Managing Wound Care: Addressing Dead Skin and Infection Issues

Issues with necrotic tissue and infection in wounds?

Hello Dr.
Chen,
I apologize for the inconvenience, but I would like to ask about my father's condition.
He initially had a pimple on his scrotum that turned into a small wound (about 0.2 cm) after being squeezed.
At first, he did not cover it and only used povidone-iodine and tetracycline, which led to a worsening infection with yellow discharge and redness.
It was possible to squeeze out pus at that time.
However, yesterday, as the wound developed a thin layer of dead skin, he applied a burn ointment for debridement, which seems to have been too irritating and caused additional small wounds nearby.
Now, five days later, the wound has grown to 1 cm in size and has a layer of yellow tissue covering it.
There is no discharge, and the surrounding skin appears to be in poor condition, as it is a sensitive and wrinkled area.
Therefore, today he refrained from using the debridement ointment and instead applied tetracycline.
I am unsure how to proceed.
Should we stop using the burn ointment and return to just using tetracycline? I am concerned that the dead skin might hinder the wound from healing properly.
Isn't the current approach to keep the wound moist to prevent excessive dryness and dead skin from interfering with healing? Does dead tissue need to be debrided to accelerate healing? Would it be best to use artificial skin or dressings containing silver ions, like Mepilex, which can provide autolytic debridement? Isn't debridement the most crucial step?
However, given his current condition, it seems that using debridement ointment and artificial skin may not be suitable, right? Did I start using them too early? Should we wait until the wound stabilizes and shows no signs of inflammation before applying them? What is the correct way to handle this? I am quite confused.
2.
Can artificial skin be used on the genital area? When is the appropriate time to use it? I am really troubled about how to handle this correctly, as my elderly father is reluctant to go to the hospital for such a sensitive area, but it seems to be getting worse.
3.
My father insists on using yellow antiseptic solution, claiming it can help absorb pus and improve the current situation.
(Isn't this an outdated belief?) Does it actually help? Will it stain the skin yellow?
4.
Which specialist should we consult for the scrotal wound? Urology or dermatology? Should we consider surgery (plastic surgery)?
Thank you for your assistance.
This is my first time dealing with such a situation, and it seems to be getting more complicated, which is quite frustrating.
Please advise me on how to proceed.
I apologize for the many questions, but I am genuinely at a loss about what to do.
Thank you.

Xiao Xin, 30~39 year old female. Ask Date: 2017/08/17

Dr. Chen Jiaming reply Surgery

Wound care cannot be managed with a one-size-fits-all approach; each stage of healing requires specific treatment methods.
It is advisable to consult a urologist or a general surgeon, and some hospitals have specialized outpatient clinics dedicated to wound care.
The skin of the scrotum is very thin, and if a sebaceous cyst becomes infected and is not promptly treated (with oral antibiotics and appropriate wound protection), it can lead to local ischemic necrosis of the skin due to the infection.
If necrotic tissue is visible, although some ointments claim to promote debridement, effective removal of necrotic tissue typically requires surgical intervention for quicker and more efficient results.
Otherwise, if necrotic tissue occupies that space, no matter how often you change the dressing, healing will not occur (as new tissue cannot grow to repair the area).
Wound care is a specialized field, and each physician and patient has their own experiences.
It is best to seek professional evaluation at a medical facility and to adhere to a regular follow-up schedule for optimal recovery.

Reply Date: 2017/08/17

More Info

Managing wound care, especially in sensitive areas like the genital region, requires a careful and informed approach to prevent complications such as infection and delayed healing. Based on your description, it seems that your father’s wound has progressed from a small pimple to a more complicated situation involving infection and dead skin. Here’s a comprehensive guide on how to manage this situation effectively.

1. Initial Assessment and Cleaning
The first step in managing any wound is to assess its condition. Since the wound has increased in size and shows signs of infection (yellow discharge, redness), it is crucial to clean the area properly. Use a saline solution or mild soap and water to gently cleanse the wound. Avoid using harsh antiseptics like iodine or alcohol directly on the wound, as these can irritate the tissue and delay healing.

2. Avoiding Further Irritation
Given that the area is sensitive and has already been irritated by previous treatments (like the burn ointment), it’s advisable to stop using any harsh topical agents. Instead, focus on keeping the area clean and dry. If the wound is oozing, you may need to change the dressing frequently to prevent maceration of the surrounding skin.

3. Moist Wound Healing
Current wound care practices emphasize the importance of maintaining a moist environment for optimal healing. This can be achieved using hydrocolloid dressings or silver-infused dressings like Mepilex. These types of dressings can help manage exudate and promote autolytic debridement, which is the body’s natural process of removing dead tissue. However, it’s essential to apply these dressings only when the wound is stable and not actively infected.

4. Debridement Considerations
If there is a significant amount of necrotic (dead) tissue, debridement may be necessary to promote healing. However, this should be done by a healthcare professional, especially in sensitive areas. Avoid attempting to debride the wound at home, as this can lead to further injury and infection.

5. Antibiotic Treatment
Since there are signs of infection, it may be necessary to use topical antibiotics like tetracycline ointment. However, if the infection persists or worsens, systemic antibiotics may be required, which should be prescribed by a healthcare provider. It’s crucial to monitor for signs of systemic infection, such as fever or increased redness and swelling.

6. When to Seek Medical Attention
Given the complexity of the situation, it is advisable to consult a healthcare professional. A dermatologist or urologist would be appropriate for wounds in the genital area. They can provide a thorough evaluation and recommend the best course of treatment, including possible drainage if there is an abscess.

7. Addressing Old Treatment Beliefs
Regarding the use of yellow antiseptic solutions, while they may have been commonly used in the past, modern wound care has shifted towards more effective and less irritating methods. These older treatments can sometimes do more harm than good, especially in sensitive areas.

8. Follow-Up Care
Once the wound begins to heal, continue to monitor it for any changes. If there are signs of worsening infection or if the wound does not show signs of improvement within a few days, a follow-up visit is necessary.

Conclusion
Managing a wound, particularly in sensitive areas, can be challenging. It’s essential to balance cleanliness with the need to avoid irritation. Keeping the wound moist, using appropriate dressings, and consulting with healthcare professionals when necessary will help ensure proper healing. Encourage your father to seek medical attention, as this will provide the best chance for recovery and prevent further complications.

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