What is the appropriate wound care and treatment for a de-roofed blister with serous fluid and old blood, sustained in a motor vehicle collision (MVC)?

Management of a Deroofed Blister from Motor Vehicle Collision

Deroofing a compromised blister with brown exudate and serous fluid was the appropriate intervention to reduce infection risk, and should be followed by gentle cleansing with antimicrobial solution, application of a topical antibiotic, and coverage with a sterile non-adherent dressing. 1

Wound Care Protocol for Deroofed Blisters

Immediate Management

1. Cleansing:

   • Gently clean the wound with an antimicrobial solution 2
   • Avoid aggressive scrubbing which can damage healing tissue
   • Remove any visible debris or foreign material

2. Antimicrobial Treatment:

   • Apply topical mupirocin 2% ointment three times daily 2
   • This has clinical efficacy rates of 71-93% in preventing infection

3. Dressing:

   • Cover with a sterile, non-adherent dressing 2, 1
   • Change dressing daily or if it becomes soiled or wet

Monitoring and Follow-up Care

Monitor for signs of infection, which may include:

• Increasing redness extending beyond the wound margins
• Increased pain or warmth
• Purulent discharge
• Red streaks extending from the wound
• Fever or systemic symptoms

If signs of infection develop, oral antibiotics may be necessary. The Infectious Diseases Society of America recommends the following options 2:

• Dicloxacillin: 250 mg four times daily
• Cephalexin: 250 mg four times daily
• Clindamycin: 300-400 mg three times daily (if penicillin allergic)
• Amoxicillin/clavulanate: 875/125 mg twice daily

Evidence-Based Rationale

The Initiative Chronic Wounds (ICW) consensus recommends removing the blister roof when there are clinical signs of infection or when the blister is already ruptured 1. Your decision to deroof the compromised blister aligns with this guidance, as the presence of brown exudate (likely old blood) and leaking indicates the skin barrier was already compromised.

Research indicates that deroofed blisters should be treated with appropriate dressings to provide pain relief and allow continued physical activity if necessary 3. The maintenance of a moist wound environment with appropriate dressings promotes epithelialization and reduces pain.

Common Pitfalls to Avoid

1. Inadequate cleansing: Failure to properly clean the wound can lead to infection
2. Inappropriate dressing selection: Using adhesive dressings that stick to the wound bed can damage new epithelial cells
3. Delayed treatment of infection: Watch closely for signs of infection, especially in wounds from trauma like MVCs which may have higher contamination risk
4. Neglecting tetanus prophylaxis: Consider tetanus immunization status in traumatic wounds 4
5. Overlooking pain management: Provide appropriate analgesia as many patients report pain during blister care 2

By following this evidence-based approach to wound care for your deroofed blister, you can minimize infection risk and promote optimal healing.