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Thread: Wound Butt Cheek not healing

  1. #1
    Senior Member iskumbro's Avatar
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    Wound Butt Cheek not healing

    I hope you excuse me guys for posting the wound in my butt cheek. I use silver to dry it up but it takes long to heal. the wound is red and pinkish but the surrounding skin with the white skin around it makes the wound bigger and bigger. I dress it twice a day with gauze and micropore tape. Comfeel does not stick even with micropore tape. I will appreciate any help. Any advice from SCI-nurse will be a big help

  2. #2
    Senior Member lynnifer's Avatar
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    Using Google Chrome, I can't get the picture to expand ... but do you have incontinence? You need to put a skin barrier on the skin all around the wound (not on the wound). Find something better than gauze as well ... it sticks. Every time someone is changing the wound, you're tearing new fibroblasts (new skin) off. I like Mepilex dressings but they're expensive. I'd see a wound specialist at this point because I don't like the look of the skin around.

  3. #3
    You have a fairly serious stage III pressure ulcer. Are you sitting at all?? You should not be sitting on it at all, not even sitting up in bed. What kind of mattress are you sleeping on?

    It appears to me that you have a non-proliferative edge (rolled edges) on the wound as well. This indicates it has been there some time, and it is unlikely to close as long as that edge is that way. It may need debridement of the edge (by a wound specialist or plastic surgeon).

    Not sure why you are trying to dry the wound up. Pressure ulcers heal better if kept moist (not wet). Silver is used to decrease infection. This does not appear to be infected. If you are using dry gauze, I agree with Lynnifer that this will make it likely you are actually damaging the wound bed when removing this. A dressing that keeps the wound moist, and does not stick would be much more appropriate. Hydrocolloids are not one of my favorite. We use a lot of Xeroform, which is a petroleum jelly and bismuth impregnated gauze, then cover it with a non-adherent dressing like Telfa, and tape in place. This can be changed 1-2X daily. Calcium alginate is also an option here. I would love to put a biologic matrix dressing (Oasis or MatriStem) on this wound, but it is expensive, and unlikely you have access to this except through a wound specialist.

    How is your nutrition? Have you had any labs done to check your pre-albumin levels?? Are you pushing protein in your diet??? Are you taking a multivitamin? Zinc supplement is sometimes recommended, although recent evidence is that it does not do a whole lot to help wound healing.

    Do you have access to a wound care expert or plastic surgeon?

    (KLD)

  4. #4
    Super Moderator Sue Pendleton's Avatar
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    Oasis Matrix dressings are made by Cook Biotech and their web site under About Us says they have a worldwide delivery system. This stuff has healed so many truly bad sores I know of. I would highly recommend asking a wound care doctor about if it is available in the Phillipines. It is made using cells from pigs so I am not sure it is importable there. There is also a drug that is approved in much of Europe called Actovegin that can help restore oxygination and healthy cells to the wound bed in pressure sores and burns. This can be used in conjuction with the petroleum jelly and bismuth impregnated gauze dressings.

  5. #5
    Oasis (TM) is the more expensive of the two widely available matrix dressings, the second being MatriStem. Both are made out of pig tissue. They are actually acellular...they are made from the collagen tissue layer of pig intestine (Oasis) or bladder (Matristem). All the cellular components of these tissues are removed. They act as a scaffold for fibroblast to grow across the wound, and for capillaries to grow into the new tissue. Epifix is another similar product (even more expensive) made from the collagen layer of human placentas.

    (KLD)

  6. #6
    Super Moderator Sue Pendleton's Avatar
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    I knew when they were able to mass market such dressings that most of the porcine cells were removed or a non-animal component added but not they could make them without any pig cells. Thanks! And great news. I hadn't heard of Epifix. One of our European members told me he had used the Actovegin and it did speed up how fast new, good skin formed as the sore healed. It is made from calfs blood products. Currently it is banned in the US because athletes have been known to use a form of it to "dope" their bodies with extra oxygen. It has been studied though with favorable outcomes and may be more easily available and cheaper in some countries.

  7. #7
    Senior Member iskumbro's Avatar
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    I will go to the wound clinic asap. Additional info, I have to say seated on the chair because of intermittent catheterization and cleaning my bag. I cannot help but wet the portion and then replace the gauze again. Well I have to look at xeroform or oasis if they are available. It made me nervous to know it is already stage 3 pressure sore and the rolled edges. Unfortunately, I do not use egg foam mattress either.

    Will update you all again on how everything works (KLD, Sue and Lyn)

  8. #8
    Eggcrate foam is useless for pressure reduction. You really should be on a low air loss mattress right now. Why can you not cath in bed and get someone else to clean your bag for you??? It will never heal if you sit on it, regardless of what dressing you use. I am on sure what you mean by this comment:

    "I cannot help but wet the portion and then replace the gauze again." Can you explain more??

    (KLD)

  9. #9
    Super Moderator Sue Pendleton's Avatar
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    He mentioned Comfeel in his first post and those are mainly hydrocolloid dressings. He may be rewetting one that is rolling up.

    A better solution until you see a wound doctor, Iskumbro, is to wash the area gently with warm saline and pat dry , then apply a thin coat to maintain a moist but not wet wound with Comfeel Purilon Gel 15 grams. Then cover with a gauze dressing and tape in place. Use a clean cotton swab or a new piece of gauze to apply the gel each time. If you need more get a new swab or gauze so you don't contaminate the entire container of gel. If you have petroleum jelly apply that to the dry areas around but not in the wound. This will protect that skin from any more wetness but keep it pliable too.
    What level of injury are you?

  10. #10
    Super Moderator Sue Pendleton's Avatar
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    I looked for low air loss matresses in his area and www.sulit..com.ph/low+air+loss+mattress came up with one for 9,000 Philippino Pesa which is about $210 in the US. Says it's new from Taiwan. The shop is called Golden Horse Medical Supplies and is in Quezon City. If that is nor possible than you need to rotate from one side to the other for sleeping and on your stomach if possible. But you must do everything possible to stay off of the sore. When you see the wound doctor you may want to discuss having a foley catheter inserted until it heals.

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