From the Research
This skin tear in an 83-year-old with a history of left mastectomy and lymph node removal requires immediate medical attention, and the patient should seek care from a healthcare provider within 24 hours due to the risk of lymphedema and infection. The patient's history of lymph node removal compromises the lymphatic drainage in the affected arm, putting them at higher risk for infection and delayed healing 1. Until medical attention is received, the patient should gently clean the wound with mild soap and water, apply an antibiotic ointment like Bacitracin or Neosporin, and cover with a non-stick dressing such as Telfa. The dressing should be changed daily or when wet.
Some key considerations for the patient's wound care include:
- Elevating the affected arm when possible to reduce swelling
- Avoiding tight clothing or jewelry on the affected arm
- Monitoring for signs of infection, including increased redness, warmth, swelling, pain, or fever
- Recognizing that the compromised lymphatic system in the left arm following mastectomy can lead to serious complications, including cellulitis or lymphedema, making proper wound care and medical evaluation essential 2.
The use of topical antibiotics, such as those mentioned, can help reduce the risk of infection, but it is crucial to use them judiciously to avoid contributing to antibiotic resistance 3, 2. The patient's wound should be assessed holistically, considering factors that affect wound healing, such as the patient's overall health and any comorbidities 4.
Given the most recent and highest quality evidence, the management of this acute wound should follow the principles outlined in the expert panel consensus statement on the management of acute wounds, which emphasizes timely and evidence-driven intervention to achieve optimal clinical outcomes 1.