By Hilton G. Tranchell
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Extra info for Circulatory Ulcers. A Physical Approach
On no account must the floor be made to bleed, for haemorrhage may organize and slough. During the floor massage, the lesion must be covered by a thick pad of sterile gauze. n. —This, if indicated, should be given before the final toilet. So should the exercise in elevation. o. Wash hands and dry them. p. Thoroughly clean the skin around using forceps with cotton-wool swabs dampened in the toilet solution: work from within outwards. Then thoroughly clean the ulcer using frequent changes of swabs.
The pressure pad, if of plastic foam, may be boiled in order to sterilize it; if of rubber it would have to be sterilized in an antiseptic solution. Needless to say, neither must be used unless dry. The limb is then bandaged firmly. Upon removal of dressings on the next visit, the floor will be flattened to the level of the skin. This must be maintained by continuance of the pressure pad in subsequent treatments. i. Chronic ulcers become so through either a low grade infection, inadequate support, or both, affecting it for a 46 CIRCULATORY ULCERS long period of time.
When the interval between treatments is long, a dressing such as Lassar's paste, or chlorophyll ointment, or tulle gras should be applied. These are non-irritative and can, in unavoidable circumstances, be left in situ for up to a week. If the interval is likely to be longer, sterile packs similar to the war-time shell dressing can be prepared and given to the patient with instructions for him to change his dressing. We are against the patient changing his own dressings, but under these circumstances it is the only thing that can be done.