Pressure wound treatment?

[azgirl]

What is the best way to treat and early pressure wound? It is red, sore and itchy but not yet open.

 

[Diane H]

The only way to treat a pressure sores is to get the weight/pressure off of it. There are no creams or dressings that will heal it while pressure is cutting off the blood supply. I assume that it is on your bottom since you are in a wheelchair. Removing pressure from these sores requires bedrest, ideally including some time spent lying on your sides. Time up in your chair has to be very limited and the chair has to have a good quality pressure relief cushion such as a ROHO.

Staying in bed is a really hard thing for most of us who are hanging on to the closest thing to a normal day as we can. I have done it when pain signaled that a pressure spot was heading to become a pressure sore. (Finally found out that the problem was that I was getting to "broad in the beam" for my too small ROHO to be able to float me!)

Anyway, a few days now can prevent a lot of pain and weeks or months in bed trying to get an open wound to heal. They don't heal like a bad gash. The tissue is dead, not just cut open, and healing requires filling in the area with a large amount of scar tissue. Scar tissue is living tissue but in spite of its appearance and popular belief, it is not strong. Hopefully that is enough info and I don't have to go into the risk of infection or the loss of protein from a leaking sore. Or tell you stories of pressure sores I have seen on patients. Preventing those out comes is more than worth a few days in bed beginning immediately!!!

While you are lying there, ticked off by the whole business, decide if you need a better seat cushion, more pressure breaks by tilting and/or reclining, or someone to do pressure mapping to find if lateral supports of your trunk or a custom cushion is needed because you are sitting with your weight off center. Or maybe you are sitting on a seam of clothing that is the problem. Jeans are often thick seamed. Does your panty line correspond to position of the pressure area? Don't believe for one minute that the sore won't come back if you haven't corrected the cause.

 

[lgelb]

Diane has very good advice. I would just add that pressure can also come from inadequate off-loading in bed, where you spend a lot of time, as well as the chair. It is worth looking at the sheet/overlay when you transfer out to see if it looks compromised (smushed) where the wound is and what the wound site looks like when you get up. Nutrition and hydration are also important to prevention.

Also, for those who aren't familiar with "pressure mapping," it's a machine that shows a colored map of how much pressure your cushion is putting on the different areas of your butt. "Seating clinics" in major hospitals, which see a lot of pts with spinal cord injury, cerebral palsy and the like, will have such a capability. Your ALS clinic can refer you or you can refer yourself, depending on the hospital/your insurance.

 

[azgirl]

Thanks so much Diane and Laurie, I was hoping to hear from you two. The sore is not on my backside but under my breasts. It seems to be caused by skin on skin, and is especially bad when I get overheated and sweat is involved. I've tried keeping it dry with powder, with a tissue or cloth Kept So that the skin doesn't rub. Also tried Aquaphor for a few days. My nurse suggested trying bacitracin, which I did for three days and there was no change. I'm afraid it's going to open up and then there will be A major problem. It's about 1 inch high and 4 inches long and quite painful, this all started about three weeks ago.

I spent about 12 hours a day in bed and so far my mattress and adjustable dad are working well. The other 12 hours I'm in my wheelchair and it has the ROHO Seat cushion, so no problems yet on the backside.

Any suggestions for this type of store?

 

[affected]

Kaye can you tape your breast up a bit to relieve pressure and get some air circulating underneath?

 

[Nikki J]

Are you sure it is a pressure issue and not a fungal infection? That is a very common location for one, red, sore and itchy sounds like one

 

[affected]

Good point from Nikki about fungal possibilities. For some reason PALS seem very prone to fungal infections and they are sore and itchy, and your mention of it becoming worse when you feel overheated. Chris developed lots of these patches.

Have you had it checked by a doctor? They can even do a swab if not sure to check what is growing in there.

Antifungal creams are great, but you have to balance between enough cream to treat and not too much that keeps it all too moist. Powder is often bad as when you sweat it becomes a sludge that fungus just loves. However there are antifungal powders, but again that balance of not too much.

Taping the breast up slightly may help for a few days with an antifungal treatment.

 

[azgirl]

Thanks all, it may be fungal now that I read more about it. Going to drop by the doctor tomorrow. So glad that this forum is fullof so many knowledgeable people!

ALS just keeps piling on

 

[lgelb]

Given the location info, I agree a fungus is more likely, and it's also true that "antifungal" creams/powders are hit and miss. That's not a site they can really penetrate efficiently + they are often irritants.

In addition to morning/night soap/water/totally dry, would spray w/ grapefruit seed extract (Nutribiotic or similar) after you are settled in your chair for the day, and do the same once settled in bed + dust very lightly w/ the unscented body powder version of it at bedtime. Maybe apply some wound honey to the raised region. And of course try to keep the area cool and dry based on whatever you are or are not wearing.

 

[manding]

You have to keep moving around or the sore will break the skin. In the meanwhile check out this old remedy Calmoseptine Ointment Tube 4 Oz. Amazon will sell you a 3-pack but you might be able to find it a some local high-end pharmacy. Seems to work pretty good on lot of sores as long as the skin in not broken. Other recommendation once the sore ha broken the skin.

 

[Diane H]

Unless you have gigantic boobs, that isn't a pressure sore! I have a recurring problem with "jock itch" since being seated in my chair all day. A good soapy wash and rinse and thorough drying followed by an antifungal cream or powder stops it. Especially in the crotch, towel drying doesn't really get me dry. Time to air dry helps but a quickly blow dry with a hair dryer on cool is faster. If it doesn't respond to the over the counter stuff for athletes foot or jock itch with improvement in just one day, you need something prescription strength.

 

[Green Queen]

Kaye you poor thing! It sounds dreadful for you!
You've been given some great advice, fingers crossed!

Yet more proof that boobs are for men, not women!

After you have this sorted, could you try singlets with the built in bra for support? It's not really supportive, but may help with the skin on skin issue without the hassle of an actual bra.

All the best with it.

 

[twitchykitty]

As well as a anti fungal cream etc you could try a combine dressing , basically just a thick dressing that could soak up any moisture/sweat to keep it dry as possible till it healed . Just a thought if you can't air the area out or keep it dryish

 

[gooseberry]

Sounds fungal...I get them with some regularity. They usually look shiny in the middle of the red area.

 

[azgirl]

Thanks for all your advice, and thought I would give an update. By last night I was so miserable, almost in tears, and ready to try anything. I have been taking apple cider vinegar for six months and it has helped with keeping my throat clear of mucus. After deciding I was dealing with a fungal infection I read that the vinegar can be used on such skin infections. There was so much pain that I was willing to give it a try. We applied a mixture of 50-50 vinegar and water with a cutip. It stung like hell but after about 30 minutes the pain subsided. This morning it looks much much better so after shower and drying with the cool hairdryer we reapplied. There is a bit of a rash left but the pain is gone. We are watching it carefully and will contact the doctor if it does not clear up

Sure never thought I would become a person who discusses What used to be private parts in public!