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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So, we just went over how to put on an oonaboot, and the other component of that is when your patient comes back, either in a few days or a week, how to appropriately take it off without injuring the patient. Again, several of our patients and our patient population primarily is wound care based, so you want to be cognizant of the nature of their skin, whether it's arterial disease, venous disease, systemic disease. A lot of patients don't have the healthiest of tissues, so even a nick of the scissor can result in a pretty severe wound, so be mindful of that. An easy way to take this off is just layer by layer. You can get your finger underneath, make sure that you're not cutting the skin, so basically just follow and pull up as you go. Check in with the patient. Do you feel any tenderness or impingement?
No. Okay. Another thing to be mindful of is some of your patients are neuropathic. We had just put this oonaboot on, so you do see some of that paste still there, and you can come from the proximal end as well, and again, ride your finger underneath, sort of guiding it, lifting it away from the skin, making sure your scissors are pointed upward, there's a blunt tip here that doesn't allow the skin to be punctured, but slow and steady, checking in with your patients, making sure they're comfortable, because some patients will see scissors and automatically be a little bit more fearful, so putting them at ease, putting yourself at ease, making sure that you're not causing any new problems. Good. Just slowly work your way down. We'll find landmarks you want to be cognizant of. Your tibial crest is right here. You don't want to come down centrally because your tibial crest is right there. You don't have a lot of soft tissue coverage over that tibial crest.
The lateral side here, your lateral leg compartment, your peroneal tendons, peroneal right over the bone, and then when you get down to the ankle, you have your medial malleolus here and your lateral malleolus here, and you don't want to cut right over those either, just because the anatomy of those areas can be a little bit difficult to get around, so be mindful of that when you feel that. Be extra careful to pull up the dressing and away from the skin, and then you can make the turn and go into the pedal or the foot compartment. And this should not be quite as pasty because it'll have been dried and been on for a few days, but issues or if the patient is a heavy exudator in terms of venous wounds or chronic weepage, some providers prefer to see the dressing to see what type of drainage is there, whether it has like a greenish color, you'd be concerned about some pseudomonas. If there's bloody drainage, different drainage patterns can help the provider with the appropriate diagnosis and treatment protocol.
So before you go to toss this out, either keep it on the ground on a chuck so that when the provider comes in they can assess that, or double check with your provider before you go ahead and discard that, and then you can go ahead and clean the skin as normal.”
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