WOUND BLOG

Here are pathways for treating and protecting skin and wounds under multilayer compression bandaging (Profore or dynaflex) for patients with venous hypertension:

Dry Skin

Dry flakey skin – Moisturizer or thicker moisturizer.

Dry denuded skin – Xeroform

Dry lightly reddened skin – Topicort, change underlying padding to pure cotton cast padding.

Dry itching burning skin – Viscopaste wrap as first layer.

Moist Skin

Moist denuded skin – wound veil (Smith and nephew) covered with alginate. I recommend the wound veil cover because it will prevent the alginate from binding with the denuded tissue.

Draining wound – alginate or a beveled foam dressing. Note that foams have a tendency to dig into the skin around the edges, so it is important cut and taper around the foam edges.

Still Edematous

Swollen moist red skin with new breakdown (even with 30-40mmHg compression) – Typical with fluid over load patients including renal disease. Treat the  etiology.

Swollen extremity with reddened skin and new onset calf pain – Rule out DVT

Infection

Swollen red skin with open wound and new onset fever or pus – Rule out infection, culture wound, antibiotics.

Inflammation

Bright reddened skin   (Inflammatory with no signs of infection) – Topicort topical, medrol dose pack

Recurrent reddened skin with an open non-healing wound  – Consider differential diagnosis including autoimmune or another micro-occlusive disorder. Micro-occlusive disorders are covered in the Scottsdale Wound Management Guide (which can be purchased at swmghandbook.com). – Topicort to the wound bed and Prednisone oral weening over 6 weeks.

Dermatology

Reddened vessels around hair follicles – Rule out  folliculitus

Smaller reddened vessels (in groups or singular) – Consider treatment as fungal infection. Anti-fungal ointment for small area fungal breakouts.

Itchy rash over the majority of lower extremity below and maybe just above the knee (If using latex compression  wraps) , also possible systemic effects including puffy face, etc… – Rule out latex allergy, Consider Medrol dose pack, Benadryl, and Profore LF (Latex Free)

Shriveled skin – This is a common situation which happens during the first few weeks of compression therapy. The skin typically tightens on its own.

Pain

Vague recurrent pain with application of compression dressing – To much tension, consider less compression to the extremity. Including placing Tubigrip instead of Coban on the final layer. Insure that ABI indicates no arterial component.

Recurrent pain over bone with the application of compression dressing – Assess the skin for areas of bruising or open skin. Cover the area with a hydrocolloid.

Recurrent pain over small protruding bone with the application of compression dressing – Cut out foam around the prominence with the idea of offloading the small protruding bones from the pressure of the wrap.

Recurrent pain over prominent shin bone with the application of compression dressing – Build up an offloading  layer of cast padding to the shins sides.

Pain related to wrap cutting in to skin of fluted lower extremity.  Note that fluted refers to a thick upper calf and a narrow distal third of the lower extremity – Assess for rolled undulating skin with straight indentations or openings into the skin that match up with the wrap. Place extra cotton layers around the lower third of the dressing to build the area up. This protects the skin and helps prevent the wrap from sliding down.

Swollen extremity with reddened skin and new onset calf pain – Rule out DVT