How to manage an open wound in the axilla with a serous blister?

Management of Open Wound in Axilla with Serous Blister

For an open wound in the axilla with a serous blister, management should include gentle cleansing with saline solution, proper blister care, application of appropriate topical antimicrobials, and consideration of systemic antibiotics due to the axillary location which carries higher risk of gram-negative and anaerobic infection.

Initial Wound Assessment and Blister Management

1. Blister management:

   • Gently cleanse the blister with an antimicrobial solution 1
   • Pierce the blister at its base with a sterile needle (bevel facing up) to facilitate drainage 1
   • Do not remove the blister roof - leave it in place as a biological dressing 1, 2
   • Apply gentle pressure with sterile gauze to facilitate drainage 1
   • Cleanse again with antimicrobial solution after drainage 1

2. Wound cleansing:

   • Use simple saline solution without additives for cleansing 1
   • Avoid antiseptics or soaps as additives provide no additional benefit and may impair healing 1

Antimicrobial Management

Topical Treatment

• Apply a topical antibiotic such as bacitracin 1-3 times daily 3, 4
• Triple antibiotic ointment (containing neomycin, polymyxin B, bacitracin) has been shown to promote faster healing and effectively eliminate bacterial contamination 4
• Cover with a non-adherent dressing 1

Systemic Antibiotics

• Due to the axillary location, consider systemic antibiotics as incisions in the axilla have a significant recovery of gram-negative organisms 1
• For axillary wounds, recommended antibiotics include:
  • Ceftriaxone or a fluoroquinolone (ciprofloxacin or levofloxacin) in combination with metronidazole 1
  • This combination provides coverage for both gram-negative organisms and anaerobes commonly found in axillary wounds

Ongoing Wound Care

1. Infection prevention:

   • Daily washing with an antibacterial product to decrease colonization 1
   • Change dressings using aseptic technique 1
   • Monitor for signs of infection (increased redness, warmth, pain, purulent drainage) 1

2. Barrier protection:

   • Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin to support barrier function 1
   • This helps reduce transcutaneous water loss and encourages re-epithelialization 1

3. Pain management:

   • Provide analgesia prior to wound care procedures 1
   • Consider both acute and background pain control 1

Special Considerations

• Axillary wounds have higher risk of infection due to:

  • Increased moisture and bacterial colonization in this area
  • Higher incidence of gram-negative organisms compared to other body sites 1
  • Potential for anaerobic infection 1

• If signs of infection develop:

  • Obtain bacterial and viral swabs 1
  • Consider adjusting antibiotic coverage based on culture results
  • For severe infections, follow guidelines for skin and soft tissue infections 1

Follow-up

• Regular assessment of wound healing progress
• Continue dressing changes until re-epithelialization occurs
• Adjust antimicrobial therapy if signs of infection develop

This approach prioritizes proper wound cleansing, appropriate blister management, and targeted antimicrobial therapy based on the anatomical location, which is crucial for preventing infection and promoting optimal healing in this challenging area.