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Hi, I'm working with my orthopedic surgeon to provide wound care to a patient's hand that's now undergone 2 surgeries for a removal of an abscess that started from IV drug use. There are some sutures and some areas that are healing by secondary intention. Wondering what some good options are for wound care in this situation. The deeper area of the wound between the 2nd & 3rd digits (right hand) in the web area go down to the nerves. He currently has an order for betaine soaks and dry sterile gauze packing/wrapping BID.... this doesn't seem to be the most effective, he was going to look into getting another opinion from a hand specialty surgeon, but wanted to consult the wound world. Thanks
Nov 9, 2021 by Nora Kolnaski,
3 replies
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, CRNFA
Hi Nora!
Has he been worked up for osteomyelitis and treated if so? What is his social situation/hygiene/access to medical supplies? Is he insured? (Negative pressure could be an option if wound bed continues to granulated over the nerves you stayed were exposed, but may be technically challenging). Otherwise from the small area I can see, assuming no current infection, enzymatic Debridement may also be a good option. I would consider some type of immobilization as able due to the highly articulating areas that may pose a problem with healing (make sure to involve your PT comrades for more info here, the hand can be tricky).

Nutrition and hydration, as always, can be optimized for healing. This is wholly dependent upon patient social situation and compliance.
Nov 9, 2021
Hi,
Thank you for the response. Negative for osteomyelitis. She lives at home with her mom, unclear of how clean the environment is. She has medicaid. Will have home health nurse come do visits however they likely cannot go out to the house as often as necessary for the dressing changes so plan is to do some teaching with pt. & her mom. Looking at adding some hydrogel to the wound beds as they are starting to dry out from the dry gauze dressing. Any other topical recommendations? She will f/u w/surgeon in out patient setting, unclear how compliant she will be.
Nov 9, 2021
Elaine Horibe Song
MD, PhD, MBA
Hi Nora,
Sharing Scott Robinson MD's thoughts as well:
Piggybacking on Samantha's reply, it looks like the wound bed could still use some debridement. Also, the margin near the base of the index finger seems a bit necrotic. Would conservative sharp wound debridement for faster removal of necrotic tissue be an option? Regardless, the first stitch near the base of the index finger (black area) could be removed, to allow any exudate to more easily drain and facilitate dressing change. If the patient doesn't have a recent wound culture (besides culture obtained upon I&D), a wound culture could be obtained after debridement if the wound is not healing as expected, to guide antibiotic therapy if indicated. For moisture management, hydrogel as you stated could be an option if the wound bed is dry. Another option is fluid based silver alginate (e.g. Algidex Ag paste), a wound filler with antimicrobial properties. See more here https://woundreference.com/app/topic?id=dressing-brands-quick-summary&find=algidex+paste
In addition to the above, the interventions Samantha mentioned would be important as well
Nov 9, 2021
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