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Thread: wound

  1. #1
    Senior Member Norm's Avatar
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    wound

    please help with question. need treament for wounds r/t active fungal infection in groin area. tried topical creams and Nystatin powder..now taking Diflucan oral tablets for 10 day regimen. wounds are chronic erythema, yellowish with serous-sanguinous drainage. skin appears cracked/fissured doughy and very fragile. also areas are in some skinfolds and have little air exposure. weight bearing causes irritation and dysreflexia. hoyer lift sling gathers in groin and causes areas to reopen. any help appreciated
    "Some people say that, the longer you go the better it gets the more you get used to it, I'm actually finding the opposite is true."

    -Christopher Reeve on his Paralysis

  2. #2
    We've been battling about the same thing minus the fungal infection with Matt. Used about a dozen different things, but here is what seems to be working.

    -Medihoney is a pretty good protectant and we saw some improvement with the wound after it had stagnated; however after about 2 weeks it too, stagnated.

    -Bactroban - generic mupirocin - prescription only; don't sub bacitracin or neosporin. Matt's wound care surgeon recommended this and it really works! And you really have to 'smear' it on; don't be stingy with it. (So make sure you get a script with lots of refills).

    We've also tried several different wound cleansers, but this one seems to be helping the most - http://www.allegromedical.com/wound-...e-p174343.html

    If there's any way at all you can not use the Hoyer, at least for a week or so, it would probably help the wound from getting reopened. If you just can't use any other transfer method, then try protecting the area with some padded gauze. I've opened up 4x4s and rolled them up and placed them in the groin crease.

    When you're sitting up in bed, can you frog leg your legs to open them up a bit? Also, staying out of your chair as much as possible so you can open up your legs a bit more will help. If you're in a power chair and you have those thigh supports on the side of the chair, try positioning them so your legs are spread a bit more in the chair.

    Wear light, light fabric pants or sweatpants to keep as cool as possible.

    It's been a really frustrating area for us to try and heal, but Matt is on the last stages now, and we're hopeful that using the above will finally get it closed. His started as a fungal infection and the skin just got macerated and went downhill from there.

    Good luck!
    _____________

  3. #3
    It is critical to get the area dry and keep it that way.

    Bath with mild soap and water twice daily, then dry off well (pat dry) and then lie on your back and get into a frog position. Dry like this for at least an hour. Gentle and careful use of a hair dryer on cool is OK (never on warm or hot). The apply your antifungal powder. Do not cake it on! Just dust lightly and brush off any excess.

    When getting up into your chair and getting dressed, fold clean dry ABD (dressing) pads into the folds of your groin skin. Change these as soon as they become damp.

    What type of sling do you have for your lift? If it is a hygiene type sling (open buttocks, sling under thighs), try using the sling in the modified amputee method. Instead of bringing the sling up between the legs and crossing, put each thigh piece under BOTH thighs (overlapping) and then up to the bar without crossing further. This will reduce pulling in the groin area. Some slings also have a sheepskin over option for the leg sections.

    People with diabetes are often more at risk for fungal skin infections. If you have not been tested for diabetes, do so. If you are already diabetic, focus on getting your disease under control. It will help a lot.

    (KLD)

  4. #4
    related question (getting mixed answers/thoughts on this):
    what is the best way to keep a new (healing) surgical incision clean - specifically, how to keep large sutured area covered with steri-strips clean when the strips get soaked with urine? not wanting to pull off strips, is it ok to gently wash with some type of cleanser instead of just leaving the strips dry with the urine on it?

    I actually just did a quick wipe with betadine swabs over the strips and rinsed with water in the shower. I didn't let the betadine stay on at all really, quickly rinsing it off. Used this instead of soap so not to distrupt the strips too much.

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    It is critical to get the area dry and keep it that way.

    Bath with mild soap and water twice daily, then dry off well (pat dry) and then lie on your back and get into a frog position. Dry like this for at least an hour. Gentle and careful use of a hair dryer on cool is OK (never on warm or hot).
    I use a hair dryer to dry between my toes and twig an berries after every shower. Probably the best preventive measure I know of. I set the dryer to hot, but I have full hand control and move the dryer aggressively when using it and use my other hand to sense the heat. It's imperative that the skin be completely dry; moisture leaves an open door for fungus to take hold.

  6. #6
    Quote Originally Posted by chick View Post
    related question (getting mixed answers/thoughts on this):
    what is the best way to keep a new (healing) surgical incision clean - specifically, how to keep large sutured area covered with steri-strips clean when the strips get soaked with urine? not wanting to pull off strips, is it ok to gently wash with some type of cleanser instead of just leaving the strips dry with the urine on it?

    I actually just did a quick wipe with betadine swabs over the strips and rinsed with water in the shower. I didn't let the betadine stay on at all really, quickly rinsing it off. Used this instead of soap so not to distrupt the strips too much.
    Betadine is OK as long as you rinse it well, as it is well known to inhibit the growth of fibroblasts, which are the cells that heal a wound. Hibiclens (chlorohexidine) would be better if you can get that. If I have an area at risk of contamination with urine or stool, I try to find a way to cover the wound with Tegaderm or other clear plastic adhesive type dressing. For our flap wounds, for example, we coat the incision lightly with bacitracin, cover with a single layer of Xeroform, then Telfa, and hold all in place with Tegaderm.

    Avoid showering or getting an incision that still has staples or sutures in place wet. We only allow showering if plastic can be taped over the incision to keep it dry in these circumstances.

    (KLD)

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