WoundReference improves clinical decisions
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Sep 15, 2019 by Melissa Khoo,
8 replies
Cathy Milne
APRN, MSN, CWOCN-AP
Melissa,
I don't see anything posted about your request...can you please resend?
Thanks!
Cathy
Sep 15, 2019
Sorry. I have a 26 y/o with abcess from a fall. Albumin is normal. Wound bed is pink with some slough, full thickness wound from I and d. Infection under control. No other hx. Currently on IV abt.is it okay to use collagen?
Sep 15, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Without images or additional information, I would ask if further sharps debridement to remove slough would be advantageous prior to applying collagen? The inflammation from further tissue necrosis will likely outweigh the purported benefits of collagen. If sharps Debridement is not possible, can you use enzymatic debridement since infection is not a concern?
Sep 15, 2019
Those are great suggestions. It is only about 10%. It is more towards the margin.
Sep 15, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Thank you for the response!
I see—well given the information you have provided, collagen is not contraindicated, and if the gross majority of the wound bed appears healthy and your assessment indicates supporting it with collagen will be advantageous, I do not see that as being unreasonable. Sharp debridement of the remaining non viable tissue is still of benefit if that is an appropriate, available modality in your setting.
Sep 15, 2019
Cathy Milne
APRN, MSN, CWOCN-AP
I agree with Samantha, it is important to get rid of all the devitalized tissue before using collagen..That said it is only 10% and at the margin..so I would consider using a combined approach...Again, this is a generalized response as I have nothing else to go on in this patient, including a medical history or wound location....that said - debridement can be mechanical (such as a microfilament pad, pulse lavage - or patient can use handheld-shower head (this last one has no solid evidence base behind it but is common practice in the home health setting); or enzymatic or autolytic and combine with a topical antimicrobial to reduce bioburden for about 2 weeks - then change over to a collagen (in theory no antimicrobial should be needed) If you do a collagen now with no antimicrobial component will just act as a substrate for the high MMP levels - this can do one of two things - #1 patient will be able to form his own extracellular matrix and he'll be fine or #2 he won't be able to do this and wound won't heal because he can't put his own collagen down....
Sep 15, 2019
Thank you. I appretiate your input. This is my first time using this service, so getting use to it. Thank you. Very knowledgeable
Sep 15, 2019
Thank you. I appretiate your input. This is my first time using this service, so getting use to it. Thank you. Very knowledgeable
Sep 15, 2019
* Info provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional.