Granulation BedMoist Necrotic Tissue Moist Necrotic Tissue Either Yellow or BlackEither Yellow or BlackMay be used at any body May be used at any body location effectivelylocation effectively

Hydrogel to entire Hydrogel to entire wound bed + NS wound bed + NS gauze + cover with gauze + cover with dry gauze + dry gauze + occlusive tape 2 cm occlusive tape 2 cm around around Change Daily to Change Daily to Every Other DayEvery Other Day

Dressing Type Dressing Type -- HydrocolloidHydrocolloid

Goal . . .Goal . . .Absorb small to moderate Absorb small to moderate amounts of drainage for amounts of drainage for shallow woundsshallow wounds

Wound Bed is . . . Wound Bed is . . . RedRedVery ShallowVery ShallowSmall to moderate Small to moderate amount of drainageamount of drainageBest used on the Best used on the extremities or trunk; extremities or trunk; avoid the sacrumavoid the sacrum

Apply to entire Apply to entire wound bed with 2 wound bed with 2 cm around wound cm around wound bed bed Change every 3Change every 3--5 5 daysdays

Dressing Type Dressing Type -- AcrylicAcrylic

Goal . . .Goal . . .Absorb moderate Absorb moderate amounts of drainage for amounts of drainage for shallow woundsshallow woundsHydrocolloid falling out of Hydrocolloid falling out of favor in many settings favor in many settings and this is newest and this is newest substitutionsubstitution

Wound Bed is . . . Wound Bed is . . . RedRedVery ShallowVery ShallowModerate amount of Moderate amount of drainagedrainageCan be used anywhere Can be used anywhere on bodyon body

Apply to entire wound bed Apply to entire wound bed with 2 cm around wound with 2 cm around wound bed bed Change every 7 daysChange every 7 days

Dressing Type Dressing Type -- FoamFoamGoal . . .Goal . . .

Absorb moderate to large Absorb moderate to large amounts of drainage for amounts of drainage for shallow woundsshallow woundsIf hydrocolloid not lasting If hydrocolloid not lasting may want to bump up to may want to bump up to foamfoam

Wound Bed is . . . Wound Bed is . . . RedRedShallowShallowModerate to large Moderate to large amount of drainageamount of drainageBest used on the Best used on the extremities or trunk; extremities or trunk; avoid the sacrum avoid the sacrum

Apply directly to Apply directly to wound bed with 2 wound bed with 2 cm surrounding skin cm surrounding skin overlapoverlapChange every 3Change every 3--5 5 daysdays

Dressing Type Dressing Type -- AlginateAlginateGoal . . .Goal . . .

Absorb large to copious amounts of Absorb large to copious amounts of drainage for shallow or deep woundsdrainage for shallow or deep woundsHemostasisHemostasisAgain, foam not working so bump it Again, foam not working so bump it upupAbsorbs 20 times its weightAbsorbs 20 times its weight

Wound Bed is . . . Wound Bed is . . . Red or slough but not black necroticRed or slough but not black necroticShallowShallowLarge to copious amount of drainageLarge to copious amount of drainageNew wound usually so lots of outputNew wound usually so lots of outputMay be used at any body location May be used at any body location effectivelyeffectively

Cover or Fluff into Cover or Fluff into wound bed, cover with wound bed, cover with dry gauze, secure with dry gauze, secure with tape occlusivelytape occlusivelyChange every day or Change every day or every other dayevery other day

Dressing Type HydrofiberDressing Type HydrofiberGoal . . .Goal . . .

Absorb large to copious amounts of Absorb large to copious amounts of drainage for shallow or deep drainage for shallow or deep woundswoundsHemostasisHemostasisAgain, foam not working so bump it Again, foam not working so bump it upupAbsorbs 3 times AlginateAbsorbs 3 times Alginate

Wound Bed is . . . Wound Bed is . . . Red or slough but not black necroticRed or slough but not black necroticShallowShallowLarge to copious amount of Large to copious amount of drainagedrainageNew wound usually so lots of outputNew wound usually so lots of outputMay be used at any body location May be used at any body location effectivelyeffectively

Cover or Fluff into wound Cover or Fluff into wound bed, cover with dry gauze, bed, cover with dry gauze, secure with tape occlusivelysecure with tape occlusivelyChange every day or every Change every day or every other dayother day

Dressing Type Dressing Type –– Zinc Based Zinc Based CreamCream

Goal . . .Goal . . .To treat superficial wounds To treat superficial wounds while protecting surrounding while protecting surrounding skin from moistureskin from moisture

Wound Bed is . . .Wound Bed is . . .Superficial with lower dermis Superficial with lower dermis still intactstill intactGood for groin, buttock, Good for groin, buttock, sacrumsacrumGood for incontinence Good for incontinence maceration and break downmaceration and break downWorks well around Works well around macerated tube sitesmacerated tube sitesWound is not Wound is not ““developingdeveloping””but stablebut stable

Apply thin layer of Apply thin layer of cream to affected cream to affected area and area and surrounding skinsurrounding skinApply twice daily Apply twice daily and PRN and PRN incontinenceincontinence

Dressing Type Dressing Type –– XenadermXenadermGoal . . .Goal . . .

To treat superficial wounds To treat superficial wounds while protecting surrounding while protecting surrounding skin from moistureskin from moistureBest for developing Stage I Best for developing Stage I or II and/or deep tissue or II and/or deep tissue injury newly diagnosedinjury newly diagnosedMay prevent progression to May prevent progression to deeper injurydeeper injury

Wound Bed is . . .Wound Bed is . . .May have break in dermis but May have break in dermis but typically superficialtypically superficialGood for groin, buttock, Good for groin, buttock, sacrum, skin tearssacrum, skin tearsGood for incontinence Good for incontinence maceration and break downmaceration and break down

Apply thin layer of Apply thin layer of cream to affected cream to affected area and area and surrounding skinsurrounding skinApply twice daily, no Apply twice daily, no cover dressing, no cover dressing, no massagemassage

Dressing Type Dressing Type -- BetadineBetadineGoal . . .Goal . . .

Keep necrotic tissue Keep necrotic tissue drydry

Wound Bed is . . .Wound Bed is . . .Dry and blackDry and blackOn the heel or toesOn the heel or toesStable injury not Stable injury not getting biggergetting biggerMay be awaiting May be awaiting vascular consult for vascular consult for arterial etiologyarterial etiology

Apply betadine to Apply betadine to wound and wound and surrounding skin surrounding skin Twice dailyTwice daily

Wound Description ExampleWound Description Example

Diagnosis: Stage I and Stage II pressure ulcer complicated by maceration

There is a There is a 10x6cm 10x6cm wound on the wound on the bilateral bilateral buttock/coccyx buttock/coccyx with with no no undermining and no undermining and no tunnelingtunneling that has that has 100% epithelial tissue100% epithelial tissuewith with a small amount of a small amount of tan, nonodorous tan, nonodorous drainagedrainage and the and the surrounding skin is surrounding skin is pink pink and moistand moist

Dressing: Zinc oxide twice daily to protect and prevent furtherbreakdown

Wound Description ExampleWound Description Example

Zinc Oxide Paste

Diagnosis: Skin tear left arm partial thickness.

There is a There is a 1.5x2cm1.5x2cm wound wound on the on the Left forearmLeft forearm with with no no undermining or tunnelingundermining or tunnelingthat has that has 100% skin flap 100% skin flap coveringcovering wound bed with a wound bed with a small amount of small amount of nonodorous serosanguinous nonodorous serosanguinous drainagedrainage and the and the surrounding skin is surrounding skin is warm, warm, intact, and bruised without intact, and bruised without edemaedema..

Wound Description ExampleWound Description Example

Dressing: Steri-strip flap and apply transparent dressing or if exudating then try acrylic

Diagnosis: Skin tear right arm partial thickness.

There is a There is a 2x1cm2x1cm wound on wound on the the right forearmright forearm with with no no undermining or tunnelingundermining or tunnelingthat has that has 50% epithelial and 50% epithelial and 50% residual tissue/scab 50% residual tissue/scab wound bed with a wound bed with a small small amount of nonodorous amount of nonodorous serosanguinous drainageserosanguinous drainageand the surrounding skin is and the surrounding skin is warm, intact, and bruised warm, intact, and bruised without edemawithout edema..

Wound Description ExampleWound Description Example

Dressing: Transparent dressing or if exudating, acrylic

Wound Description ExampleWound Description Example

There is a There is a 2x1cm2x1cmwounds on the wounds on the left left greater toegreater toe with with no no undermining or undermining or tunnelingtunneling that has that has 100% necrotic100% necrotic tissue tissue with with no drainageno drainage and and the surrounding skin is the surrounding skin is mottled, painful, and mottled, painful, and erythematouserythematous..

Diagnosis: Arterial ulceration of the left greater toe unable to stage

Dressing: Betadine once daily (increase to twice daily if moistens)

Wound Description ExampleWound Description ExampleThere is a There is a 15x4cm15x4cm wound wound on the on the forehead and above forehead and above the left eye on the headthe left eye on the headwith with no undermining or no undermining or tunnelingtunneling that has that has 60% 60% bone and 40% granulationbone and 40% granulationwound bed with a wound bed with a moderate moderate amount of nonodorous amount of nonodorous serosanguinous drainageserosanguinous drainageand the surrounding skin is and the surrounding skin is warm and intactwarm and intact

Diagnosis: Status post head trauma with scalp avulsion injury full thickness bone exposed

Dressing: Hydrogel daily

Wound Description ExampleWound Description ExampleThere is a There is a 4x2cm4x2cm wound wound on the on the plantar surface of plantar surface of the left footthe left foot with no with no undermining and no undermining and no tunnelingtunneling that has that has 100% 100% granulationgranulation tissue with tissue with minimal, nonodorous, minimal, nonodorous, pink drainagepink drainage and the and the surrounding skin is surrounding skin is intact intact with surrounding callouswith surrounding callous

Diagnosis: This is a grade 2 or stage 3 diabetic ulceration of the plantar left 3rd metatarsal full thickness

Dressing: hydrogel plus foam pad and specialized shoe from podiatry

Wound Description ExampleWound Description ExampleThere are multiple wounds There are multiple wounds ranging from ranging from 1x1.5cm 1x1.5cm ––7x3cm7x3cm of the of the bilateral lower bilateral lower extremitiesextremities with no with no undermining and no undermining and no tunnelingtunneling that has that has 100% 100% granulation of right lower granulation of right lower extremity wounds and 50% extremity wounds and 50% granulation and 50% slough granulation and 50% slough of left lower extremity of left lower extremity woundswounds with copiouswith copious, , moderately odorous, thick, moderately odorous, thick, tan drainagetan drainage and the and the surrounding skin is surrounding skin is dry, dry, scaly, hyperpigmented, scaly, hyperpigmented, hemosiderin with 4+ pitting hemosiderin with 4+ pitting edemaedema

Diagnosis: Multiple full thickness venous ulcerations of the bilateral lower extremities

Dressing: Silver impregnated gauze,

Covered with calcium alginate, covered with foam, and wrapped in compression from toe to knee

Wound Description ExampleWound Description ExampleThere is a There is a 5x3x1cm5x3x1cm wound wound on the on the coccyxcoccyx with with undermining at 11undermining at 11--1 o1 o’’clock clock and no tunnelingand no tunneling that has that has 40% slough vs fibrinous 40% slough vs fibrinous tissue, 40% muscle tissue tissue, 40% muscle tissue and 20% granulationand 20% granulation tissue tissue with with copious, nonodorous, copious, nonodorous, clear drainageclear drainage and the and the surrounding skin surrounding skin has an has an erythematous papular rash erythematous papular rash with coalescence at the with coalescence at the margins of the wound with margins of the wound with satellite lesions extending satellite lesions extending out from the woundout from the wound

Diagnosis: Stage IV coccyx pressure wound with surrounding fungal rash

Dressing: Calcium alginate or if saturating alginate, try hydrofiber and mycostatin to surrounding skin

Wound Description ExampleWound Description ExampleThere is a There is a 5x4 cm5x4 cm wound wound on the on the left heelleft heel with with no no undermining and no undermining and no tunnelingtunneling that has that has 100% 100% blister intact cap with blister intact cap with visible blood componentvisible blood componentwith with no drainageno drainage and the and the surrounding skin is surrounding skin is pink pink and intactand intact

Diagnosis: Deep Tissue Injury – may progress

Dressing: Betadine; if this were to open, debride blister cap and make alternate dressing selection based on wound characteristics

Wound Description ExampleWound Description ExampleThere is a wound There is a wound measuring measuring 6x4cm 6x4cm on the on the sacrumsacrum with with no no undermining and no undermining and no tunnelingtunneling that has that has 100% 100% moist necrotic tissuemoist necrotic tissuewith with copious, strong copious, strong odor, tan drainageodor, tan drainage and and the surrounding skin is the surrounding skin is macerated, redmacerated, red

Diagnosis: Unable to stage pressure ulcer

Dressing: Surgical debridement 1st, calcium alginate for drainage management and hemostasis and then ultimately switched to hydrogel

Wound Description ExampleWound Description ExampleThere is a There is a 35x20cm 35x20cm wound wound on the on the left posterior and left posterior and medial thighmedial thigh with with no no undermining and no undermining and no tunnelingtunneling that has that has 90% 90% eschar and 10% pink eschar and 10% pink epithelial tissueepithelial tissue with a with a copious amount of foul odor copious amount of foul odor serosanquinous and tan serosanquinous and tan drainagedrainage and the and the surrounding skin is surrounding skin is intact intact with large amount of non with large amount of non pitting edemapitting edema

Diagnosis: Full Thickness wound from “fracture blister” after significant pelvic injury and edema

Dressing: Tried to cross hatch and apply debridement ointment but eschar to thick so Debride and . . .

Dressing: Then . . . Hydrogel, ns gauze, dry gauze, daily, then . . .

Wound Description ExampleWound Description ExampleThere is a There is a 4x2cm 4x2cm wound of right Achilles wound of right Achilles heel and 2x1cm of left heel and 2x1cm of left Achilles heelAchilles heel with with no no undermining and no undermining and no tunnelingtunneling that has that has 100% dry hard eschar 100% dry hard eschar with with no no exudate and exudate and the surrounding skin is the surrounding skin is intact and dry with intact and dry with some flakingsome flaking

Diagnosis: Unable to stage pressure ulcer of bilateral Achilles area

Dressing: Betadine daily; remove multipodous boot as cause of injury

Wound Description ExampleWound Description ExampleThere is a There is a 17x8 cm 17x8 cm wound on the wound on the abdomenabdomenwith with undermining 3cm undermining 3cm at 7at 7--9 o9 o’’clock and no clock and no tunnelingtunneling that has that has 60% 60% granulation tissue and granulation tissue and 40% slough40% slough with with a a large amount of tan, large amount of tan, yellow, slightly odorous yellow, slightly odorous drainagedrainage and the and the surrounding skin is surrounding skin is pink, pink, dry, and intact (and dry, and intact (and tattoo)tattoo)

Diagnosis: Full Thickness trauma wound status post GSW to the abdomen with complication of compartment syndrome

Dressing: was negative pressure therapy but not appropriate with this amt. of slough so switch to debridement ointment on slough and hydrogel on granulation tissue

Wound Description ExampleWound Description ExampleThere is a There is a 20x4cm 20x4cm wound on the wound on the abdomenabdomenwith with no undermining no undermining and no tunnelingand no tunneling that that has has 100% granulation 100% granulation tissuetissue with with a large a large amount of amount of serosanquinous serosanquinous nonodorous drainagenonodorous drainageand the surrounding and the surrounding skin is skin is pink, dry, and pink, dry, and intactintact

Diagnosis: Full Thickness wound after exploratory lap

Dressing: negative pressure therapy changed M, W, F was used but could easily use Calcium Alginate or hydrogel if drainage were to slow down

ConclusionConclusion

QuestionsQuestionsmarcia.spear@vanderbilt.edumarcia.spear@vanderbilt.eduamanda.bailey@vanderbilt.eduamanda.bailey@vanderbilt.edu