Wound in the tropics ?

[lowflyer]

I'm a retired MD. I'll tell you what I would do, but I'm not giving advice.

I would dive with it. When not in the water I would gently cleanse it with soap and water. I would put antibiotic cream on it and cover it. No Betadine. It's too hard on raw tissue. I wouldn't use sugar, though in the past studies have suggested it could be helpful in open wound healing, including in the form of Manuka honey.
While in the water I would try to get a patch of old neoprene or a smooth sock and stick it under my booty. That way there are two layers between the foot and fin, decreasing the friction on the wound a little. I think the risk of infection is overstated, though healing will take longer. Arguably, the risk of infection in the tropics might be worse on land.

Of course, if you came into my office I would be obliged to tell you to stay out of the ocean

 

[scubajunky17]

Ok thanks, I can afford to give it a few days though to get some healing happening. So will stay out of the water for a few days, I have one month before I need to move from here anyway.

I'm a retired MD. I'll tell you what I would do, but I'm not giving advice.

I would dive with it. When not in the water I would gently cleanse it with soap and water. I would put antibiotic cream on it and cover it. No Betadine. It's too hard on raw tissue. I wouldn't use sugar, though in the past studies have suggested it could be helpful in open wound healing, including in the form of Manuka honey.
While in the water I would try to get a patch of old neoprene or a smooth sock and stick it under my booty. That way there are two layers between the foot and fin, decreasing the friction on the wound a little. I think the risk of infection is overstated, though healing will take longer.

Of course, if you came into my office I would be obliged to tell you to stay out of the ocean

 

[Germie]

For a wound on this toe, I would use honey ointment. This is a sort of natural antibiotics, but has not the problem as real antibiotics have. It holds the wound moist, as then it heals faster than just on air. It cleans the wound also.
I would not be afraid of diving with this toe. Just clean it after every dive. And put a sock over it to protect it in a boot.
Last year I got attacted by a dog and had planned a trip to Egypt. They made this nice thing of the wound and the answer was when they were doing this about my question with Egypt 2 weeks later: You are allowed to swim and dive tonight in open water without being afraid of any infection. Just wash it after a swim or a dive with fresh water. Rinse it 2 times a day with fresh water, the drains will be taken out in 1-3 weeks. If they cannot be taken out before your trip, don't worry, go diving in Egypt and we take them out after it. I have asked it for sure 3 times or more if I could go diving directly again and they said yes.
So the first thing I did as soon as de epidural stopped working was taking my car and did a dive in a wetsuit (I normally only dive a drysuit in my country) . This picture was taken after cleaning the wound less than 12 hours after they made this 'nice' thing.
1 week later the drains were removed, and also that doctor said go swimming as much as you want, don't worry about Egypt. And also a 3rd said no risk of swimming in open water. That doctor said he worked in Malaysia and they always sent people to the sea with wounds.
A lot of people said you cannot swim or dive with this, but 3!!!!!!!! doctors in hospital (the only 3 I have met there) said GO, don't worry, swim, dive. So I think there will be a lot of opinions about wounds and swimming in open water. Staying out of the water will also let a wound heal, but then you are not happy. I am really angry when I cannot dive and want to go diving.

I used honey ointment for about 4 weeks and then it was completely healed, it was not said by a doctor, but when I asked about it, he said you can use if you prefer it over vaseline. In Egypt I did 4-5 dives a day and half of the dives I holded the wound dry with tegraderm (yes, this hold it completely dry, so it will work for toes also I guess). And the rest I did not put anything over it, just a 1mm wetsuit, and went to take a shower right after the dive, let it dry and putted bandage over it. During night also honey ointment again.

Honey ointment seems to be not known by a lot of people and doctors here. But it is THE way to go with wounds on horses. And if you don't get wounds of horses infected with this, I really believe in it. Horses are really bad animals with infections. They are soooo sensitive for it. It is also a natural product.

So this is no real medical advice, but my own experiences.

 

[The Chairman]

No betadine
No sugar
and DEFINITELY NO COOKING OIL!!!

 

[berndo]

I wouldn't use sugar, though in the past studies have suggested it could be helpful in open wound healing, including in the form of Manuka honey.

I brought up the sugar. It's only supposed to go on infections not on fresh wounds. I had a buddy with an infection that didn't get any better even after he stayed on land. Get got it because he kept diving with a wound was fresh. This was an instructor, not somebody on a one or two week vacation... like in all these stories here.
The guy who told us to put sugar on these wounds that discharge pus and keep getting worse was a surgeon from a major hospital in Germany.
It seem like a lot of people here missing that OP is there for a month and not for a week or two. Staying out of the water, letting it heal some and missing out on some dives early is a better option than risking an infection in the first week and having to deal with it for the last 2 or 3 weeks.

 

[scubajunky17]

Just cleaned it after 24hrs of sugar and betadine and it looks better already hopefully it will stay clean and heal soon.

 

[scubajunky17]

Doc it seems to be weeping quite a lot of clear liquid, have just washed it now and put a dab of betaine and then some petroleum jelly over it.
How do you think it looks?

 

[scubajunky17]

Thanks, would you band aid over the PJ or not ?


QUOTE="kinoons, post: 10032802, member: 533530"]
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.
[/QUOTE]

 

[lowflyer]

It looks like you lost tissue in this injury, and in the third picture it looks deeper than I thought originally. It looks deeper than a simple abrasion. It's going to take a while to heal. There are some spots of dead tissue.

I'm assuming there is no medical resource available to you? If there is, go consult with it. If not, I suggest you stop using betadine. It may impede granulation, which is necessary for this type of wound to heal. Try to get some antibiotic ointment, and continue gentle washing daily. Cover the wound. Why are you able to get betadine but not an antibiotic ointment? You have internet, or are you using a SAT phone?

 

[scubajunky17]

I have internet, I can get antibiotic ointment, should I start with it straight away?
At the moment I have put a little betadine on it then covered it with PJ.
A few people have suggested this local topical ointment, I will stay out of the water another three days or so, that would be six and hopefully we'll on the way to recovery.