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Basic Wound Care Tips
1.3k Plays2 years ago
Miranda and Josh cover some quick wound care tips.
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Transcript
Introduction & Focus on Wound Care
00:00:06
Speaker
Hi, I'm Josh McDonald. And I'm Miranda Materi, and we are Hand Therapy Academy. Today, we're going to cover some wound care tips. We're not going to get too deep in the weeds on the technicalities of things. We're just going to talk about some things that are good to teach your patients about and some things that are good for us as therapists. So let's jump into them.
Importance of Range of Motion with Wounds
00:00:23
Speaker
Miranda, range of motion. What do you tell patients or new therapists about range of motion when they've got some complicated wound going on?
00:00:30
Speaker
So wounds are okay to perform range of motion with, right? So even if it's crossing a joint, it is okay. The only time it is not okay is if there is a skin graft of some sort, right? Where we're trying to hold that area immobilized. And usually that immobilization period is from seven, anywhere from five to 14 days. So if there's a skin graft, no, but if there is a wound, we do want you moving it. We don't want the joints to get stiff. And also sometimes that movement can actually help with some of the healing stuff.
00:00:59
Speaker
Movement is OK. And with good clinical judgment, patients will be scared. And so we need to kind of de-escalate that a little bit. But at the same point, if it's crossing the distal polymer crease, we don't want them going at a massive extension. So good clinical judgment. Short arc range of motion is a fantastic way, like you said, to kind of prime that healing pump a little bit. Yeah, yeah. We're not going to be doing maximum extension or flexion stretching at that joint. But yeah, a little bit is good, right? Yeah, yeah.
Debriding Devitalized Tissue
00:01:27
Speaker
Okay, what about, what do you do with a de-vitalized or dead tissue? Do you de-breed it? Do you leave it? What is your tip on that? I prefer for sure to de-breed it. I want to get dead, de-vitalized tissue out of the way. It can cover and hide infections. It can trap bacteria. Even like someone who had an open carpal tunnel release and they got that little bit of dead skin hanging out there, it'll eventually slough off. But is it hiding something? Is it not closing all the way or de-hissing underneath there?
00:01:57
Speaker
If you don't remove that devitalized tissue, you don't know. I'm going to be careful and only remove devitalized. I tell like students, I'm like a sunburn. I'm not going to take it to where it removes more vital tissue. I'm just going to stop at the edge, trim it down, but I want to see what's going on underneath there. Great.
Avoiding Aggressive Dressings & Solutions
00:02:14
Speaker
Yeah. So how about wet to dry dressings? What do you think about that?
00:02:18
Speaker
Well, so from what I have read recently and from what I understand, we are not doing wet to dry anymore. They found that they're too aggressive and they can interrupt even some of the healing tissues. So what to dries are out. I do still think that some people are doing them and I think there is some benefit. But like you said, using your clinical judgment. But for the most part, I don't do wet to dry and I don't get a lot of
00:02:46
Speaker
you don't orders for it, so. Yeah. When you pull that now dry, previously wet gauze packing whatever out of there, yes, it's taking all the dead stuff, but it's also taking away good positive granular tissue that you need and it's causing increased blood like bleeding on top of the surface and it just stalls everything out. So yeah, wet to dry is not a fantastic plan of care right now. Right. What about hydrogen peroxide? Are you using it? Are you telling your patients to use it?
00:03:14
Speaker
This is one that's relatively new for me. Up until recently, I was doing the 50-50 mix of water and hydrogen peroxide. I tell patients put a little half a cap full of hydrogen peroxide, half a water, use a Q-tip, clean the pin site. I've learned recently from a talk at a surgeon's conference
00:03:30
Speaker
that that serves really well at killing the biologic tissue that we want, but doesn't do a fantastic job of killing the bacterial cells, the microbes, that kind of thing. So they just say soapy water. If the pin site is clean and dry and looks healthy without excessive redness or swelling, leave it alone, keep it lightly covered. Don't wrap pins with zero form, because again, that traps in moisture and microbes and bacteria. So clean and dry and covered is the way to go. No hydrogen peroxide. Okay, that was a good tip.
Post-Procedure Care & Surgeon Preferences
00:04:00
Speaker
How about showering? How soon can we get a wound wet?
00:04:04
Speaker
So I believe the newest research from the CDC says that 48 hours. So pretty soon after the procedure and by what we're not like sticking it in a bathtub and submerging it, but just letting warm water run over it. They say it's safe to do it at 48 hours. Of course, with all of these like little tips and caveats, always find out what your surgeon's preferences are because they're all very different, right? So usually when you're first meeting a surgeon or you have a patient without
00:04:32
Speaker
wound, you want to ask what their preferences are so you're meeting their goals and you want to match what the surgeon's saying, right? You don't want to be conflicting with what they're telling the patient.
00:04:42
Speaker
Yeah, we definitely want to match our surgeons preferences. We can educate them also too. So if you find like patients are leaving those dressings on for super extended periods of time, say, Hey, can we get that off? Can we clean it? Take CDC articles, those kinds of things to your surgeon to help educate them too. And say, Hey, this is an okay thing. Are you okay with me doing this? But yeah, that flowing water, soapy water, soap is all antibacterial. That's what makes it soap. That's going to be effective. And it washes away some of the contaminants that we don't want to there anyway. So
00:05:10
Speaker
Yeah. Okay. So since you talked about, so are you doing like a foam soap, a liquid soap? Um, uh, what I learned from, uh, again, from a surgeon's conference is any general antibacterial soap that you would use in the shower or sink side is perfectly fine. As long as the water is washing away in the process. Okay. Great. Yeah. Yeah.
Choosing the Right Ointment
00:05:30
Speaker
Okay, what about ointments and creams? Bassetracin, Neosporin, those, are you using those or you're not? Yeah. Neosporin has, literature finds that it has a significantly higher rate of contact dermatitis. So we're staying away from Neosporin, but Bassetracin may be a triple antibiotic ointment, but mostly Bassetracin is what I'll use in the clinic.
00:05:49
Speaker
and I use it very sparingly. Two times when I'll use it is if there's a differential between the wound bed height and the height of the neighboring epithelial cells of the healthy tissue. I'll use that to kind of quote unquote pack it a little bit and that will help those epithelial cells migrate in.
00:06:05
Speaker
I may do that instead with a zero form product or something but I'll also do it if that wound is getting a little bit of desiccation or drying out if it's starting to crack at that wound bed. I tell patients put just a very small amount on your finger and apply it to that wound just to make it shiny. We're not globbing on the size of a grape
00:06:24
Speaker
and covering it. That imparts maceration to the neighboring, healthy, non-wound tissues, so very small amounts, but very sparingly. The body produces a good amount of humidity, and so if that wound has good moisture, there's no need to get fancy with creams and lotions and all that stuff. Nothing more than like a basitracin, nothing with scents or other features to them. Right, yeah.
Maintaining Moisture Balance
00:06:49
Speaker
How do you feel about letting wounds air out?
00:06:52
Speaker
So I will say if they're very macerated, you do want to let them air out, but not this concept where you're going all day with your wound open, right? So we know that a moist wound heals much better. And we know that when it's because of that healing better, we're less likely to have scar adhesions and those sorts of things. So keeping it moist is important. And also, it helps, you know, if you have a deep wound, it helps from like really that getting that divot in there. So making sure that it's moist is
00:07:20
Speaker
key if it is macerated I might say hey you just got out of the shower pad it dry and let it air out you know for 10-20 minutes and then put your dressing back on.
00:07:31
Speaker
Yeah. The key concept in most wound care seems to be the level of moisture or humidity in that environment and making sure it's not too wet for maceration, not too dry for desiccation in that happy medium. And then everything we're doing is trying to find that balance. So in general, they should be looking at that wound every day, undressing it, finding, you know, is it too wet? Is it too dry? They can text us pictures and say like, is this okay? They get wound dressings in the clinic and we educate them on what wounds should and shouldn't look like. But managing that moisture is key.
Regular Assessment & Care Plan Updates
00:08:01
Speaker
Right, and then I think when they do have these booms, seeing them, you know, early on more frequently so you can help show them the signs of what to look for, you take it off and it's really masqueraded, you're like, oh, see that part where it looks like you sat in the bathtub too long, that's too wet, right? So giving them those key things so they know what to look for, like you said, is really important.
00:08:18
Speaker
Yeah. And another quick tip is not sticking with one wound care plan for more than two weeks. We're not talking about patients that have a dedicated wound care nurse and they're kind of off a different plan, but clinical presentation stuff. If you're doing the same thing for more than two weeks, it's not working and that wound has stalled. So if you're using zero form for two weeks, if you're using
00:08:39
Speaker
you know, a hydrogel or something like that for more than two weeks, you need to change your plan because it's not being effective at progressing that wound. So nothing more than two weeks on the same wound care plan just to make sure we're advancing it well. Okay, great.
Conclusion & Contact Information
00:08:53
Speaker
All right. That covers some quick tips with wound care. Of course, there's a lot more to it, but those are just some quick highlights that might help you in your day to day clinic. All right, guys, if you have any questions, reach out to us at info at handtherapyacademy.com.