Dressing of Necrotic Wounds

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Hi All,

I have been treating an 87 year old man recently who has Atrial Fibrillation and Polycythaemia which he takes medication for. At his initial appointment he had wounds to the left second and fifth toes that were infected and he had cellulitis from the toes to the midfoot. He was prescribed antibiotics which have now cleared the infection and cellulitis. Vascular assessment concluded that both Dorsalis Pedis and Posterior Tibial pulses were faint, capillary filling time was delayed, temperature gradient was warm to cool and the patient explained he has restless legs in bed at night which is worse on the left side. The patient was referred urgently to the specialist vascular team and has since undergone an angiogram and angioplasty to the left leg.

The wounds are now dry and covered in a hard layer of dark necrotic tissue. Is it best to leave this in place and continue to protect from infection and further tissue damage and let it come off by itself? Would it be better to remove the necrotic tissue and create a better wound bed for healing? If I remove the necrotic tissue I was thinking of using medihoney gel sheet to do this.

Any advice and opinion would be greatly received.

 

I would suggest referring this patient (with their permission) to a High Risk Foot Clinic.
Regards
Ros

 

I agree with Ros, I would refer because the role of the DFC is to manage the eschar / wound in the context of the patient. Hard and well adhered eschars are left in situ to shrink back and reduce at the edges often unless they form a rigid body disturbing the wound below, and loose fluctuant eschars or rigid detached ones might be amenable to reduction in order to minimise the amount of dead tissue around the wound.
They will also be able to get the AF evaluated by cardiology if necessary, and monitor the vascular supply post angioplasty to ensure that re-obstruction is identified early and is not mistaken for reperfusion pain. Infection and prompt treatment of it with i/v or oral antibiotics pending sensitivities runs along side this often as well.
Hope that helps
Jane

 

Thank you Ros and Jane, your advice has been helpful.

Regards
Sarah