Wound in the tropics ?

[scubajunky17]

Your hardcore Rambo, betadine and sugar are all I have right now.
I'm leaning towards trying to keep it dry and out of the water for a few days and get it healing early on, I have time, six weeks here in total, four before I need a new visa, I can give it four or five days now to see where it is at.

I would not recommend this but ....

On first day in Coz I slipped and cut 1.5" gash on my leg on a broken pool tile.

I did not want doc to tell me no diving. I stitched closed with sterilized thread and needle from hotel repair kit. I dressed with antibiotic ointment and waterproof dressing. Changed daily after diving. No complications, kept my leg LOL.

I probably got lucky and I WOULD NOT recommend it to anyone else.

 

[berndo]

The exposed muscle looked desiccated. I wish I took a picture of it back then.

I'm glad you didn't.

 

[uncfnp]

Is there a doctor in the house? How about a FNP? @uncfnp

Hey Lorenzoid and thanks for the tag. I will try to help if I can. We just lost our pet today and I am low on sleep so I my thoughts might be a bit scattered.

If the OP had come to my office with this I would have told you to clean it daily with warm soapy water and keep covered with bandaid. And to stay out of any “dirty” water like streams, lakes, hot tubes and yes, the ocean. But divers being what they are I know most would ignore this advice.

It is hard to tell from the photo but I think maybe it is not too deep? Of course any break in the skin is a portal for infection.

Sites more distal to the heart do have a greater risk of infection. Age and health also play a role.

As for ointments, I usually recommend polysporin or equivalent for at least the first few days, especially if I feel there is a more than average risk of infection. But I know some dermatologists that recommend vaseline for low risk wounds. The purpose here is to decrease infection but also to keep the wound base moist. Scabs slow healing as does a dry wound. Broad spectrum antibiotics and drug resistance isn’t really a part of this discussion, yet.

As for sugar and betadine, we stopped using chemicals on wounds many years ago. If a wound is particularly contaminated I might use a half strength peroxide mix briefly. The problem with betadine, alcohol, peroxide, is they don’t know good from bad and will destroy indiscriminately. All that is needed for most wounds is clean water.

As for sugar, I have never recommended it’s use. I have seen a honey paste used for dirty, necrotic or slow to heal wounds but not routinely and not for clean cuts.

IF you choose to dive with the cut make sure you clean it very well after diving. If you can manage a waterproof dressing all the better (and yes here a sock might help protect the dressing). But absolutely keep a close eye on it and seek care early for any signs of infection.

 

[Tom Winters]

Yeah, uh, tropical wounds. Feel free to just take care of it.
What’s the worst that can happen? A long, slow lingering death with lots of sectional amputations?
Well, yes…TAKE THE EFF CARE OF IT!!!

 

[scubajunky17]

Sorry for your loss and thanks for responding, I'm going to stay out of the water for three or four days to get some healing happening, I'm remote, I have few options, I only have sugar, betadine and some access to cooking oil.
I also have sudocream a zinc based cream.
I appreciate your help, hopefully a few days and it will be much better.

 

[scubajunky17]

Yeah, uh, tropical wounds. Feel free to just take care of it.
What’s the worst that can happen? A long, slow lingering death with lots of sectional amputations?
Well, yes…TAKE THE EFF CARE OF IT!!!

I know, and im looking for the best advice to do that.
Had infections before and they are not fun in the tropics for sure and very dangerous.

 

[kinoons]

Hey Lorenzoid and thanks for the tag. I will try to help if I can. We just lost our pet today and I am low on sleep so I my thoughts might be a bit scattered.

If the OP had come to my office with this I would have told you to clean it daily with warm soapy water and keep covered with bandaid. And to stay out of any “dirty” water like streams, lakes, hot tubes and yes, the ocean. But divers being what they are I know most would ignore this advice.

It is hard to tell from the photo but I think maybe it is not too deep? Of course any break in the skin is a portal for infection.

Sites more distal to the heart do have a greater risk of infection. Age and health also play a role.

As for ointments, I usually recommend polysporin or equivalent for at least the first few days, especially if I feel there is a more than average risk of infection. But I know some dermatologists that recommend vaseline for low risk wounds. The purpose here is to decrease infection but also to keep the wound base moist. Scabs slow healing as does a dry wound. Broad spectrum antibiotics and drug resistance isn’t really a part of this discussion, yet.

As for sugar and betadine, we stopped using chemicals on wounds many years ago. If a wound is particularly contaminated I might use a half strength peroxide mix briefly. The problem with betadine, alcohol, peroxide, is they don’t know good from bad and will destroy indiscriminately. All that is needed for most wounds is clean water.

As for sugar, I have never recommended it’s use. I have seen a honey paste used for dirty, necrotic or slow to heal wounds but not routinely and not for clean cuts.

IF you choose to dive with the cut make sure you clean it very well after diving. If you can manage a waterproof dressing all the better (and yes here a sock might help protect the dressing). But absolutely keep a close eye on it and seek care early for any signs of infection.

I’ll echo the same as an ENP myself. For most wounds I take care of in the ED I tell folks to keep them clean, keep them dry (IE no hot tubs, long baths, swimming pools…) and yes wash them gently each day with soap and water. Neosporin or similar is fine. Then protect the wound with a bandaid. A general timeframe is likely 7-10 days.

Proper wound care: How to minimize a scar

Learn about dermatologists' recommendations for properly caring for a wound to minimize scarring.

www.aad.org

I wouldn’t use new skin over a wound like this.

So we come to diving. I’d tell you not to. The relative risk for infection goes up greatly, where as the absolute risk stays fairly low, as you have seen by many divers here on the board saying they frequently dive with similar wounds.

No oral antibiotics until infection is apparent.

I would consider the availability of medical care before I chose to continue diving.

 

[scubajunky17]

I’ll echo the same as an ENP myself. For most wounds I take care of in the ED I tell folks to keep them clean, keep them dry (IE no hot tubs, long baths, swimming pools…) and yes wash them gently each day with soap and water. Neosporin or similar is fine. Then protect the wound with a bandaid. A general timeframe is likely 7-10 days.

Proper wound care: How to minimize a scar

Learn about dermatologists' recommendations for properly caring for a wound to minimize scarring.

www.aad.org

I wouldn’t use new skin over a wound like this.

So we come to diving. I’d tell you not to. The relative risk for infection goes up greatly, where as the absolute risk stays fairly low, as you have seen by many divers here on the board saying they frequently dive with similar wounds.

No oral antibiotics until infection is apparent.

I would consider the availability of medical care before I chose to continue diving.

Thanks so should I wash the sugar off every day or keep the sugar over it with a little betadine and keep it dry and aired?
Definitely staying out of the water for a good few days until it's started healing and no longer an open wound.

 

[kinoons]

Thanks so should I wash the sugar off every day or keep the sugar over it with a little betadine and keep it dry and aired?
Definitely staying out of the water for a good few days until it's started healing and no longer an open wound.

I wouldn’t use the sugar, and I absolutely wouldn’t use the betadine at all.

When we use betadine in the ER we use it at 1/2-1/3 strength (we dilute it to look like weak tea), and then only briefly.

Soap, water, petroleum jelly, plus or minus triple anabiotic. Occlusive dressings if you insist on diving. That’s what I’d stick with.

 

[scubajunky17]

I wouldn’t use the sugar, and I absolutely wouldn’t use the betadine at all.

When we use betadine in the ER we use it at 1/2-1/3 strength (we dilute it to look like weak tea), and then only briefly.

Soap, water, petroleum jelly, plus or minus triple anabiotic. Occlusive dressings if you insist on diving. That’s what I’d stick with.

Ok, thanks, unfortunately I don't have PJ right now.