Good wound care requires careful follow-up and documentation

LAS VEGAS – Wound care requires careful follow-up, especially in the first few weeks after amputation, according to a speaker at the Hanger Education Fair & National Meeting, here.

Mark Delia, CP, described several wound and drainage states that prosthetists might encounter soon after a patient’s amputation. Documentation and taking photos of wounds postoperatively help in the communication with the patient’s physician and surgeon, he said.

Vascular insufficiency resulting in ecchymosis and ischemia is not uncommon in patients after surgery. Ecchymosis, the escape of blood into tissues from ruptured blood vessels, results in bruising. He said he frequently sees ecchymosis in patients postoperatively, but it generally goes away within 72 hours.

“If it is not resolved within 72 hours, [then] you need to have a conversation with the surgeon. He should already be kept in the loop through documentation and email. I email and send photos. I make sure they stay in the loop and aren’t blindsided,” Delia said.

He said practitioners need to note the different drainage states, including sanguineous (red), sero-sanguineous (light red/pink, or clear/blood-tinged fluid) serous (clear/light), sero-purulent (cloudy yellow/tan) and purulent (yellow/tan or green, malodorous, and typically a sign of wound infection). Sometimes drainage from a wound may look worse than it actually is.

 “When you see [sero-sanguineous drainage], don’t ‘freak out’ until you get to the actual wound,” he said.  “It could just be a little fingernail type wound or a gap in the suture line, as opposed to the whole thing falling apart. Try to wait until you get to the wound before you start making assumptions.”

Drainage that appears to be sero-purulent on the dressing may actually be caused by Xerofoam on the wound bed, and not a sign of infection, he said. A wound that is granulated, or is forming new tissue, may look like “‘gunk’, as a lot of people call it,” Delia said. Prosthetists can’t débride the wound, so the job is best left to the physician. Follow-up is important to prevent wound maceration, particularly if the wound is draining a lot.

He described different negative pressure therapy systems, manual and automatic, which should only be applied to a wound protected by gauze or foam.

“I think it is a good thing to have because when you go in there to do a dressing change, it is dry. It is clean,” he said. “It is the surgeon’s preference, but I wish they would all use it because it makes our job a little cleaner, for those of us who do wound care.” – by Carey Cowles

For more information:

Delia M. The wound care environment. Presented at: Hanger Education Fair & National Meeting. Feb. 3-7, 2014, Las Vegas.

Disclosure: Delia has no relevant financial disclosures. 

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