Wound Care Made Incredibly Easy

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Moisture-associated skin damage

This inframammary (under the breast) example of the effects of ITD shows inflammation and maceration of the deepest crease. Teaching nursing assistants and technicians to recognize this as moisture damage and report it before it worsens is a great way to achieve success in prevention because early treatment saves skin.

This deep ITD occurred in a continent patient who was in a chair constantly due to pain issues. The patient was diaphoretic from pain and did not let nursing staff check the area for over a week. This is not a pressure injury as weight-bearing surfaces for this man who remained upright, not slouched, were ischial tuberosities, not the sacrum. There is a deep gluteal fold, and the buttocks were not separated for care initially. Once care of the area resumed, the ITD healed in a few weeks using zinc oxide applied to an anal leakage pad twice a day along with gentle cleansing with a disposable bathing cloth. This inframammary ITD shows evidence of skin infection, likely fungal. Skin infections in moist areas that cause itching (pruri tus) and have “satellite lesions” (macules and papules around the margins) are likely fungal, though they can sometimes be bacterial. The wicking textile with silver can treat either type, but if you are using an antifungal and having no success after 2 weeks, consider a culture.

When toes are deformed, be sure to check under and between for ITD, especially dangerous for a patient with diabetes who may lose toes due to infection that is allowed to penetrate the macerated skin. Lamb’s wool rope woven between toes wicks moisture away and prevents ITD between the toes.

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