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This friction and shear ulcer is not responding to any treatment, any suggestions? I have been using allograft injections which is helping but patient is not very compliant when it comes to cleaning and making sure the area is try. We have been using Vaseline for the friction. Going to use zinc oxide next. Would love any more suggestions.
Oct 4, 2020 by Bradley Olsen, APRN
3 replies
Cathy Milne
APRN, MSN, CWOCN-AP
Hi Bradley!
This is an unusual wound for just friction and shear...would love more information...What is the patient’s medical history? Is the patient incontinent? What treatments have you tried already? How long has the wound been open? Have you seen a need to do a biopsy?
Thanks!
Cathy Milne
Oct 4, 2020
Yes patient is incontinent of urine, is mobile but not much, we have done two DNA sequences of bacteria and treated appropriately! Wound has been open for months
Oct 4, 2020
Elaine Horibe Song
MD, PhD, MBA
Hi Bradley,
Cathy asked very good questions, and probably has more to add to this post. In briefly talking to Dr Worth and Tiffany Hamm this morning, some of the thoughts we had were related to how to address the underlying cause or cofactors that impede healing of the ulcer. Assuming the condition is caused or worsened by excessive moisture and friction, it'd be important to first ensure the basics are covered:
1. Divert or contain the urine: for instance, with external urinary catheter (e.g. purewick), absorbent pads
2. Ensure that skin is dry and protected from further exposure to irritants and friction/shear: options include compresses with 1:40 Burow's solution or dilute vinegar followed by fanning; washcloth between folds with daily changes or moisture-wicking textile with silver (e.g. interdry)
3. Promote healing of existing lesion: gentle cleansing (pat, not rub; cleanser that matches the pH of the skin), moisturization, and application of a skin protectant or moisture barrier. As you pointed out, zinc oxide is frequently used. Some of the combination barriers include Desitin (zinc oxide, cod liver oil, talc), Triple Paste (petrolatum, aluminum acetate, zinc oxide). Washcloths may be impregnated with barrier
4. Prevent/treat any associated cutaneous infection. 
Looking at the picture though, it is hard to tell if the ulcer is full-thickness or partial-thickness. Many lesions purely due to moisture-associated skin damage / friction tend to remain partial-thickness. If there are no signs of improvement despite adequate care (e.g. measures mentioned above), reassessment and consideration of differential diagnoses would be appropriate, including consideration of biopsy to rule out other causes. Hope this helps
Oct 5, 2020
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