gnarly pressure sore

[zillazangel]

Chad decided to sleep in his chair two nights ago. BIG MISTAKE. This is what it looked like the next night when I put him in bed. It actually looks a lot less gnarly in photo than it is in real life. And today it looks much much worse with it bubbled up badly and I am trying very hard for the blisters not to pop. I am soaking gauze in Microcyn and changing the dressing 2x a day and of course keeping ALL pressure off. This is at the top of his left thigh where the leg meets the butt.

EDITED TO ADD: THE REST OF THIS THREAD CONTAINS VERY GRAPHIC IMAGES (MUCH WORSE THAN THE ONE BELOW). DO NOT CONTINUE IF YOU ARE BOTHERED BY VERY GRAPHIC IMAGES OF A PRESSURE SORE.

[SCI-Nurse]

Yes, looks like he got a pretty bad ischial DTI (deep tissue injury) and right over a previous flap, where the skin is vulnerable. I think he also have a stage I in the lighter pink areas.

For wound like this, no dressing is indicated, and may actually interfere with frequent re-inspection of the wound. A moist dressing would add maceration problems to a wound like this, and may make it more likely to breakdown.

With the deep purple discoloration, it is very likely that this will declare itself within a week or so and become an open pressure ulcer. All you can do at this point is to keep all pressure off it, boost his nutrition to get his protein stores maximized, drink plenty of fluids and take a multivitamin...and pray. He may be lucky and it won't break open, but if I saw this on my unit, I would be expecting it to evolve into an open sore within 1-2 weeks. If it does not, it make take 4-6 weeks of staying off it for it to heal well enough to start sitting again.

(KLD)

[zillazangel]

And here it is today.

[smashms]

definately needs to be completely off of it. since it now is a full fledged pressure sore. good luck to him

[zillazangel]

And when I repositioned him just now, I found a pressure sore on his ARM where he was propped on it to be up on his side to keep the weight off his leg. #@(*&#@!! This is very discouraging. Chad, however, is taking it like a champ and is resigned to being in bed for 2 months.

[reedyd]

Best wishes to Chad it really sucks having to lay in bed. Take care and Feed him Good

[Sue Pendleton]

KLD, I have used Doctor's Choice hydrocolloid bandages in the past for small sores and had great results. Would their blister bandage work on these kind of blisters? They can be seen through and while hydrocolloid they dried my litte sore from exfloxiating some tough skin when I tried out my new tub really well. It was like they worked the reverse of the ones for abrasions that I use on anything barely open after a day with a thin coat of Xenaderm on the area. I like being prepared since my skin seems to think it might be trying to age lately.

[SCI-Nurse]

I would never put an adhesive hydrocolloid over a blister, as it is sure to tear the blister open when removed (or even when applying). The goal is to keep the blister intact. If it should open, then an antimicrobial ointment (like Neosporin) or an antimicrobial dressing that is non-adherant (Xeroform, some silver dressings, etc.) is best for the blister bed.

Nothing you put on the outside of the skin will help a DTI heal. In general, I hate having dressing there that make it difficult to inspect the wound with every turn, etc. as well. Out of sight...out of mind.

(KLD)

[thehipcrip]

Oh man, A, that looks nasty. So sorry you guys have two new problem areas to deal with.

I agree that as long as there's no open spots and the blister is intact, dressing it with Vindex is nothing more than a waste of a very costly product. The stuff is good, but even it won't penetrate through the skin to heal bruising and deep tissue injuries.

Now covering that blister with dry sterile gauze to help protect it and keep it from popping is another story.

If the blister does open, get those VVF-soaked dressings going ASAP. This will make KLD cringe, but I've had phenomenal success healing popped burn blisters using VVF Hydrogel under a hydocolloid dressing. I cover the wound be with a thick layer of Hydrogel, the seal the whole thing off with a Duoderm Ultra Thin. The dressing is changed every three days. Using an opaque dressing on a pressure wound is not recommended, but this combination has worked miracles for me.

Tell Chad I'm sorry that he's back in bed jail, and that I hope for both of your sakes that this doesn't become much nastier and heals up in record time.

[lynnifer]

They come on so easily. One thing I've never read about it electricial stimulation in the first appearance of a wound ... wonder what effect it would have?