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Wound Management

EB implicates a lot of wound management, which you hopefully will find easier following the guidelines below.

Always make sure you disinfect your hands thoroughly before taking care of blisters and wounds!

Management of Blisters

  • If not opened, blisters tend to become bigger and bigger.
  • The smaller the blister is when getting punctured, the smaller the wound will be.
  • Bigger blisters should be punctured with a large (18-gauge = pink) sterile needle and be drained as well (you do not need a sterile swap).
  • Leave the top of the blister for wound-protection. 
  • With smaller blisters (up to a diameter of about 5 mm) the safe handling of the needle is difficult, and holding the child too tight might damage surrounding skin.
  • Blisters inside the mouth should never be punctured.
  • If the opening in the blister's top is too small (e.g. because of using a very thin needle), the blister might quickly be refilled with liquid.

Wound management and dressings

How often?

We recommend changing the dressing about every 2 days, e.g. Monday-Wednesday-Friday. Each family can and should choose an individual scheme to suit their daily and weekly routine best.

What kind of dressing?

  • Use non-adhesive dressing material only. Note: Many so-called 'non-adhesive' dressing materials prove to be sticky on the skin of people with EB.
  • Plaster and other adhesive material (e.g. adhesive-electrodes) must not be used; the skin might stick to the adhesive material when being removed.

Removal of old bandages

  • In case a tape has already been applied: use Niltac-Spray (by Trio Healthcare) or Dermasol to dissolve the adhesive layer which makes a cautious removal of the plaster possible. Annother option is to soak the tape with water (e.g. in the tub). If nothing helps: leave the tape/plaster in place until it comes off on its own.
  • Other dressings are best soaked and removed in the bath.

Applying new dressings - 3 steps

  1. Covering the wounds
    e.g. using Adaptic (by Systagenix), Urgotül/Urgotül soft (by Urgo), Mepitel (by Mölnycke), or Mepilex (by Mölnycke) – a soft siliconecoated foam/ contact layer dressing which, because of its thickness and complicated application, is not recommendable for small babies.
    Cover the affected skin area carefully so that further dressing-layers will not get into contact with and stick to the wounds, causing further damage.
  2. Padding
    Use soft compresses to pad the wound and to absorb liquid from the wound as well, e.g. Topper 12 by Systagenix, Medicomp Extra or Medicomp fleece compresses by Hartmann, Vliwasoft fleece compresses by Lohmann &
  3. Fixing the dressing
    Use gauze bandage, e.g. Peha-Crepp or an elastic tube bandage, e.g. Coverflex elastic tube-bandage (both by Hartmann).

Creams and ointments

  • For spots where dressing is difficult, use a soft zinc-containing cream for skin-care (e.g. ZCR Zinkcream by dline) for drying off the punctured blisters.
  • In case of infected or smelly wounds always contact a doctor. Flammazine cream (containing silver sulfadiazin) is often used in such cases. This cream is effective against bacteria but should, as silver is toxic, not be applied longer than 6-8 weeks maximum.
  • Infected wounds might be treated with antibiotic ointments. Such ointments should only be used in case of infection, and even so, only for short periods (2-3 weeks) as the germs tend to develop resistance against antibiotics. If longer application is necessary, different ointments should be used from time to time. Alternatives are e.g. Refobacin, Diprogenta (containing Cortison as well), or Baneocin – for all of these products a prescription is necessary.

Source of information:

Alexandra Waldhör, EB Nurse, EB House Austria, Salzburg (2011)

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