Hematology consultation, case characteristics.
1. the patient had leukemia for several years, and after the end of this chemotherapy, the patient was poor in nasal and mental health, and was treated with rehydration on April 4, with no abnormality in the needle hole after extraction, and a day later with local swelling, partial epidermal blackening, and areas of fluctuation.
2. physical examination: a 7×7 cm red and swollen area on the back of the right hand, with blackened skin in the middle and local pain of 6 points.
The patient was transferred to a laminar flow bed, and the surgeon's opinion: the patient's leukocytes were too low for incision and drainage.
Wound specialist nurse treatment: since surgical incision and drainage is not possible, we handled conservatively, using 75% alcohol to disinfect the skin extensively for a total of three times, covering the entire dorsum of the hand and wrist for 5cm, discharging pus with a large needle at fluctuating points with multiple punctures, retaining the secretion for bacterial culture, then using 4-6 layers of 75% alcohol gauze wet dressing for anti-infection, applying surgical patch externally to maintain the alcohol concentration, and for skin protection q6h change once, with a 1-hour break in between.
For 3 consecutive days, wound condition: redness and swelling on the back of the hand gradually disappeared, local infection was contained, and on April 8, the middle area of the black scab was cut under aseptic operation, SSD drainage was placed in the small cavity, external gauze dressing was placed, and medication was changed daily, in the same way until April 11.
April 13 black scab loosened: after removal, I was relieved to see that the innovation was fresh: the
Continued use of SSD and alginate dressing with external gauze and surgical patch:.
April 15 basic healing.
Patient's leukocytes rose to 0.79 x 109/L, neutrophils dropped to 0.17 x 109/L, HB 76g/L, and the wound healed.
Personal experience.
Faced with a patient with such a low resistance and the previous advice from the doctor not to cut, I would be very cautious in treating the wound to not aggravate or stop the development of local infection and strive for the best result without taking drastic measures.
The use of alcohol gauze wet dressing comes from the experience accumulated at work. Soft tissue infections on the surface, staphylococci are common, and 75% alcohol has a good inhibitory effect on staphylococci, and the patient in this case also received a better result.