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Old 04-26-2010, 11:13 AM   #1
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Necrotic Wound and Unna Boot

Necrotic wound( 7cm x 7cm) circle on lower leg from crush injury in healthy 44 year old. Dr is using Santyl along with other methods of debridement and continuing to wrap leg in a Unna boot.

Still slight swelling in the ankle and foot. Once the necrotic tissue and slough are removed, is the Unna boot necessary? The Dr. says the Unna boot stays on till the wound heals.

7 weeks since the accident. I find very little online about Unna boots and necrotic wounds. The Unna boot is restricting for rehab of muscles. Any advice is helpful.

 
Old 04-26-2010, 03:33 PM   #2
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Re: Necrotic Wound and Unna Boot

Santyl is a good choice for necrotic wounds. It is an enzymatic debrider and will help to dissolve the necrotic tissue.

7cm x 7cm is a large wound, when you say he is using other methods to debride the wound do you mean he's using sharp debridement?

The only problem I see is santyl is meant to be applied daily and you can't do that if you're wearing an unna boot. The unna boot stays on anywhere from 3 to 7 days. I'm not sure why he's using the unna boot, are you having a lot of swelling?

 
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Old 04-27-2010, 05:01 AM   #3
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Re: Necrotic Wound and Unna Boot

[QUOTE=Mari526;4233910]Santyl is a good choice for necrotic wounds. It is an enzymatic debrider and will help to dissolve the necrotic tissue.

7cm x 7cm is a large wound, when you say he is using other methods to debride the wound do you mean he's using sharp debridement?

The only problem I see is santyl is meant to be applied daily and you can't do that if you're wearing an unna boot. The unna boot stays on anywhere from 3 to 7 days. I'm not sure why he's using the unna boot, are you having a lot of swelling?[/QUOTE]

 
Old 04-27-2010, 05:11 AM   #4
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Re: Necrotic Wound and Unna Boot

I still have slight swelling in the ankle & foot. Injury was to the lower leg only. No crush impact to the ankle or foot. All black eschar and most slough have been removed. The wound looks more red/pink with some slough left. The Dr. used a scalpel to debride and this week will try some type of wash. The Unna boot stays on for 7 days.During last weeks wrap with santyl, gauze was used instead of the usual material. I was told the gauze would not keep it as moist as the other material. I just want to know if the Unna boot is really necessary to heal the necrotic wound or would other wraps work? The Unna boot is restricting and doesn't allow proper rehab for the muscles/nerves in the leg that were injured. Most info for use of the Unna boot refers to venous ulcers.

 
Old 04-27-2010, 08:11 AM   #5
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Re: Necrotic Wound and Unna Boot

There may be other reasons why he's using the unna boot. The unna boot offers compression and support to the lower leg by turning into a semi rigid cast. Your doctor may want this to increase circulation to the area, increased circulation will help the wound to heal faster.

Tell the doctor the problem you're having when attempting therapy. Ask the doctor if you can switch to wrapping with Coban instead. The coban will offer some compression/support, but is a little more flexible than the unna boot.

 
Old 05-03-2010, 06:11 AM   #6
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Re: Necrotic Wound and Unna Boot

[QUOTE=Mari526;4234351]There may be other reasons why he's using the unna boot. The unna boot offers compression and support to the lower leg by turning into a semi rigid cast. Your doctor may want this to increase circulation to the area, increased circulation will help the wound to heal faster.

Tell the doctor the problem you're having when attempting therapy. Ask the doctor if you can switch to wrapping with Coban instead. The coban will offer some compression/support, but is a little more flexible than the unna boot.[/QUOTE]

 
Old 05-03-2010, 06:17 AM   #7
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Re: Necrotic Wound and Unna Boot

[QUOTE=Gilliam;4238252][/QUOT
Sharp debridement was preformed at last visit and Santyl is no longer being used. Granulated tissue is well established. Dressing was changed to Silver Alginate. Unna boot was still used and will be changed in 7 days. The Dr. says the Unna boot stays on till the wound closes. Is this the quickest, best way to close this wound? With the least amount of scarring? Wound is shrinking in size maybe 6.5 cm.

 
Old 05-03-2010, 02:57 PM   #8
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Re: Necrotic Wound and Unna Boot

I don't think you have much choice, your doctor does not seem very flexible. The silver alginate is the only choice if the unna boot is staying on for 7 days.

Your question asking if this is the best, quickest way is debatible. I see wounds heal pretty quickly when the dressing is changed every other days either using a silver gel or alginate depending on the drainage.

 
Old 05-31-2010, 11:24 AM   #9
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Re: Necrotic Wound and Unna Boot

[QUOTE=Mari526;4238597]I don't think you have much choice, your doctor does not seem very flexible. The silver alginate is the only choice if the unna boot is staying on for 7 days.

Your question asking if this is the best, quickest way is debatible. I see wounds heal pretty quickly when the dressing is changed every other days either using a silver gel or alginate depending on the drainage.[/QUOTE]
Finally out of unna boot. Doctor changed course based on my insistance. Wound has gone through silver alginate, silver nitrate , santyl & more sharp debridement and is now bandaged with collegen gel. After this, it closed in a lot faster. Maybe 3.5cm by 3cm.
Concern now is small top necrotic wound/hole. 1cm wide but tunnels down 1.5 cm. It is not filling in. Doctor tried Promogran and me changing the dressing every other day. Too early for Promogran. Devitalized tissue still present. Now I am inserting antimicrobial gauze strip into the hole every other day. Hole tunnels over to another wound that closed over maybe too soon. A culture was done for the first time on Friday and I am on Bactrim. I am a little concerned about the hole. Dr. is on vacation this week so I will see the RN. Any ideas on what might happen next?

 
Old 05-31-2010, 12:54 PM   #10
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Re: Necrotic Wound and Unna Boot

[QUOTE=Gilliam;4256534]Finally out of unna boot. Doctor changed course based on my insistance. Wound has gone through silver alginate, silver nitrate , santyl & more sharp debridement and is now bandaged with collegen gel. After this, it closed in a lot faster. Maybe 3.5cm by 3cm.
Concern now is small top necrotic wound/hole. 1cm wide but tunnels down 1.5 cm. It is not filling in. Doctor tried Promogran and me changing the dressing every other day. Too early for Promogran. Devitalized tissue still present. Now I am inserting antimicrobial gauze strip into the hole every other day. Hole tunnels over to another wound that closed over maybe too soon. A culture was done for the first time on Friday and I am on Bactrim. I am a little concerned about the hole. Dr. is on vacation this week so I will see the RN. Any ideas on what might happen next?[/QUOTE]

You need to irrigate a tunneled wound with normal saline then lightly pack the wound with packing gauze moistened with a silver wound gel. I would suggest the dressings be changed daily.

Also, are you taking at 1,000 mg of Vitamin C daily? It is recommended for improved wound healing as well as increasing your protein intake.

Promogran wouldn't be the right choice due to the likelihood the wound is infected. All wounds have bacteria it only becomes a problem when they are heavily colonized.

 
Old 05-31-2010, 05:12 PM   #11
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Re: Necrotic Wound and Unna Boot

Try taking vitamin c 500mg twice per day, and zinc 50mg twice per day - can help speed healing.

 
Old 06-01-2010, 05:56 AM   #12
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Re: Necrotic Wound and Unna Boot

[QUOTE=Mari526;4256600]You need to irrigate a tunneled wound with normal saline then lightly pack the wound with packing gauze moistened with a silver wound gel. I would suggest the dressings be changed daily.

Also, are you taking at 1,000 mg of Vitamin C daily? It is recommended for improved wound healing as well as increasing your protein intake.

Promogran wouldn't be the right choice due to the likelihood the wound is infected. All wounds have bacteria it only becomes a problem when they are heavily colonized.[/QUOTE]

 
Old 06-01-2010, 06:00 AM   #13
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Re: Necrotic Wound and Unna Boot

[QUOTE=Gilliam;4256974][/QUOTE]
So packing the wound with antimicrobial gauze strip everyday is not appropriate course of action? I am not squirting saline into the hole at time of each dressing. Should I be doing that?
I see the RN on Friday. I am taking vitamin C, Zinc, and multi vitamin. Plus currently on Bactrim.

 
Old 06-02-2010, 07:39 PM   #14
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Re: Necrotic Wound and Unna Boot

[QUOTE=Gilliam;4256975]So packing the wound with antimicrobial gauze strip everyday is not appropriate course of action? I am not squirting saline into the hole at time of each dressing. Should I be doing that?
I see the RN on Friday. I am taking vitamin C, Zinc, and multi vitamin. Plus currently on Bactrim.[/QUOTE]

You should be irrigating the wound with normal saline using a syringe. What kind of antimicrobial strip are you using? Is it Iodoform gauze? That's okay to use if there is a lot of drainage. If the wound doesn't have a lot of drainage then packing it lightly with packing gauze moistened with silver wound gel works well.

Make sure to increase your protein intake as this will help the wound to heal faster.

 
Old 06-21-2010, 06:54 AM   #15
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Re: Necrotic Wound and Unna Boot

[QUOTE=Mari526;4258217]You should be irrigating the wound with normal saline using a syringe. What kind of antimicrobial strip are you using? Is it Iodoform gauze? That's okay to use if there is a lot of drainage. If the wound doesn't have a lot of drainage then packing it lightly with packing gauze moistened with silver wound gel works well.

Make sure to increase your protein intake as this will help the wound to heal faster.[/QUOTE]

 
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