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Thread: question about heel wound

  1. #1

    Unhappy question about heel wound

    Hi Everyone,
    David has healed up from all his wounds on his ischeal and sacrum areas. He had one on each heel and one is fine and the other although smaller, is still there. The wound care doctor says it keeps hypergranulating and has to be knocked down with silver nitrate every few weeks. Does anyone have any idea why it keeps hypergranulating? I asked the doctor and he said he has no idea why it keeps happening. Also, David burned his abdomen several months ago when he put a hot plate on his stomach and not feeling it, burned himself. It too is not healing well. We have tried using silvasorb, alglase and other things but every time it gets new skin, the dressing pulls it off when it gets changed. Any ideas would be appreciated. We would love to see these last 2 things go away.
    Thanks, DavesMom, Diane

  2. #2
    Senior Member
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    I don't know why it hypergranulates but my David has a sore on the bottom of his foot from pressure, we have relieved the pressure, etc. Dr. said it was actually trying to heal to fast, that the aquacel was bringing out the good skin and it was kinda bubbling up. They have used the silver nitrate on his twice now, every two weeks and it is looking much better. My fingers are crossed it works for your Dave too.

  3. #3
    DavesMom, although this will probably appall the medical professionals here, I've successfully treated several serious burns I've had (one was third degree) on areas that have no sensation with regular neosporin and gauze. Apply a hefty amount of neosporin twice a day and keep it covered at all times with the sterile gauze. It took almost two months for the bad burn -- which was about 2" in diameter -- to stop draining, at which time it formed a thick, hard scab. It took a few more months of healing for the scab to work its way off. Never had any problem with infection at all the whole time.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  4. #4
    Senior Member lynnifer's Avatar
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    The dressing should not be 'pulled' from any wound. Who is doing that? Are they soaking the dressing in saline before 'separating it' to change it? That's just wrong if not!
    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

  5. #5
    I am a big fan of using Xeroform (petroleum jelly and bismuth) gauze to cover moist wounds. This includes burns and stage II pressure ulcers or skin tears. It keeps the wound from drying out, and doesn't pull off the good tissue when it is removed. The bismuth is an antibacterial. It can be covered with Telfa or plain gauze and tape to secure it. Change it twice daily.

    Were his heels debrided? We normally leave the eschar in place on heels and avoid debriding unless mushy or oozing pus. If they are not healing, I would suggest seeing a good plastic surgeon. He may need a surgical closure, and of course, it is critical to make sure that there is no underlying osteomyelitis.

    (KLD)

  6. #6
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    I have a wound on the coccyx that I have been trying to heal for about 2 years now. I was going to a wound clinic in Springfield and they would do nothing for me except tell me that the wound looked fine and everything was going alright, well after getting tired of the lack of overall advice they where giving me and there unwillingness to provide me with alternatives I transfered to a wound clinic in West Plains. The wound doctor there informed me that the wound was in a chronic stage and needed to be reinvigorated. After applying a silver nitrate dressing for a week we started with the healing process. The doctor gave me a powder substances called multidex which she said provided the wound with nutrients and are using a rubber type packing that looks like a worm but expands as it absorbs the drainage. The results have been terrific, in two weeks we measured the wound and it had decreased in size by 33%. Im not sure if your wound would benefit from this but I thought I would inform you of it.

  7. #7
    Thank you everyone for the information. HipCrip, I thought about the neosporin for the burn and I think I will try that. Nothing else works and it sure can't hurt anything.

    The heel wound has definitely gotten smaller. It is just a superficial wound and has no depth to it at all. He goes to wound care again Friday and I will mention some of these things to the doctor. They are great about suggestions since one is a former heart surgeon and the other an ENT. I am just anxious to get this thing healed up for David's sake.

    Thanks again everyone. I appreciate being able to come here and discuss these things with all of you. SCI nurse, you are terrific.

    DavesMom, Diane

  8. #8
    KDL,
    Just realized I never answered your question. The heel has not been debrided ever as it never got any depth to it at all. It just hypergranulates every time it seems like it starts healing. It used to cover his whole heel but is only about an inch wide now so much smaller than it was.

    DavesMom, Diane

  9. #9
    Senior Member Van Quad's Avatar
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    For heel wounds, a home care nurse turned me on to elastic stockings. They restore some of the blood flow.

  10. #10
    Compression stockings can also cause skin breakdown if not properly fit or applied. They don't restore circulation, but can help to reduce edema. Edematous tissue is more likely to breakdown, and harder to heal.

    (KLD)

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