RTA wound management on a budget

RE: RTA wound management on a budget

Rob Loxley — Thu, 02 Jun 2016 14:53:14 GMT

[quote user="rhona kerr"]had a case that got horrible infection with intrasite[/quote]

n=1?

RE: RTA wound management on a budget

rhona kerr — Thu, 02 Jun 2016 08:30:59 GMT

I would consider sugar dressings rather than hydrocolloid for too long - had a case that got horrible infection with intrasite, advice from GUVS was sugar - worked like a charm, completely cleared, hardly any scarring, both front legs affected on a beagle, course it did take several months.... I also like salt water bathing, large volume, frequently, and a collar to prevent licking, though the cats seem to stop after a few weeks and are quite happy just with the bathing (plant sprayer to spray wound)

RE: RTA wound management on a budget

Clare Tapsfield-Wright — Mon, 23 May 2016 21:19:12 GMT

[quote user="Elivet"]

[quote user="Clare Tapsfield-Wright"]

Elivet , thanks for showing us photos of the progress , it's amazing what living tissue can do to heal. Looking really good now, you must be doing a great job with the redresses. They do stink for a while ! I agree

[/quote]

That is the appearance of the wound today, 24 days post RTA. I hastened the healing by applying some stitches last week. I also applied some manuka honey at the carpus before dressing. Thanks for all the comments and advice. That will be the last picture as the conclusion is now so obvious

[/quote]lovely and thanks for sharing on here

RE: RTA wound management on a budget

Hannah Wynne Richards — Mon, 23 May 2016 21:17:33 GMT

Brill

Wynne

RE: RTA wound management on a budget

Elivet — Mon, 23 May 2016 20:35:44 GMT

[quote user="Clare Tapsfield-Wright"]

[/quote]

RE: RTA wound management on a budget

Clare Tapsfield-Wright — Sun, 15 May 2016 01:16:16 GMT

RE: RTA wound management on a budget

Elivet — Sat, 14 May 2016 23:15:37 GMT

[quote user="Malcolm Ness"]

I wouldn't be using antibiotics here - in fact I would probably have stopped after 3-5 days. There is a healthy granulation bed which is inherently very resistant to infection as well as effectively free drainage.

Certainly you will get bacterial contamination and colonisation and therefore readily culturable bugs but they can be ignored. The unpleasant smelling gunk that these wounds produce is normal especially under this kind of moist wound management - it is easily rinsed/showered away.

This case is moving quickly in the right direction.

[/quote]

Thanks Malcolm. It's my first big one and I wasn't feeling confident enough to let go after the resistant culture results. I will be sure to handle the next one in a different way, knowing what I know now.

RE: RTA wound management on a budget

Elivet — Sat, 14 May 2016 23:10:26 GMT

[quote user="Iain Richards"]

Ain't nature wonderful? (and your input with ensuring healing can occur!)

Bearing in mind the comments re the referral fee, are you charging for time as well as dressings for each dressing change?

[/quote]

I am amazed every time I remove the dressing. I only charge the standard bandaging charge on the PMS. Looks like we are on course to having it sorted under 1k but still too early to say. So, fingers crossed, touch wood.

RE: RTA wound management on a budget

Iain Richards — Sat, 14 May 2016 21:22:21 GMT

Ain't nature wonderful? (and your input with ensuring healing can occur!)

Bearing in mind the comments re the referral fee, are you charging for time as well as dressings for each dressing change?

RE: RTA wound management on a budget

Malcolm Ness — Sat, 14 May 2016 05:49:52 GMT

[quote user="Richard Carter"]any particular reason why it is on abs? (pyrexia, septicaemia, osteomyelitis?) if it is just the superficial wound, best to do without so the normal bacteria can re-establish and keep out the nasties[/quote]

This case is moving quickly in the right direction.

RE: RTA wound management on a budget

Elivet — Fri, 13 May 2016 19:09:56 GMT

[quote user="Richard Carter"]

any particular reason why it is on abs? (pyrexia, septicaemia, osteomyelitis?) if it is just the superficial wound, best to do without so the normal bacteria can re-establish and keep out the nasties

[/quote]

Was put on Amoxclav at the referral centre and their C&S showed sensitivity. Had a temp of 40.1 when I first saw her on 5th May. I took another C&S swab that came back resistant. The bandage has a foul smell emanating from the distal aspect of wound so you can understand my fear of a ripe MRSA.

RE: RTA wound management on a budget

Richard Carter — Fri, 13 May 2016 17:54:38 GMT

any particular reason why it is on abs? (pyrexia, septicaemia, osteomyelitis?) if it is just the superficial wound, best to do without so the normal bacteria can re-establish and keep out the nasties

RE: RTA wound management on a budget

Evelyn Barbour-Hill — Fri, 13 May 2016 14:22:16 GMT

Coming along nicely, it will soon be fine.

RE: RTA wound management on a budget

Elivet — Fri, 13 May 2016 13:55:56 GMT

Wound appearance 13 days post RTA. Much better I think. Bacterial culture resistant to Amoxclav so changed to Clindamycin

RE: RTA wound management on a budget

Hannah Wynne Richards — Tue, 10 May 2016 09:35:01 GMT

Looks hopeful

Wynne

RE: RTA wound management on a budget

Linda Filshie — Mon, 09 May 2016 20:55:06 GMT

Ooh I love a granulating and epithelialising wound bed :) I'm always amazed how fast they start to heal when they reach this stage.

RE: RTA wound management on a budget

Evelyn Barbour-Hill — Mon, 09 May 2016 18:52:25 GMT

RE: RTA wound management on a budget

Elivet — Mon, 09 May 2016 17:55:07 GMT

Appearance of wound today, 9 days post RTA. Dog is otherwise well in self but had to be sedated.

RE: RTA wound management on a budget

David Mills — Mon, 09 May 2016 09:26:07 GMT

[quote user="grumpyoldman"]& Its easier &quicker than it looks and sounds. [/quote]

This is a good option, esp for a small dog or where owners might lose enthusiasm for redresses in the coming weeks. We did one recently and as said it is surprisingly easy and effective. I'm somewhat jaundiced by our clientele and their ability to follow simply dressing instructions (they always manage to get them wet), but you might be OK if the weather holds for the next few months!

RE: RTA wound management on a budget

Elivet — Mon, 09 May 2016 09:05:46 GMT

[quote user="Michael Woodhouse"]

I may be being dense, but why would anyone refer such a case?

[/quote]

It was a direct referral by our OOH provider. I think they were mainly concerned about the ligament damage. Maybe things would've been different if I had seen her initially.

RE: RTA wound management on a budget

Hannah Wynne Richards — Mon, 09 May 2016 08:21:25 GMT

Elivet Oops! I obviously didn't press the shift key hard enough.

£8k is steep, £38 k would be stratoshpheric

Wynne

RE: RTA wound management on a budget

Michael Woodhouse — Mon, 09 May 2016 01:12:37 GMT

I may be being dense, but why would anyone refer such a case? These are simple and satisfying (if not quick) to fix. The worst we had was a collie dog that fell off the quad and was dragged along. Filthy dirty, contaminated and down to bone and tendon on both front legs above the carpus.

Wet-to dry until clean wound bed. Alleyvin/hydrogel changed weekly thereafter. Back to work now. Few hundred not thousand pounds. In fact ( even with some sedates to clean and change bandages initially) I doubt it cost more than the £800 OOH fee......

It's no wonder the costs of insurance is spiralling and we have issues with insurance companies choosing to work with certain providers.

RE: RTA wound management on a budget

Elivet — Sun, 08 May 2016 22:53:03 GMT

[quote user="Clare Tapsfield-Wright"]

Elivet, do you think you could post photos of the progress at regular intervals? It would be really interesting to see how it does. I am always amazed how these wounds manage to heal given time and good management, and so satisfying.

[/quote]

Yes Clare, I will endeavour to post the photos as soon as I take them during bandage changes.

RE: RTA wound management on a budget

Clare Tapsfield-Wright — Sun, 08 May 2016 21:40:34 GMT

RE: RTA wound management on a budget

grumpyoldman — Sun, 08 May 2016 17:47:34 GMT

[quote user="Elivet"]8k[/quote]

Ouch !! sometimes I think we should refer more ,then I read things like this . The other thing I have done with these injuries if the owners are wanting a quick result is to turn the ante brachial section into a complete deglove and create a tunnel in the later chest wall ,aka Paveletik's book on reconstruction, suture the leg into place for 7 days then trim and close. But you still have the digital injuries. It may work out cheaper than dressings+meds for a month of Sundays, & Its easier &quicker than it looks and sounds.