WOUND BLOG » Products

Wound Offloading Orthotic Products

Matthew Livingston R.N. C.W.S. — Thu, 10 Jun 2010 21:23:14 +0000

Total Contact Cast ( MedE-Kast, Instant Total Contact Cast, Custom TCC):

This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot and heel wounds.

Removable Cast Walker/ Walking Boots
1. Charcot Restraint Orthotic Walker (CROW) boot:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot, and heel wounds.
2. DH Walker (also known as Active Offloading Walker):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot, and heel wounds.
3. Prefabricated Walker (any premade walking boot):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, ankle, and heel wounds.
4. Patella Tendon Bearing (PTB) brace:
This product is indicated for heel wounds.

Wedge Shoes
1. IPOS or Darco Wedge Shoe:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, and lateral metatarsal wounds.
2. Ortho Wedge Shoe:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, and lateral metatarsal wounds.
3. Reverse IPOS:
This product is indicated for offloading heel wounds (no longer manufactured)

Multipodus Splint / Boot (Prafo, L’nard, Bend-a-boot, Multiboot):
This product is indicated for offloading heel and ankle wounds.

Surgical Shoes or Shoes with Pressure relief Insoles
1. Post op shoe (e.g. the Darco med-surg shoe with “peg assist”):
This product is indicated for offloading dorsal digit wounds.
2. DH Pressure Relief shoe (also the DH offloading post-op shoe):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal wounds, and ankle wounds.
3. Plastizote Healing Shoe:
This product is indicated for offloading the dorsal digit, planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, and heel wounds.

Wound Debridement when Accuzyme and Panafil are gone (Part 1) Mesalt and Hypergel

Matthew Livingston R.N. C.W.S. — Fri, 31 Oct 2008 04:02:36 +0000

Healthpoint will stop shipping Accuzyme and Panafil in January of 2009. So it is important to look at other products that can assist in debridement. (The author will discuss Santyl and biologicals in part 2 and 3). These are some details of products that I have used to debride wounds. Again these will not be as fast as Accuzyme and Panafil, but they are quicker than autolytic debridement. This product uses osmotic debridement ( Which has increased sodium and creates a chemical pull leading to necrotic tissue being lifted up). These products include mesalt and hypergel. Below is a detail from the company web site with a link for more information.

Authors Note:

1. These products can cause pain related to the sodium.

2. The products work very well in patients with peripheral neuropathy

Mesalt^{® –}Molnlycke

Sodium Chloride Impregnated Gauze helps stimulate the cleansing of moist necrosis (slough), draining, and infected wounds.

It absorbs exudate, bacteria and necrotic material from the wound and into the dressing, thereby facilitating the natural wound healing process. Mesalt is intended for the management of heavily discharging and discharging infected wounds in the inflammatory phase and deep cavity wounds such as pressure ulcers and surgical wounds.

http://www.molnlycke.com/item.asp?id=15159&catid=15076&lang=2&si=181

Hypergel^®Molnlycke

Hypertonic Saline Gel for the black, necrotic phase of wound healing.

This water based hypertonic saline gel softens eschar and draws drainage and debris from the wound. Hypergel debrides dry necrotic tissue (eschar), which is essential for wound healing to progress. Use directly from sterile, single dose tubes without mixing, mess or waste.

http://www.molnlycke.com/item.asp?id=15051&pid=15009&lang=2&si=181

Wound debridement when Accuzyme and Panafil are gone (Part 2)- Santyl Collagenase

Matthew Livingston R.N. C.W.S. — Wed, 29 Oct 2008 15:46:48 +0000

Santyl Collagenase (Enzymatic Ointment) - Healthpoint

Description: Santyl Collagenase digests collagen in necrotic tissue

Indications: debridement for chronic dermal ulcers including pressure ulcers, venous ulcers, arterial ulcers, diabetic foot ulcers, and severely burned areas. (Healthpoint, 2006)

Authors notes:

1. Slowest debridement ointment verses Accuzyme or Panafil

2. Less risk for pain or inflammation than with Accuzyme or Panafil

3. Can be used in a wound bed that has a combination of non-viable tissue along with granulation tissue and epithelization

4. Because Santyl doesn’t lead to inflammation, evidence suggests that (While slower to debride at first)the closure times of the wound are the same as papian based products (Brett, 2004).

5.Panafil and Accuzyme are not going to be made after January of 2009 (So Santyl may be the only ointment for debriding wounds)

6. For dry wounds that need to be debrided, use a moist primary dressing (hydrogel impregnated) to keep the Santyl from drying out.

Wound Debridement when Panafil and Accuzyme are gone (part 3) – Maggot Therapy

Matthew Livingston R.N. C.W.S. — Wed, 29 Oct 2008 02:40:21 +0000

The U.S. Food and Drug Administration (FDA) has ordered companies to stop marketing unapproved drug products that contain papain in a topical dosage form. This includes Accuzyme, Allanfil, Allanzyme, Ethezyme, Gladase, Kovia, Panafil, Pap Urea, and Ziox. A few options have already been discussed in the prior two prior blogs. One good option is biologicals (A nice way to say maggot therapy). Our clinics use Monarch Labs for our medical maggots or medical debridement therapy (MDT). To learn more go to the Monarch Lab web site at http://www.monarchlabs.com/

Mechanisms of Action – Debridement results from the necrotic tissue through proteolytic digestive enzymes and the physical action of the maggots mouth hooks on the tissue (this tears the tissue), allowing the digestive enzymes penetrate deeper into the necrotic tissue.

Clinical Indications – Maggot debridement therapy is indicated for infected, sloughy, or necrotic wounds, irrespective of etiology and including non-healing necrotic skin, pressure ulcers, neuropathic (diabetic) foot ulcers, chronic leg ulcers, malignant wounds or non-healing traumatic or post-operative wounds.

Contraindications for maggot therapy include: dry necrotic wounds, fistulae, wounds that connect with the abdominal cavity, wounds that bleed easily, wounds close to major blood vessels or nerves and any situations where the blood supply is insufficient to permit healing to take place.

Authors notes:

Read the package insert it is very informative

Don’t use harsh chemicals around the maggots (Kills them fast)

Stoma paste allowed to dry before introducing the maggots is a good adhesive

Advise the patient to call you ASAP should the dressing open.

If the maggots make it the full two days they will be much bigger. Open the dressing and they will escape pretty fast. Use an alcohol soaked 4×4 to swoop them up an smother them (place in double red bag). Irrigate the wound to flush out any strays.

Remember a straight face helps the patient cope with the thought of active maggots on their body.