i'll second you for President John C !
a senior , Consultant Plastic Surgeon recently advised me of the uselessness
of Flammazine in that after 6 - 8hrs it loses its anti septic potential and
effectively creates a nice culture medium
he seems to favour telfar for its non adherence quality and and a variety of
'anti sepsis' agents of which dermasorb and cerium fllamazine appear popular.
(see Simon's lit search )
his main message, though was contentious, although probably true in my
experience A&E staff are notoriously good at innoculating bug free wounds
with their interest in 'replacing' dressings, totally unnecessarily. Ask
yourself why exactly are you covering the wound in the first place ? (
prevention of strike thru, ingress of bacteria, anti sepsis - likely if
dermal, not if superficial erythema) and how long is it necessary ? ( the
original non adherent dressing does not need removal at 48 hrs if truly non
adherent but the overlying cotton crepe does). The use of jelonet/innadane ,
although based on sound principles may not be the 'specialists' choice but
appears to be the popular and probably cost effective choice in UK AED's. His
use of flammazine is restricted to digits, where occlusion with gloves can be
used, and patient taught how to replace fresh flammazine occlusive when its 8
hr effectiveness is up. Even more interesting was his management in kids
where he advised thoracic superficial/partial thickness scald injuries, is
one area where the temptation 'to cover' really can do harm, and often once
the initial hoo haa has calmed down, taking a hair drier to the wound, drying
it out until a nice 'dry surface has developed, obviates the need for
dressings innoculated with bugs ! some of this experience he explained came
from looking after thousands of burns victims in the 3rd world. His other bug
bear (s)appeared to be the gel applied to burns victims in the pre hospital
phase (causes hypothermia, difficulty therefore in assesing depth), and use
of blankets as opposed to cling film, which he believes is often the primary
source of innoculation, and water intoxicated kids from resuscitation (ivi)
following innaccurate depth/BSA burn assessment
I think a combination of Robin Cocks' thoughts and John C's care is how i'd
ideally like to practice.
Shaf
SpR Chelsea & Westminster
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