05/19/2016    Don Peacock DPM, MS

Preventing Scab Formation (Wm. Barry Turner, BSN, DPM)

The concept of maintaining a moist environment seems
to be more common in wound care these days. I’ve had
some patients with problematic healing despite
keeping the wound moist, even when combined with
enormous efforts to heal these wounds, including very
expensive modalities such as biologics and HBO
therapy.

Recently, I was referred a patient who had been
treated by one of my colleagues at our wound center.
The patient was non-ambulatory and had an ulceration
over the first metatarsal phalangeal joint (bunion
area). Her ABI was 1.4 and she was considered
circulatory compromised due to non-compressible
arteries and compression dressing were avoided. She
had received HBO therapy, numerous biologics, and
antibiotics for more than six months. During this
time, the wound was kept moist.

Because these modalities had failed I took a
different approach and decided to let the wound dry
and scab over. I placed the patient in compression
stockings (not usually a problem with ABI over.7,
etc.) to relieve some of the swelling she was having
and cut out the area around the bunion sore. We did
not apply topical to the wound. We prescribed
nitroglycerin topical to be applied just proximal to
the wound. In addition to this, we splinted the toe
over to take pressure off at the bunion prominence,
reducing the local ischemic effect caused by
abduction of the hallux.

As soon as this treatment began the wound started
healing. In this case, keeping the area moist was
actually working against her. I think when treating
wounds we sometimes have to ‘play it by ear’ and try
anything we can to get a wound to heal. In my
opinion, some ulcers require a moist environment and
some do better by drying out scab and all.

Don Peacock DPM, MS, Whiteville, NC

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