Wednesday, 25 November 2009

A wardrobe of wounds dressings

A different kind of person

The illness I had has been a road of experiences I probably would never have travelled by any other means – I could see nothing that would have brought me in contact with many of the things I have learnt about doctors, nurses, hospitals, care and many other areas of health and healthcare management.

Most importantly, that aspect of humanity that moves beyond sympathy to empathy, the sharing of common interests or experiences and the willingness of many to go long beyond the call of duty for so little remuneration for their services and they gain such satisfaction, fulfilment and contentment for what they do.

As one thinks about these things you can only count your blessings and be in gratitude for meeting people in whom hope and enthusiasm is in ascendancy whilst cynicism, scepticism and apathy finds little place to take root – we can hopefully learn from them that the whole wide selfish and independent world owes a lot more to the better virtues of these people dotted around our lives than the independent spirit of grabbing all you can get for the adrenalin fix of winning against everyone else.

Do not touch those wounds

My last visit to hospital was another revelation in wounds management, now, I have always been of the impression that all wounds need to be treated directly, plasters and bandages need to be under-laid with ointments, potions or some sort of rub, it needs to be picked at, if not molested till it all turns out right – well, that, I have learnt is wrong.

In my case, the cancer lesions which present themselves as deep tissue wounds were never touched except when biopsies were taken, they were covered with a gauze, then some lint to absorb and pus or draining fluids, then bandaged up.

The only time the wounds were touched was a good 4 weeks into my treatment when the wounds nurse decided all the necrotic tissue had to come off to allow fresh tissue to breathe and heal over.

Greasy bits and old things

Until then, the gauze applied as a very greasy fine netting which kept the wounds moist and for a while, it was the best course of treatment, that gauze came under the marketing name of Cuticerin [1]. Before then, when I visited my doctor, she removed the cotton wool which I have put on the wound and as you know that tugs at the main wound if any exudate were produced and it did not help in the healing process.

Then she used Betadine [2], a gauze impregnated with a brownish household disinfectant for wounds, but as I got to the hospital, I was told that kind of treatment was old because it stained the wound and did not help in identifying clearly if the wound was healing or not. I would suppose the brown colour comes from the iodine content.

Gauzes with transparent or colourless impregnations were the in-thing as far as they were concerned, in fact, there was no trace of Betadine in the hospital.

So, for weeks, my wounds were dressed with Cuticerin, until the neighbourhood nurse got concerned that the moistness seemed to be spreading to other seemingly healthy areas and healing did not seem to be progressing as they thought it should.

Ionised from greasy looks

This caused the re-evaluation that had the specialists think things were maybe fine, but in need of the opinion of the wounds nurse.

The wounds nurse had one look and decided the gauze should change whilst cutting away the necrotic tissue. That gauze was an Antimicrobial Calcium Alginate Wound Dressing, generally known as alginate to the industry and this with the tradename Suprasorb A [3].

The active component of this dressing was the silver oxide ions which bind with bacteria in wounds, hence lowering infection; more so, it was dry and very absorbent. You can leave the dressing on for as long as 7 days till it literally falls off, that way you never adversely tampered with the wound or the platelets formed as part of the healing process.

I did not know that there was this big debate about wounds management in the medical world between moist dressings and dry dressings, but the use of alginate represented great progress in the management of the wounds I had.

All those deteriorating moist areas dried up, adhered to the dressing and within weeks all the areas were dry and healing progressing apace. In the process a lot more necrotic tissue could be removed.

Good feeling touch

On my last visit to the hospital, the doctor had a look at my foot and decided the alginate dressing was now not as effective as it should be because the core area of the wound was dry apart from some small areas producing fluid and the source of most of the pain I suffered.

This doctor apparently knows a lot about wounds management and changed the dressing to a silicone based film with 1 millimetre diameter holes commonly called Mepitel [4]. This film places snugly on the wound and allows it to “breathe” and all seepage or exudate to be soaked up on the lint compress which should be thick enough to absorb the fluids if any.

Removing it is also kinder to the wound surface and it can last up 7 days, though the lint dressing should be changed daily as advised.

I must say, through experience, I have learnt quite a bit about wound care, it is all very interesting, I doubt if a new type of dressing would be needed between now and the full healing of the wounds.

Sources

[1] Smith & Nephew - Cuticerin*

[2] Betadine - Wikipedia, the free encyclopedia

[3] Activa Healthcare - Products - Suprasorb A

[4] Mepitel Dressings Datacard

No comments: