Today's Wound Clinic - Winter 2008 - (Page 53) instruction Figure 8:The use of foam to pad sensitive areas before applying compression wrap. Figure 7: Iatrogenic injury caused by rubbing of wrap at anterior ankle. the application of the wrap will place the foot in an ambulatory position that allows smoother wrap application. Additionally, the use of foam dressings to pad areas such as the anterior ankle and tibial areas, Achilles tendon, and metatarsal heads can provide protection and an added level of comfort. (See Figures 7&8). Moisture-related skin damage. Wound exudate can cause maceration at the very least and skin breakdown at worst. A barrier ointment such as Calmoseptine®(Calmoceptine, Inc. Huntington Beach, Calif) for protection or Xenaderm® (Healthpoint, Fort Worth, Tex) can be applied before the dressing and the wrap. (See Figure 9). Showering and bathing. The wrap applied for a week or even several days at a time makes personal hygiene a challenge because the wrap needs to be kept dry. Consideration must be given to the patient’s stability and strength and specific suggestions should be included in the patient education for bathing. Bathing at a sink is always an option, although not particularly acceptable one depending on the patient’s occupation and daily activity. Getting in a bathtub while keeping the leg out is another option but requires considerable upper body strength and mobility. Many patients will choose to shower with the wrap on and covered. Devices designed to keep dressings and casts dry have the added benefit of a non-slip surface at the foot. For the patient who chooses to shower with a Today’s Wound Clinic Winter 2008 at each visit to confirm the adequacy of the edema management. Hygiene and skin care. With each visit, the leg should be thoroughly washed and moisturized. This step is essential not only for the skin health, but also the patient’s sense of well being. Footwear. Many wraps may prohibit patients from wearing not only the shoes worn into the clinic on the day of the initial wrap, but possibly all of their shoes. An inexpensive alternative to have on hand are standard post-op shoes. These can provide safe ambulation and foot protection and can last for the entire episode of care. (See Figure 5). Prevent Sliding. Multilayer wraps tend to be thicker and heavier and as a result can tend to slide as one unit, especially in the case of very irregularly shaped legs. (See Figure 6). This effect can be lessened by wrapping the leg with adequate tension and can be reduced or avoided completely by applying a thick ointment to the leg such as Aquaphor®, (Bieresdorf AG, Hamburg, Germany), Dermabase®, (Paddock Laboratories, Minneapolis, Minn), or a non-gritty barrier ointment. This will cause the cotton layer to stick and reduce slippage. Additionally, this practice provides excellent moisturization. Compression wraps may cause rubbing, discomfort, and possibly blistering, resulting in iatrogenic injury and further ulceration. Avoid wrinkles. Compression wraps may cause rubbing, discomfort, and possibly blistering, resulting in iatrogenic injury and further ulceration. Instructing the patient to dorsiflex the foot during 53
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