Posterior neck wound

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We have a pt. who is 53 y.o. female with no past medical history who was admitted on 10/17/22 with DKA, hypokalemia, undiagnosed DM, and cellulitis to the posterior neck. Her DKA and electrolyte imbalance were treated. She developed a diffuse rash throughout her body while she was in the hospital which has since resolved. CT of neck showed severe cellulitis. Blood cultures grew gram-positive cocci. MSSA blood culture and cephazolin was started per ID. Repeat CT consistent with abscess of the suboccipital muscle group surrounding by phlegmon. Drainage from neck was cultured and grew MSSA. Pt. was taken OR for I&D on 10/29/22. Two drains placed. Daily packing dressing changes, may repeat I&D if necessary.

My question is, we are a small rural hospital with little to no resources available in complex wound care - both in the acute care setting and the outpatient community setting. Due to patient's hair, it's very difficult to get a good seal on dressings and we have had to get creative. What are some options or recommendations for long term wound care plan in a wound that is this extensive and in this difficult location on the body? Currently there is circumferential undermining and significant packing needed. There is also significant pain which is being well managed at the moment.

Nov 2, 2022 by Nora Kolnaski,

1 replies

Elaine Horibe Song
MD, PhD, MBA

Hi Nora,
Discussed with Cathy Milne, here are her thoughts: it seems like the wound still needs further debridement, wondering if the patient has been evaluated by plastic surgery yet? If this is not available in your community, it might be worth trying to arrange a televisit. As for securing the dressing, place hydrocolloid strips on the healthy skin, and you can tape the dressing to the hydrocolloid strips that are surrounding the wound. Another thought is to surround the wound with Dermatac drape and tape dressings to that. Might want to look up where to get turbans for breast cancer, which might additionally help secure dressing.
If unable to get skin surrounding the wound dry, may use marathon liquid skin sealant or 3M Advanced Cavilon skin protectant. Once protectant is allowed to dry, you'll be able to get things to stick, but don't use this underneath Dermatac drape.
If available and not contraindicated, may use NPWT with application of cleansing solution (e.g. Veraflo). See case study: https://woundreference.com/app/topic?id=how-to-select-and-apply-negative-pressure-wound-therapy-devices&find=how+to+apply+wound+vac#how-to-assess-effectiveness-of-npwt
Hope this helps

Nov 2, 2022

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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