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Wounds
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Wounds - November 21, 2005 2:50:00 PM
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cindyn
Posts: 11
Joined: September 11, 2005
From: Newport, RI
Status: offline
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I just evaluated a patient with Freiberg's disease, a condition that affects the 2nd metatarsal head. Seems like it begins in adolescence and progressively worsens with hypertrophy of bone and loose bodies inside the joint space.
My patient had surgery where the surgeon remodeled the bone, tightened the medial aspect of the capsule and loosened the lateral aspect of the capsule. He also had to do an extensor tendon release. This was her second surgery, her first surgery was not successful secondary to extensive scar tissue formation.
The wound is not pretty. She had hardware removed 2 weeks ago, and the skin is extremely dry and still open areas at the incision with oozing at the proximal aspect.
She really hadn't been doing anything to care for this wound. My advice was to use neosporin/bacitracin with a dressing to keep the wound covered while in a sock so as to avoid sticking to the sock and preventing healing (not to mention the bacteria!)
Does anyone have alot of experience in wound care with any other suggestions to speed up healing? Additional things that she should be doing at home, or additional things i should be doing in the clinic?
I've never heard of this condition before...I saw her prior to the surgery (her 2nd one), and in weight bearing positions, her 2nd toe extended and crossed over the 3rd toe. In non-WB, there was no deformity. Very interesting.
_____________________________
Cindy
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Re: Wounds - November 22, 2005 5:18:00 PM
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Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline
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Hard to give wound advise without seeing it. Wound care is all about contolling moisture in the wound bed. A good dressing should control the drainage for at least 2 days. Is the wound on the plantar or dorsal surface? Type of drainage? Wound bed color? Evidence of infection? What type of closure did the MD use? She should've recieved some sort of orders from the MD about this. If you are concerned about it you could always call the MD.
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
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Re: Wounds - November 29, 2005 8:09:00 AM
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toddbirmingham
Posts: 1
Joined: November 28, 2005
Status: offline
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Can't advise without more information. Here are some questions to consider:
-Is it infected? What does the drainage look and smell like, as well as the surrounding skin. Is there edema? Is there osteomyelitis?
-Is the pt bearing wt on the area and preventing it from healing?
-How is the arterial and venous circulation in the limb?
-Is the pt diabetic? Blood sugars controlled? Sensation intact?
It may be that an appropriate dressing to provide a moist wound healing environment will do the trick, but there may be underlying complicating issues that are impeding the ability to heal as in one of the above questions.
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