wound management

Re: wound management

Saskia Quinn — Sat, 11 Jul 2009 13:57:47 GMT

[quote user="SaskiaVN"]

But today, a lump the size of a fist was removed from the leg of a sbt - there was absolutely no way it was going to go together again so has to be left as an open wound. There will be a lot of after and nursing care with this one so any ideas wonderfully appreciated!

For the forseeable future though, he will be back for sedation and redress (coming in on sat again) as it will be way too painful to redress conscious. There was bone in the lump which came off too.

[/quote]

Well, an update on Sophie, came back as Osteosarcoma the bone that was removed in the lump was part of the metatarsal bone.

She was coming back for regular bandage changes but suddenly stopped doing well and was becoming very sad and listless at home - no wanting to do anything as seemed in a lot of pain according to the owner.

This, coupled with the fact she had osteosarcoma, he was given the option of amputation, he didnt want to put her through that as she was quite old anyway, so he made the decision to have her euthanased. It was one of the worst consultations I have ever witnessed. The man & his son were absolutely devastated, they spent a very long time with Sophie afterwards and she then went for private cremation. That was last week, and I am still thinking about it all every day.

Re: wound management

Kim Buckley — Wed, 01 Jul 2009 20:26:53 GMT

Hey just thought I would give an update!

Wound is looking really good and granulating well! We used honey on it for a while and it seemed to do the trick! Still doing daily bandage changes but it doesn't smell anymore and is all looking healthy and pink!

She's probably going to have surgery on Monday to try and reduce it a bit so all going well! Hurrah!

Re: wound management

Kim Buckley — Mon, 22 Jun 2009 19:08:56 GMT

Kim was back in today and my boss is really pleased with how it's looking! I think it's slowly getting there. I think regular bandage changes and lot's of flushing is doing the job! Hurrah!

Re: wound management

Caro Laithwaite VN — Mon, 22 Jun 2009 16:01:03 GMT

Just been to see my Dad. His leg dressing was off for a change. I made my feelings clear. At the state of it the top of the leg was swollen the lowed post bandage section like a stick.

FFS.. i told 2 nursing staff (qual human nurses) the last dressing was a disgrace did noone know how to apply the dressing One ummed and slid out saying err not seen him for a few days got to run.

The other that came in to dress the ulcer and l snarled at and her said the other dressing was a disgrace for causing such a mess and said said l assume you are leaving the dressing off for the swelling to equalize.

I have clashed with this "dwarf" before and said well l suppose we could bandage it all the way up. So she did up to the knee. She knew l was watching every move, you could see it in her shoulder set..l was sitting behind her thinking about kicking her ***.

I was not happy that the bloody thing was dressed so swollen but l can not do to much as my folks are worried that it will be "taken out on my dad and by default on my mum"

I am so not sodding impressed.

Re: wound management

Nick Shackleton — Mon, 22 Jun 2009 14:02:47 GMT

[quote user="A Little TLC"]

Flamazine cream.........another personal favourite!!!

[/quote]

I currently have that stuff smeared on a burn of mine!

Re: wound management

A Little TLC — Mon, 22 Jun 2009 09:28:09 GMT

Flamazine cream.........another personal favourite!!!

Re: wound management

Kim Buckley — Sun, 21 Jun 2009 23:25:49 GMT

Yeah I think we will do. She currently has a bill close to £1000 which I think is good going for a farm dog! The boss has stopped charging now though. I took a pic so I'll have to try and upload it up on here.

Re: wound management

Saskia Quinn — Sun, 21 Jun 2009 20:43:01 GMT

I am pleased to hear that Kimbo! Definitely keep us updated. It sounds like you will be seeing her for a while yet!

Re: wound management

Kim Buckley — Sun, 21 Jun 2009 20:41:54 GMT

The dog was back in today and to be fair it was looking a lot better! She has started to use the leg and it didn't smell nowhere near as bad as it did yesterday! The skin is looking nice and pink and even started bleeding when I was flushed it. I think wet to dry was going to be the next thing. She's back in tomorrow morning to see her regular vet so will have to see what he says. I really hope she gets better soon because she's such a lovely dog and we're all getting quite attached to her!

Re: wound management

Saskia Quinn — Sat, 20 Jun 2009 22:59:33 GMT

[quote user="Kimbo1985"]

Had to bandage a horrendous wound this morning! We had a farm collie in a few weeks ago who got kicked by a cow and dislocated her hip. It got replaced under GA and the vet strapped the leg up and wanted it left like this for a few days. The hip has stayed in since but the skin on her hind foot has just died and sloughed off!! Vet reckons it is due to the original bandage as he had to do it quite tight because it slipped off once and the hip popped out again!

Anyway he had her in again and debrided the skin on her foot and ended up removing a couple of her toes. She's since been having regular bandage changes but it has been breaking down and is badly infected with pseudomonas. Our head nurse has been in charge of bandaging it and has been using inadine on it but I really can't see it healing! It smells horrendous and I feel so sorry for the poor dog! Was chatting to the vet on call with me today and we both reckon the leg needs amputating but who knows what will happen because the vet in charge of the case thinks it's healing well!

[/quote]

Thats absolutely terrible. Surely the vet in charge of the case would know the difference between a wound that is healing and a wound that is not!

Definitely have a word, I would not leave that poor dog a moment longer. If you or the other nurses are not comfortable with speaking to he/she, get the vet you were chatting to today to speak to them.

Regarding the breaking down and infection, have any of you thought about using a different anti-microbial? If chlorohexidine (hibiscrub) doesnt seem to be helping, then change to povodine-iodine? Flamazine cream is also a great healing agent if you find other topicals are not doing the job well enough.

Is she a candidate for wet to dry?

Re: wound management

Freckle — Sat, 20 Jun 2009 22:03:23 GMT

[quote user="Charlotte says smile"]

The issue with using soffban is:

As it is synthetic it can cause reactions.
It is not at all absorbant and the other reason we use cotton wool between the toes is to help absorb the sweat so reducing bacteria growth

Soffban should never be used between the toes if there is no access to cotton wool it is better to use nothing at all.

I was always taught to use cotton wool and I have once used soffban as padding but the dog reacted too it being between the toes as it absorbed nothing and the skin was red raw, I will never use it again and if i see a vet using it I do actually ask them not too, I am lucky that they all listen.

[/quote]

That's very interesting! I am the only person at my practice who favours cotton wool - in over 8 yrs as a vet nursing asst / svn i have never seen a problem with it........ perhaps i shall start advocating its use more in practice...

Very interesting about the padding too - seems my 'instincts' about soffbans lack of absorbency may have had some truth in there somewhere lol! Would still be interested to try it for myself though...

Re: wound management

Kim Buckley — Sat, 20 Jun 2009 19:28:24 GMT

Everyone at my practice uses soffban and we've never had a problem with it and we do a lot of long term bandages. Maybe it was just a one of case. Aslong as the bandage is kept dry, clean and changed regularly I don't see how it would cause a problem.

Re: wound management

Charlotte says smile — Sat, 20 Jun 2009 19:18:30 GMT

The issue with using soffban is:

As it is synthetic it can cause reactions.
It is not at all absorbant and the other reason we use cotton wool between the toes is to help absorb the sweat so reducing bacteria growth

Soffban should never be used between the toes if there is no access to cotton wool it is better to use nothing at all.

Re: wound management

Kim Buckley — Sat, 20 Jun 2009 19:14:43 GMT

Ah get ya! Yeah cotton wool is good for robert jones. I do love a good bandage! hehe

Re: wound management

Freckle — Sat, 20 Jun 2009 18:58:16 GMT

i am liking the idea of soffban between toes, but i have always preffered cotton wool for the actual dressing is what i mean. especially for robert jones dressings!

its all about making sure the cotton wool is 'even' though - if you know what i mean! lol

Re: wound management

Kim Buckley — Sat, 20 Jun 2009 18:50:08 GMT

I think it's all about personal preference because I got taught to use cotton wool and then saw soffban being used and decided to give it a go. I find it stays between the toes better.

I feel I need to make a stand for this dog coz her name is Kim! hehe

Re: wound management

Freckle — Sat, 20 Jun 2009 18:31:33 GMT

Ooh soffban between the toes sounds like a good idea to try! It kinda comes off in perfect little thin strips doesn't it? Although it never seems as absorbent as cotton wool - For some reason (probably because I was trained that way back in the day whn I started nursing), I always prefer to use cotton wool for most dressings.

It sounds like you may be able to help the pooch, if you nurses all get together Go nurses!

Re: wound management

Kim Buckley — Sat, 20 Jun 2009 17:55:49 GMT

I use strips off soffban to pad the toes. Find it works really well.

It's one of the partners cases! He is very laid back and always likes to give things time but I just don't see this one healing! Hopefully he'll see after the weekend and take a different course of action. The nurses are quite good at persuading him to change his mind about things so maybe I'll make that my mission. She's such a nice dog aswell! She was a typical aggressive farm collie at first but now she's always happy to see us and wags her tail. Makes it even more horrible to see! She's coming back in tomorrow so will see what it looks like then!

Re: wound management

Freckle — Sat, 20 Jun 2009 17:24:05 GMT

i usually pad between all the toes, but only with tiny bits of cotton wool - hate it when you see a redress where they have those hard balls of cotton wool between their toes- ouchy!

i hope the poor pooch is ok kim! can one of the other vets or a partner not diplomatically intervene?

Re: wound management

Sandra Taylor RVN, MBVNA — Sat, 20 Jun 2009 17:15:27 GMT

Kimbo, thats awful someone needs to say something surely!

Re: wound management

Kim Buckley — Sat, 20 Jun 2009 16:32:17 GMT

Re: wound management

Maisy — Sat, 20 Jun 2009 14:01:06 GMT

Over the last few months we've been using quite a bit of Manuka honey and had some really good results on wounds that were slow healing or just generally difficult. The patient comes back every 2-3 days as standard for another application and redress.

As for toes, I put a small sliver of cotton wool between them, nothing too bulky because I agree it must be uncomfy otherwise. One of our vets used to put big wadges of cotton wool between each toe, ouch!

Re: wound management

Sandra Taylor RVN, MBVNA — Fri, 19 Jun 2009 23:13:37 GMT

I pad between the toes, because if you dont you can get pressure sores/fungal/bacterial infections more than if you dont.

I do agree however that padding should be minimal.......... I have seen some vets putting Waaaaaaaaaaaaaaaaay too much padding, and this causes sores and also can be a harbour for infection.

I have never had any probs with padding as long as it is done correctly there should be no problem whatsoever with it.

Minimalistic is the order of the day

Re: wound management

A Little TLC — Fri, 19 Jun 2009 09:38:00 GMT

working in wildlife, see a looooot of wounds, in various stages of infection, loads of de-glovings etc. we did a project with silver dressings recording each redress with photographs, absolutly incredible results. superb stuff.

Re: wound management

Fiona Leathers — Fri, 19 Jun 2009 09:33:38 GMT

I agree with vets not doing dressings, they can't seem to get them to stay on unless they've been horse owners as children, then they seem to have a better grasp of bandaging.

But I don't pad between the toes, because I think it must be uncomfortable for the houndlings, I know I would be annoyed by stuff between my toes and we've all seen cotton wool out of toes when its in a hard rolled up ball - ouchy! I do pad the dew claw though. I change bandages every 2-3 days and have never had a problem because I don't pad the toes. Very rarely do my patients come back with chewed bandages or bandage sores. Haven't have on fall off in a while either actually made I should delete that cos now I've jinxed it!!