Wound management in Buruli ulcer patients

1. Wound management in
Buruli ulcer patients
BY : JUSTICE ABOTSI

2. 2
Wound
A break in the continuity of the skin or
membrane.
It may be due to
Injury-
Rupture- “Oedematous form” of BU
Disease-

3. 3
Types of wound
• Intentional wound
– Surgical excision, incisions, skin grafting
• Accidental wounds
– Lacerations, stab wound, burns, traumatic
injury, disease (Buruli ulcer)

4. 4
Buruli Ulcer
Presentation of BU wounds
– Clean wounds
– Contaminated wound
– Clean-contaminated wounds
– Dirty or infected wounds (septic wound)
– Grafted wound

5. Example of clean wound
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6. Contaminated wound
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7. Clean contaminated wound
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8. 8
Dirty and septic wound

9. Early and after grafting
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10. Grafted wound
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11. 11
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 used
Lotions
• 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 ,
Ointments
Betadine 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 DRESSING
Loosen 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

16. 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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17. 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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18. 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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19. 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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20. 20
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.

21. Thank you
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