Wound management in Buruli ulcer patients

BY : JUSTICE ABOTSI

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Wound

A break in the continuity of the skin or membrane.

It may be due to

Injury-

Rupture- “Oedematous form” of BU

Disease-

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Types of wound

• Intentional wound– Surgical excision, incisions, skin grafting

• Accidental wounds– Lacerations, stab wound, burns, traumatic

injury, disease (Buruli ulcer)

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Buruli Ulcer

Presentation of BU wounds– Clean wounds– Contaminated wound– Clean-contaminated wounds– Dirty or infected wounds (septic wound)– Grafted wound

Example of clean wound

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Contaminated wound

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Clean contaminated wound

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Dirty and septic wound

Early and after grafting

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Grafted wound

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Wound Dressing Essentials

• Get all requirements set/ready

• Ensure privacy and explain procedure

• Wound dressing is done after complete/partial bath (of the patient).

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Lotions & Ointments usedLotions• Normal saline .• Savlon • Povidone Iodine (aqueous)• Acetic acid ( 1 part of white vinegar in 9 parts of normal saline) is

used to clean wound with bluish green discharge. (Pseudomonas infection) after adequate cleaning of the wound ,

OintmentsBetadine or Wokadine

Vaseline gauze with betadine or wokadine ointment is applied followed by several layers of sterile gauze or other absorbent sterile materials for adequate absorption of fluid.

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DRESSING REQUIREMENT

Top Shelf• Gallipot(s) for lotions.• Dressing forceps.• Dissecting forceps.• Sinus forceps.• Probe• Stitch scissors.• Covered bowl with sterile cotton wool and gauze swabs.

Bottom Shelf• Bottles of lotions & ointment e.g. savlon, normal saline, acetic acid

Povidone Iodine (Aqueous), wokadine or betadine.• Adhesive plaster• Vaseline gauze• Scissors.• Bandages, crepe.• Covered receiver containing parazone 1:10 for soiled instruments.• Mackintosh with cover.• Receptacle for soiled dressings

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Basics

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REMOVING OLD DRESSINGLoosen the soiled dressing by holding the

patient’s skin and pulling the plaster or dressing towards the wound.

• If the gauze adheres to the wound loosen it by moistening with sterile normal saline solution.

• Observe the dressing for the amount, colour, odour and amount of exudates.

• Discard the dressing and gloves in a water proof trash “polythene” bag

Dressing of wounds(steps)

• Explain procedure to patients and ensure privacy

• Wash and dry hands,prepare and take trolley to patient’s bedside.

• Position patient comfortably and protect bed cloths and exposed the wound.

• Pour out lotion into gallipots and remove plaster or bandages

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continue

• Wash and dry hands

• Remove soiled dressing with dissecting forceps or gloved hand and discard.

• Wash and dry hands again.

• Create a sterile field

• Clean wound from within outward using one swab only once.

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continue

• Clean wound with swabs soaked in saline or boiled cooled water using sterile forceps or gloves

• Clean wound with series of swabs until clean.

• Apply enough sterile dressing and secure into position (plaster or bandage)

• Make patient comfortable in bed.

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continue

• Explain relevant findings to patient and thank him/her.

• Discard trolley and decontaminate instruments and wash hand.

• Remove gloves and screen,wash hands and dry hands.

• Document and report state of the wound.

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Conclusion

• BU wounds require special attention

• Always make dressing environment is clean

• Provide privacy for patient

• Observe and record findings

• Be looking for signs of restriction of movement at any joint and act accordingly

• If possible reffer to the physiotherapist.

Thank you

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