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Dressings and caring for necrotic toe

Discussion in 'Diabetic Foot & Wound Management' started by Richie, Mar 19, 2009.

  1. Richie

    Richie Member

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    Hi guys

    What advice can you give for caring for necrotic toes without ischemia? Say you have a small toe that is non-viable due to frostbite. What would be the best way to ensure a safe and timely auto-amputation.
  2. zaffie

    zaffie Active Member

    Not sure where you are based. In UK I have found the tissue viability nurse service of great help.
    TVN has a lot of power in UK I would take their advice
  3. Tuckersm

    Tuckersm Well-Known Member

    Paint with betadine daily. This helps the necrotic part shrink, keeps it dry and prevents infection

    GHARKIN Member

    I would tend to stick woth iodine based dressings, either betadine spray as previously suggested or inadine with a dry sterile dressing. These tend to have the effect of further dehydrating the tissues while also providing antimicrobial cover.

    Other than that, nothing you can do but give it time.
  5. Footsies

    Footsies Active Member

    I agree that betadine would be the best here - you don't want to do anything to macerate the area and cause "wet gangrene" - what do you all think?
  6. cwiebelt

    cwiebelt Active Member

    I Rithcie,

    I tend t agree with the general theme of Betadine liquid applied to the affected toe. As perviously mentioned this helps protect from infection and does not maccerate the tissue.
    It will take time for the toe or part of the toe to auto amputate but give it time.
    it can be a slow process at times


  7. tsdefeet

    tsdefeet Member

    Wet to dry dressings with dilute (1:1000) betadine/saline.
    Debrides necrotic tissue, anti microbial allow wound to demarcate
    then do what you must. I am assuming appropriate abx coverage.
  8. Rie

    Rie Guest

    Past experience for me would back up the Betadine theory, with a simple dry dressing to protect if that is the only way forward. However I would also discuss with our TVN and possibly podiatric surgeon, especially as you specify not ischaemic - can be a long wait otherwise! If it is due to frostbite rather than an underlying systemic disease would a quick surgical removal not be a track to follow. Is it really necessary to put the patient (assuming otherwise healthy) through the long process of auto-amputation, if a (relatively) quick and minor op could remove the digit, provide good wound closure in a well vascularised area and combined with appropriate medical/pharmacological cover as required, lead to a rapid healing process (followed of course by an urgent referral to the Biomechanics Service for appropriate orthotics once healed)? If the patient has an underlying medical condition such as DM, RhA, PVD etc, then totally different picture, but the original thread does specify not ischaemic!

  9. Tuckersm

    Tuckersm Well-Known Member

    Attached hopefully are the results of a heater burn to a diabetic foot.

    The whole process has been able to be managed on an out patient basis, with the patient continuing to work full time. as wellas the povodine iodine we stabilised the foot in a CAM walker until the toe auto amputated. If he had undergone surgery the amp site would have been quite a bit more proximally.

    Attached Files:

  10. footsiegirl

    footsiegirl Active Member

    From my nursing experience, i would go with the above advice (except I dont think prolonged use of iodine is advantageous , I would suggest no longer than 6 weeks) . Then change to non adherent dressings (NA dressing). If it begins to odour then charcoal dressings to prevent patient distress.

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