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Thread: Wound care question

  1. #1

    Wound care question

    Can a wound heal if it is developing callous (somewhat thick white) skin? Details: Wound about 1" below tailbone. Wound about 1 inch long. It has been there about 6 months and just wouldn't close. Was no problem except we put a polymem on daily hoping that it would close. About 3 weeks ago called a doc and he debrided-cut away the callous tissue, so the would is a little wider than it was, probably 3/4 inch. Anyway more callous tissue is forming. Can it completely close with this callous tissue? What do we need to do? Also sureprep caused a yeast type redness around the wound. We are putting Lamisil on the red area and Silvasorb gel on the actual wound and covering with Optifoam. The person does alot of transferring and physical therapy.
    thanks, sheila

  2. #2
    Calloused whitish tough and lumpy material on the edge of the wound will prevent wound closure, and does need debridement.

    Is this doctor a wound care specialist? How did you decide on this combination of wound care products? How deep is the wound? Is bone exposed? The basic principle is to keep the wound moist but not wet, and keep it covered. Nutrition is also important with plenty of veggies, fruit and protein intake. No smoking or other tobacco use, absolutely.

    Bottom line, the only way a pressure ulcer will heal is to stay off it completely. No transfers, no sitting, no commode or shower chair, no sitting up in bed on the tailbone. Ideally, bedrest with no back laying (side to side and prone only).

    Remember the old rule:
    "You can put anything on a pressure ulcer and it will heal...as long as it is not the patient"!

    (KLD)

  3. #3
    SCI nurse,
    Thank you for your quick reply. The wound is not deep at all. Maybe like 1/8 to 1/4 inch, kind of like a scrape, but it is open and I think it has some very slight drainage at times.
    The doc had said the last time to cover it with hydrogel pads. Then when the nurse came she said it was too moist. So the treatment we are doing now is pretty much what the doc said the first time he came out.
    The doc is not a wound care specialist but he said he treats lots of wounds.
    How do we keep it moist but not wet?
    What makes the callous tissue form? and how do we prevent it from forming.
    The doc and the nurses said it was healing quickly, but the problem is the callous tissue.
    thanks,
    sheila

  4. #4
    See a wound care specialist. The callous is both a symptom of a stable, non-healing wound, and the cause of it. In this area, it is easy for even a shallow pressure ulcer to go to the bone and cause osteomyelitis.

    Is the wound bed moist or dry when you don't put anything on it? If dry, then you need a hydrogel, if moist, use something like Sorbsan or Oasis, covered with a gauze and then Tegaderm/Opsite.

    Bottom line, though, you need to see a plastic surgeon or wound care specialist. All doctors and nurses see a lot of wounds, but few are expert on the latest and most effective treatments.

    Is he sitting at all?

    (KLD)

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