any experts on wound dressings around ?

[gingeroots]

looking specifically for advice on dressing finger tips / fingers .

My mother has awful gout in her fingers . ( caused by kidney problems and medicine ,not diet )
After a flare up ,when the swelling is going down the skin breaks down and she's left with open wounds ( with the white lumpy crystals embedded ...but lets not go there ) .

The nurse who comes to dress leg ulcers 3 times a week doesn't seem very interested in my mothers fingers though I pressed her yesterday and she used the same dressings as used on the legs . ( she looked quickly at the current one that's a wound but didn't really seem sure if the finger was infected or not ... not that it matters at moment as mum just started antibiotics because leg ulcer swab has shown infection )

I'm sure nothing wrong with that ,but they're not the right shape IFYSWIM and also mum can't keep them dry . ( rinsing her false teeth and hand washing biggest factors ) .

The trouble is that this situation with fingers is ongoing .I find it hard to believe ( send men to moon etc ) that there aren't dressings specifically designed for fingers .
Or perhaps the answer is that I change them daily and that way deal with inevitable dislodging and getting wet ?

She needs to get them looked at by a doctor, and maybe referred to a wound care specialist.

and it might be that her medications need to be reassessed.

Yes ,that makes sense .
Wonder why nurse hasn't suggested ?
And what to do mean time ?

I've seen the mini condoms on line but was worried these would create a damp climate/make finger sweat under the condom and the dressing .
Oh frankly I feel overwhelmed by all this , I know she needs to see GP but the one who's good is only there 2 days a week .
Plus it will be a struggle ( mainly emotional ) to get her to GP .
Oh I feel like crying ( there are ,of course other practical aspects to her other health problems that I struggle with ) it seems impossible .

gingeroots it could simply be that the nurse has ordered the correct dressings and is waiting for them to arrive. Please speak to her, and say that your mother needs to see the doctor again. The nurse will be able to speak to the doctor, and it's possible a home visit can be arranged.

thanks belgo ,will take your advice .

I agree you need an expert - especially to show you what to do. We were lucky in attending a hand clinic.

Not an expert on wound dressing, but ds recently had finger surgery so sypathise with the problem. We were told to keep the dressing dry ( fat chance at school), and used a selection of ways to do this. Waterproof gloves ( the physio gave us wound dressing gloves one day when ds was returning to school just in time for cooking lesson but really they are a bit short - long marigolds might work better) -this may work for an adult, but obviously only for wet jobs as the wounds need to breath the rest of the time. The bath is tricky. We tried taping on a long washing up glove but ds ( who has SN) got water in over the top despite the tape. I was shown how to put on a finger bandage so it does not fall down , by tieing the split ends of the cylindrical finger bandage around the wrist ( and in ds case taping over the ends) at the hand clinic. More than one finger bandage can be tied to a wrist ring of bandage. I was told to only change the outer bandages whenever it got a little wet, but leave the sterile gel dressing stuff inplace. Once healed on the outside ( ie once sticking plaster was not harmful) we used an oblong dressing with sticky plaster edges, precut with a v in the ?middle of each long side to reduce the volume over the finger tip. Difficult to describe. The position of the cuts depends on where the dressing goes. There are waterproof finger stalls in chemists but the one we got was huge and impractical for ds.
Someone expert will be along soon I'm sure.

Sorry took so long to posts the experts are here already - no slight intended!

magso thats really helpful ,I have to dress it at the moment and until we get more advice , what you've posted is great .
I'm very stressed at present and not thinking straight - but see a way forward now in just changing the top dressing .
And yes I see what you mean about splitting the finger tube gauze type bandage and tying around wrist .
And using more than one - brilliant .

They do make little condom things which might have helped your son .
THANKS AGAIN

Having just had hand surgery I was going to suggest a lovely big pair of marigolds for regular stuff. As a vet I also have access to arm length examination gloves (obtained from agricultural merchants) that kept my dressings completely dry in the shower even with washing hair.

Glad it was helpful. My first few attempts at finger dressing were useless but I practiced the technique on the dishy physiotherapist till I felt confident to manage on Houdini DS. There is an applicator gadget that makes life easier. You need a piece of finger bandage about 4 times the length of the finger ( asuming going round the wrist as well but if it is too short you can always do a separate wrist loop. We added micropore tape to cover the bit around the wrist to prevent the wrist bit falling down. Might not be needed on an adult - especially if the skin is not robust.

Oh dear it all seems so hopeless .
The finger is not dry ,nurse suspects that condensation under dressing is cause .
And it seems near impossible for mother to keep digit dry ,she is trying but I suspect she is spilling tea on to it when she drinks tea . Her fingers are v.misshapen ,gouty and arthritic .
But the wound simply has to be covered ,not least because of the well known scenario of not being able to poo without hands .

Nurse has not orderd any dressings ,she says they don't make special ones .
GP appt next week ( earliest I could get ) .
sigh ,wanders off muttering about men and moon again ....

Well I'm a podiatrist and they don't make toe shaped ones either so we cut them down with sterilised scissors and use mefix tape to aseptically apply the dressing.

Most nurses just unwrap a dressing and stick it on.

I don't believe wounds cause condensation, that's an old theory. Even melolin will absorb wound exudate. The wound is likely to be weeping because that's what wounds have to do, that fluid usually stays under the skin but where the epidermis is lost the fluid leaks out, large burns are the same. If you lose skn you lose fluids.

The crystals keep the wound open, they are essentially a foriegn body.

Have you tried ordinary latex/vinyl gloves whilst using the loo? Sainsburys pharmacies often have big boxes that would work out cheaper fir you in the long run.

Fwiw frequent dressings disturb the healing tissues and can slow wound healing. If I get a heavily exudating wound I use lyofoam extra as it holds more fluid, it's the sight of fluid leaking through that makes dressings look dirty. You can use tubegauze to cover the finger to make it look neater, cheap viscose is easier to use than the cotton for patients. Pm me if you want me to explain how to use it. You need 00 size.

Lastly, any area that moves a lot eg fingers bending and flexing won't heal as fast as a immobile area, the movement pulls at the wound and can open it up again.

Wounds never heal as fast as patients expect them to, I tell patients not to worry until we do.

fluffy - a podiatrist ,of course ,you must be used to dressing digits and might even have experience of the ghastly looking tophaceous gout !
Thank you so much for your reply .

re glove wearing and loo - I've not yet quite managed to tell my mum that her hand is far from clean . She can't see ,guess when she was washing them it dealt with it ,but now she's using baby wipes because she can't get her hand wet ,it's not so effecient I guess .I do clean them for her ,so she might be realising .

I have PM'd you ,sorry .

Ds had his whole hand overbanged in a fist with the thumb sticking out for limited use and padding between the fingers and palm. This meant a large dressing but the wound was very well protected. He only needed this for a day or so. Just mentioned in case it might be a way forward for your mother. It is rather impractical.