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Thread: Question for Nurse - Deep Tissue Injury

  1. #1

    Question for Nurse - Deep Tissue Injury

    Thank you for posting the staging guidelines and descriptions for pressure sores and deep tissue injuries. How do you treat a deep tissue injury? I have a fluid filled blister and I'm not sure what to do about it. I would really appreciate any advice that you could give me. Thanks!

  2. #2
    Deep tissue injuries (DTIs) are not helped by any topical treatment or dressing, in fact it is best to not cover them at all so you can regularly inspect them. The single most important thing you can do for a DTI is to keep all pressure off the area.

    I suspect this is a heel, correct? You need to wear a boot that will prevent any pressure on your heel, including while up in a wheelchair. Press lightly on the area 1-2X daily. If it feels "boggy" or pus is coming from the edges, you need to see a wound care specialist. If you are lucky, and caught it in time, and keep all pressure off it, the black blister with harden into a scab and peel off revealing normal skin below in about 8 weeks. If not, it could develop into a stage III or IV pressure ulcer very easily.

    (KLD)

  3. #3

    Not on my heel

    Actually, the DTI is not on my heel. It is a blood blister that formed on the top of my foot where the foot meets the ankle. I recently broke my leg and the ortho instructed me to wear a support stocking and a splint after doing surgery. My leg swelled really bad and the support stocking bunched up at the ankle during the night and pinched the skin causing the blister. I have stopped wearing the support stocking and my leg is swelling worse, but I figured that one problem added to the other so the best thing to do was to remove the source of pressure and you have confirmed that my decision was correct. I have an appointment to see my rehab doctor on Thursday for post surgical evaluation and now the skin problem too.

  4. #4
    Keep your leg elevated as much as possible. Edema will make this problem worse.

    (KLD)

  5. #5

    Problem is worsening

    You are so right... I am keeping my leg elevated because edema does make it worse. The few hours that I have to be at work increases the size of the blood blister because as my foot swells more fluid collects in the blood blister. I know that as long as the blister remains closed it is sterile. Is there any chance that my body will reabsorb the fluid from the blister if it remains closed? I really hope to receive any positive information from you. I'm desperate to hear anything encouraging.

  6. #6
    Senior Member lynnifer's Avatar
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    Because of that edema, the extra fluid is just scouraging and searching for a hole to go through and satisfy its purpose of finding gravity (feeling melancholy today - sorry, lol). Imagine what's happening to the tissues underneath that blister as they try to meet up ... not trying to scare you but I've been there. Feet are the bain of my existence. One problem leads to many and can get out of control quickly.

    Keep that leg elevated above your heart and avoid swelling at all if possible. Can you take two months off work? I'd really reccommend that you try to if possible. Call it 'extended vacation'.

    What kind of stockings were you wearing? TEDS are useless. Juzo, if fit properly, can stop swelling dramatically ... but I wouldn't try it now with your blister. What's the angle like on your footrest?

    When I developed my wounds, I stopped stretching my feet - I'm not sure if that was a good or bad thing to do ... maybe the nurse or doc can answer that. Hard to know what's happening where we can't see, when we can't feel.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  7. #7

    Regular Compression Hose

    Lynnifer,

    Regular Compression hose usually work fine with eliminating the swelling but when I broke my leg and had surgery on July 13 and then flew home on July 15 the swelling has been out of control. The Ortho doctor told me to sleep in the splint and compression hose and I woke up on Monday, June 23, with a dark spot (Deep Tissue Injury) and now it has grown into a fluid filled blood blister. When it rains it pours.
    You mentioned the pressure on the tissue under the skin, would I be better off popping this thing?

  8. #8
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    Quote Originally Posted by P. J.
    You mentioned the pressure on the tissue under the skin, would I be better off popping this thing?
    I wouldn;t. You said you are seeing your doc soon? That is definately a decision for him. Almost always an unbroken skin is safer. If it needs to be released, it would need to be done with a sterile instrument and such .....

    I had the same thing happen (wrinkle in hose, etc) when I had a blood clot, but it seems like mine was MUCH less severe. It went away on its own in about 3 weeks. (Trying to give you a time frame here ..... minor "blood blister" = 3 weeks.) I did continue to wear the hose after a few days. It seemed like the lesser of 2 evils for me? But I made EXTRA sure it was perfectly smooth over the spot.

    I wonder if you could do something with an ace bandage instead of hose, and avoiding the fold of the ankle?
    Last edited by sjean423; 06-25-2008 at 05:19 PM.
    T7-8 since Feb 2005

  9. #9
    Senior Member lynnifer's Avatar
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    No I wouldn't pop it at all unless you would like Mr & Mrs Infection to come and have an extended stay in your foot (gawd I'm sorry - I'm a little giddy with no sleep and coughing away since my tunneled cath removal).

    If it's swollen, trouble. Just keep it elevated until you can see a doctor. Best to catch these things early before they turn into a life-long thing.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  10. #10

    Thank You

    KLD, Lynnifer, Sjean423Thank you for your feedback and encouraging words. After 20 years with a spinal cord injury you would think that I wouldn't flip out when I experience a secondary complication, but worrying about this is making me crazy. Life with a spinal cord injury is hard enough, but when you add in something extra it is almost more than I can take.

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