Steel treatment: ointments, dressings and other options

Escara treatment can be done through the use of bandages, collagenase or papain ointments, or surgery, depending on the depth of the shuttle, and the treatment may be done separately or together. In addition, special mattresses may be recommended to decrease and relieve pressure on site, as well as regularly change the person’s position.

The treatment of crumbs should be oriented by the person responsible for the person and should be adapted to the health condition, health history of the person and depth and location of the wound. In addition, it is important that the physiotherapist is consulted to indicate an exercise routine that allow to move the person, just as the nurse should be consulted to make guidance on how to take care of the crumbs.

Steels, also called the decubitus ulcers, can appear in areas of the body that spend a long time under pressure, being more common in people who stay long in the same position, either in a bed or in a blind. These wounds usually appear in places in the body with protuberances, such as heel, ankle, hip or coccyx. Learn more about the crumbs and main causes.

Treatment Options

The main treatment options for Escara are:

1. Change of position

It is important for the person to change positions regularly so that it is possible to reduce pressure in the areas of higher risk of wound formation, such as heel, ankle, hip and coccyx, or relieve pressure in places where the rasters have already been formed. The doctor should indicate the period with which the position should be changed, which can happen every 2 to 4 hours, as well as an exercise routine.

In addition, it may be recommended by the doctor to use an anti-scaram mattress, as well as bed and special pillows to help the person sit or lean against vulnerable skin.

2. Clean the wound

It is recommended to clean the wound regularly, which should be done with saline, according to the guidance of the doctor and the nurse. After cleaning the wound, it is indicated to pass an ointment to facilitate healing.

3.

Escara ointments are suitable to help healing wounds. Some ointments that can be recommended are:

• Collagenase: It is an ointment of enzymatic debridement and it is believed that collagenase digests the collagen present in the dead tissue and contributes to the healing of the wound;
• Argued de prata: It helps to promote healing and absorb secretions and can be used on infected or not infected;
• Silver sulfadiazine: It has antimicrobial and bactericidal action, being able to eliminate different types of bacteria, mainly indicated in case infected;
• Hydrogel in Ointment (Dersani Hydrogel): It is capable of absorbing water from the skin, being indicated for the treatment of wounds, as it favors the elimination of the dead tissue, besides moisturizing, healing and protecting the skin, helping to relieve pain at the wound site;
• Papain: It is an enzyme that has properties that favor skin regeneration and should be used under medical advice.

After applying the spray ointment, it is also recommended to apply a moisturizing ointment to protect the skin from excess moisture, which should be composed of zinc, vaseline or dimeticona oxide.

Also read: Dersani: What is it for and how to use (hydrogel, oil, ointment and more)

tuasaude.com/dersani

4.

There are some special dressings that are adhered to the skin to protect the crumbs and accelerate the healing of the wound and can be purchased in conventional pharmacies:

• Hydrocoloid dressingwhich contains a gel that stimulates the growth of new cells on the skin in the wound and keeps the wound damp, as well as avoiding the contact of the shuttle with the environment and thus avoiding its contamination;
• Alginatewhich are made of marine algae and contains sodium and calcium, components that help accelerate the process of skin healing;
• Foam dressingwhich helps absorb the liquid from the shuttle and keep the environment damp.

It is important that the type of dressing is recommended by the doctor or nurse according to the characteristics of the Escara.

5.

Debridement is made to remove the dead fabric from the dull, helping in healing. This procedure should be done by the doctor or specialized nurse, being done under local anesthesia. Understand how debridement is done.

6. Surgery

Surgery to treat crumbs can be indicated by the doctor in the most severe cases, when the wound does not improve with the treatments previously indicated by the doctor. In such cases, the doctor cleans the wound and closes it surgically to accelerate healing and decrease the risk of infection.

Signs of improvement and worsening

Note that the Escara is closing and healing properly when, around the wound, small red-fabric-like granules appear with a blackberry. This is a normal condition as the wound closes from the outside in.

Signs of worsening arise when the shuttle is not being treated or when the product used for its healing is not having the desired effect. In such cases, the first signs include increased redness around the shuttle and the appearance of yellowish or brown fabric inside the wound. After that, more signs of infection such as pus or fetid smell, for example, may appear.

Clinical Review:
Dr. Leonardo Rotolo
Dermatologist

Dermatology Coordinator of Caxias D’Or Hospital and Dermatologist at Gloria D’Or Hospital, with CRM 1004115-RJ.