Aftercare/Healing of a Severe Abrasion/Laceration on Leg

[EllenL]

I received a severe abrasion/laceration injury this week when falling through an object that collapsed underneath me.  I was scraped sideways by a screw.  It is approximately 6 inches long and about 1cm wide, and runs down the back of my leg from the base of my buttocks to just above the knee.  It is surrounded by deep bruising. It is not (yet) infected, but it is extremely irritated and angry.

I had a tetanus booster, but I am not sure how to assist the healing.

Because of the location there is a great deal of pain - if I leave my leg up so it is stretched, when I stand it crunches and cracks.  If I leave the leg down, when I move or bend it stretches and cracks.  When I sit it sticks to my clothes.

I'm guessing I should have left it moist ... it has been three days.  Is it too late to return to a moist dressing?  If so, what should I use, how should I wrap it, and how often should I change it?

I was thinking of taking a bath, in salt water, to moisten the scab that has started to form and then using a product called Jelonet and a fabric bandage strip I can cut to size.  I'm not sure if I should I put a layer of dry gauze between the Jelonet and the sticky bandage?  

Is this appropriate, too much, or completely incorrect?  Would oral zinc help?

Thank you

[EllenL]

Thank you.  I'm guessing from your response that since I've already left it open to the air to heal I should just leave it that way?

It is just such an awkward and traumatic wound and I'm having trouble with the constant pain resulting from re-injury that happens with the stretch and contraction ~ cracking ~ as I move about.  It is similar to a graft because of the width of the abrasion.

I was thinking that keeping it moist (by remoistening it now with a bath and then dressing it) might reduce some of that and perhaps reduce the chances of a really nasty scar.

I only mentioned the Jelonet because I happened to have some left over from dressing a prior wound ~ an infection on my arm ~ that eventually healed with a bit of a keloid.  I had thought that I should avoid using polysporin/neosporin unless there was actually an infection?

[Dr Smitha Mathews]

Hi,

"Jelonet consists of a leno-weave fabric, of cotton or cotton and viscose, which has been impregnated with white soft paraffin (yellow soft paraffin in the case of the bulk preparations). The dressing is used as a primary wound contact layer and the paraffin is present to reduce the adherence of the product to the surface of a granulating wound.

Two formulations of Paraffin Gauze Dressing are described in the British Pharmacopoeia. These differ in the weight of paraffin present on the gauze. Jelonet, which is an example of the `normal loading' product, contains not less than 175 grams of paraffin per square metre of cloth; the alternative formulation bears a lower loading of paraffin, in the range 90-130 g/m ² (see Paratulle ).

Jelonet is used as a primary wound contact layer in the treatment of burns, ulcers, skin grafts (both donor and receptor sites), and a variety of traumatic injuries. The material is also used as a transfer medium for skin during grafting.

Although there are no absolute contra-indications to the use of Jelonet, if the dressing is placed upon a heavily exuding wound, its semi-occlusive nature may cause tissue maceration by preventing the free movement of exudate away from the surface of the wound. This is less likely to occur if a dressing bearing the lower loading of paraffin base is used.
Method of use

Jelonet is applied directly to the surface of the wound and covered with an absorbent pad held in place with tape or a bandage, as appropriate.
Frequency of Change

The frequency of dressing changes will depend entirely upon the nature of the wound. If Jelonet is left in position for prolonged periods of time, it can become adherent and cause tissue damage upon removal."
www.worldwidewounds.com/Dressings/jelonet.html

If you are not allergic to penicillins or polymixin-B, you can use neosporin ointment over the wound and scab.

You can wait to remove the scab as the scab will fall off by itself after 5-6 days when the skin below it has formed. If you try and remove the scab earlier, it can cause fresh injuries to the developing skin and could cause increased scarring.

Once the injury is completely healed, you can use mederma or other cepalin-based products to minimize the scar appearance.

Do keep us posted on your doubts and progress.
Regards