DermHelpCentral

Medihoney

Over the past few months, we have been hearing about the use of MediHoney for chronic wounds.  In dermatology, we frequently use cautery for certain lesions and this leaves superficial wounds which can take a while to heal.  We usually recommend simple Vaseline to keep the wound moist; however, for certain wounds MediHoney may be preferable.  This could just be "hype," but medical grade honey may actually be of value; and there is no downside to using it.  Your doctor may recommend it, or you may just want to try it yourself since it is safe and there are few contraindications.

MediHoney Guide: 

HEAL TO TOE: Foot Care Services

Heal to Toe is a Nursing Foot Care Service which provides professional and affordable foot care to individuals of all ages. Services are provided in the privacy of the home and in clinics organized by the Council on Aging within Berkshire County. Services include:

    Screening for pre-existing conditions
    Nail Care and Trimming
    Assessment of Circulation
    Assessment of Skin Integrity
    Foot Hygiene
    Skin, Corn & Callus care
    Foot Exercises
    Massage
    Patient Education
    Referrals

For More Information or to make an appointment, contact Lynette Dukehart, R.N. at 413-212-2144 or Email Ms. Dukehart.

WHY IS FOOT CARE IMPORTANT?
    Healthy feet are vital for the body to withstand the daily stress and critical to the elderly. A lifetime of extensive and repetitive use naturally results in changes to  both the anatomy of the foot and the range of motion in both the feet and ankles. Without proper care, the lack of mobility and reduced flexibility increases the risk    for falls which lead to loss of independence and debility. In addition to the natural loss of flexibility, the elderly often lose the visual acuity and sometimes even the cognition needed to maintain good foot health.

WHO SHOULD HAVE FOOT CARE?
    The elderly are not the only people needing foot care. Individuals with diabetes, vision issues, peripheral neuropathy, cardiac disorders, vascular issues, physical and psychosocial limitations, obesity, venous stasis, rheumatoid arthritis and other degenerative joint diseases are also at risk.

Heal to Toe is owned by Lynette Dukehart, R.N. She is a registered nurse and a graduate of the University of Pennsylvania. She gained her clinical experience by working at the University of Pennsylvania and other major medical institutions as a clinician and nurse educator. Her clinical focus in neurology, vascular and cardiothoracic trauma has afforded her the opportunity to seek related interest such as leg and foot care. She is board certified in foot care by the Wound Ostomy and Continence Nurse’s Society.

Wound Care Made Simple

Abrasions, blisters, and lacerations are common in recreational and athletic activities and inappropriate care of these wounds can result in delayed healing and infection, including MRSA.

This is the topic of a fine piece on NPR's Academic Minute by Dr. Joel Beam, a wound care researcher. (11/12/13). 

You can access Dr. Beam's Academic Minute piece here - Wound Care - or see the pdf.  Download Beam Wound Care

Non-Sutured Wound Care

Wound Care for Shave Biopsy and other No Stitches Procedures

All wounds heal best when kept clean, moist and covered.

The following steps will promote optimal wound healing and yield the best cosmetic result.

1. Keep the dressing dry for at least 24 hours.

Sometimes the wound may start to bleed. If this happens, apply local pressure with gauze or Kleenex to the wound for 15 minutes. That should stop the bleeding. If it does not, continue to apply pressure and call us.

2. Clean the wound daily with mild soap and water. Gently cleanse with a soft washcloth to remove crust or debris.  Only use hydrogen peroxide to help break up crusts that do not come away easily with a washcloth.  After cleansing, pat area dry gently.

3.  Apply a thin layer of Aquaphor or Vaseline to the wound.  Most skin surgeons prefer Aquaphor ot Vaseline to topical antibiotics since the latter can cause allergy. 

4.  Apply a non-stick dressing.  Telfa, Curad or NexCare are three suitable ones.  We especially like the latter because they are waterproof.

5. Repeat this simple regimen daily until the wound is completely healed or you are asked to stop by your doctor.  Keeping the dressing off and letting the wound dry out will slow the healing process.  You may shower or bathe 48 hours after surgery.

If the dressing gets wet, it should be changed as soon as possible.
Note: the wound should not hurt! It will be sore, like a bruise, the first night, and after that it may be tender to touch, but it should not hurt. It may sting or burn if it gets wet, or if it is exposed to the air without a protective coating of ointment.

Please contact your dermatologist for any of the following

Pain in or around the wound site
Redness extending more than about 1/3 inch from the edge of the wound
Swelling of the wound or the area around it
If you are worried that there might be something wrong

Liquid Nitrogen Skin Care

Wound Care for lesions treated with Liquid Nitrogen

Treating an area of skin with liquid nitrogen freezes the skin, which kills the tissue in the top layer of skin. The skin then regenerates: if the frozen area is left undisturbed, a superficial treatment will not scar. Here is what to expect from a treatment with liquid nitrogen, and how to care for the site.

What to expect

Discomfort at the site. If this was a light freeze on an area of skin other than the palm or sole, there will be some stinging for 10 or 15 minutes, and possibly some itching. If the area frozen was on the palm or the sole, it may be quite painful, and that pain will often last one or two days.
Blistering. Sometimes a blister will form. This could be either a clear blister or a blood blister.
Scabbing. After two or three days, sometimes as long as a week, the area will feel like a scab. Please do not pick at the scab as this could cause a scar.

Swelling. Treatment of areas on the forehead, nose or eyelids can result in painless swelling of the eyelids, especially noted in the morning. This will subside in 2-7 days.
Discoloration. The area frozen may turn darker brown or even black.
Peeling. After 7-10 days the area will start to peel, or, if it forms a scab, dark parts of the scab will start to crumble off.
Redness. After peeling, the area is likely to be slightly pink; this will fade after several days or weeks, depending on your skin type.

Care of the treatment site

Do not pick at the site as this can damage the skin and keep it from healing.  It may also cause scarring or  prolong the time for healing.
You may cover it with a bandage if you like, but this is not necessary unless the blister breaks.
If it forms a large blister that gets in the way, you may pop the blister with a sterile needle —but if you do this, keep the area covered with an  ointment and a dressing.

Please all or email your physician if discomfort in the area worsens after 1 or 2 days. Very rarely a frozen area can get infected—and if it does, it will be more painful, and would need further treatment.

Sutured Wound Care

Wound Care (with stitches)

1) Keep site dry for 24 - 48  hours.

2) Then
   a) clean gently with mild soap and water
       or peroxide
   b) Apply Bacitracin, Polysporin or Vaseline or leave dry.  Most dermatological surgeons see no value in topical antibiotics for wounds and feel that keeping the site moist with a thin layer of Vaseline is all that is needed.

3) After you cleanse the site apply:

   a) a Bandaid

   b) 3M Waterproof Bandage (Nextcare)

   c) Tegaderm

4) In most cases, it is best to keep the wound covered until the sutures are removed.

If the wound becomes red, hot, tender, drains pus or concerns you in any way please contact your physician by phone or email.
The biopsy report is usually available within a week’s time.  Please call or email your surgeon for the pathology result if you don’t hear from her or him.