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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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