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Provider Prepared’s Weekly Pearl of Wound Wisdom #22 0

A 30 year old male, who works as an auto mechanic, presents to the Emergency Department with a one week history of increasing pain, redness, and swelling to the ulnar nail edge of his right middle finger.

In general, an acute uncomplicated paronychia with abscess is treated with incision and drainage. After performing a digital block a number 11 blade is inserted under the affected cuticle margin, extending an incision along the lateral nail fold. Following incision and drainage, frequent warm soaks should be done to promote ongoing drainage.
Goldstein, BE et al. Paronychia. UpToDate December 2017.

Patients at risk for complicating infections should be placed on appropriate antibiotic treatment following incision and drainage.

Provider Prepared laceration kits with Lidocaine give you all the tools of the trade for management of paronychia at home!

Provider Prepared
Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #21 Torn and Tearing 0

A 93-year-old female presents to the emergency department for evaluation of wounds to her right forearm. She was working in her yard when she lost her balance and began to fall. As she put her arms out to catch herself, her right forearm scraped against nearby garden tools. She has several areas of torn skin upon the forearm. She otherwise did not receive other injuries.

As we age our skin becomes atrophic, has a decrease in elasticity, and develops impaired metabolic and reparative responses. The epidermis becomes thinner and there is flattening of the dermoepidermal junction. This results in a decrease in the skin’s ability to resist shear stress, increasing the fragility of the skin.
Taffet, GE et al. Normal aging, UpToDate January 2017.

Skin tears are appropriately managed with application of Steri-Strips to reapproximate the loosened epidermal and dermal tissues. After appropriate irrigation of the wounds, using Mastisol in conjunction with Steri-Strips the tissue can be secured into appropriate anatomical position. A loose nonadherent dressing should then be placed over the top of the Steri-Strip. Adherent dressings placed upon aged and torn skin will lead to additional skin tears, and therefore should be avoided.

All Provider Prepared Laceration Repair Kits are stocked with Steri-Strips and Stik-It (Mastisol equivalent) enabling you to appropriately and affordably manage skin tear wounds. Click HERE to order yours today!

Provider Prepared
Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #20 Getting on my nerves! 0

A 23 year old male presents to the emergency department, with extensive laceration to his left forearm from a motorcycle accident. In addition to the pain of the laceration, he feels numb in his little finger, with tingling in his ring finger, and tingling in a part of the palm of his left hand.

Sensory and motor functions of the hand arise from innervation by the median, radius and ulnar nerves. Examination of the hand should always include checking motor function as well as pin prick, light touch and two-point discrimination. Normal two-point discrimination will increase with age and neuropathic disease, but is considered approximately 4-5 mm.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.

On examination of this patient’s left hand, he is found to have decreased sensation in the 5th digit, ulnar aspect of the 4th digit and weakness with extension of the digits and wrist. This raises the concern for injury to the ulnar nerve associated with the forearm laceration.

Visit Provider Prepared for honest, accurate and affordable wound care at home and on the go!

Provider Prepared
Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #19 Thumbs up! 0

A 27 year old female presents to the Emergency Department for management of a laceration to her left hand. While cutting an avocado, she accidentally cut her left hand using the knife to remove the pit. The laceration is at the base of the thumb, extending into deep tissue.

Proper examination of hand wounds requires an understanding of hand anatomy and function. During assessment of the wound, function and sensation of the digits must be evaluated. The thumb requires special attention for proper examination. The thumb is made up of two phalanges, in comparison to the other digits which have three. The thumb has more movement capabilities than the other fingers. At the carpometacarpal joint the thumb can flex, extend, abduct, adduct, oppose, and retropulse. The metocarpophalangeal joint allows the thumb to flex, extend, abduct, and adduct. The interphalangeal joint provides for flexion and extension.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.

Evaluation to ensure all these thumb movements are intact must be part of thumb wound evaluation.

This patient has all movements of her left them intact with good strength, sensation is intact as well. On exploration of the wound there is no evidence of any deep structure injury. The laceration was closed with a single layer repair without complication. A thumb spica splint was then placed to immobilize the thumb, promoting less tension on the wound.

Visit Provider Prepared to see our options for all your home laceration care needs!

Provider Prepared
Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #18 Dehisced 0

Occasionally, despite careful layered closure of any wound, wound dehiscence can occur. Reasons for dehiscence include: high tension in the wound, atrophic skin, lack of patient compliance with wound care instructions, medications that inhibit wound healing, poor circulation, lack of deep absorbable sutures, wound infection.
Wounds that dehisce typically should heal by secondary intention. The wound should have a thin layer of petrolatum, or as appropriate antibiotic ointment, applied with a nonadherent dressing. The dressing should be changed daily.
Ritchie, SI et al. Skin surgery: Prevention and treatment of complications UpToDate, December 2017.

Dehisced wounds should be carefully examined for infection. With any signs of infection topical and systemic antibiotic treatment should be used as clinically appropriate.

Be prepared for wound care at home and on the go with tools of the trade from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #17 So it begins! 0

The skin healing process occurs in several stages, outlined as: coagulation, epthelialization, new blood vessel growth, collagen formation and wound contraction.

Coagulation begins immediately with vasospasm and platelet aggregation. This allows for fibrous clot formation to occur.
The epidermis is the layer capable of regeneration. This is where epithelialization occurs, leading to bridging of the wound tissues.

Four days into wound healing, new blood vessel growth is at its peak. 48 hours after the injury collagen formation begins, and peaks in the first week. Collagen gives tensile strength to the tissues. The process of collagen formation and remodeling can continue for 12 months.

Three to four days after the injury, wound contraction occurs. This process is not well understood or well described in literature. The full thickness of the wound migrates toward the center, this can have impact in the final appearance of the wound.
deLemos, DA, et al. Closure of minor skin wounds with sutures. UpToDate Nov. 2016

Start the healing process right with a laceration repair kit from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD