C09992948 / invoice 10000

Reason: AK Recheck, Rebandage Appointment Notes: 4pm , oksd by AR tfHealing wellGranulaion tissue filling in nicely. Minimal inflammaiton and swellingReplaced bandage - recheck monday    Vital Signs    

Reason: Recheck With ARAppointment Notes: ab.Seen by AK Sunday for wound breakdown/discomfort.Dehiscence on ventral aspect noted.  Other aspects of wound are still healing well. ABs recommenced.Bandage removed.Healthy viable tissue bed present on ventrum of interdigital space.Comfortable to touch.Cleaned with dilute betadene. Dried with swabs.Manuka honey thin layer applied to affected tissue and melolin applied over it.Toes pack gently with strip of softban before bandaged with softban, vetwrap and elastoplast on outside. Adhered to ankle bandage.Client communication:Expressed to client that wound has broken down, but only ventral most layer and tissue bed appears healthy and viable. Should still heal, but will likely take more time/bandage changing. Once granulation bed/scabbing achieved, can stop bandaging. Until then, recommended bandage changes every few days with aim of moving out duration between bandage changes pending appearance/healing progress. Estimated about 1.5 weeks further of bandage changes probably a reasonable timeframe to be filled in. Plan:Bandage change today.Recheck + bandage change in Friday with AK.Recheck + bandage change next week with AR or AK pending availability.    Vital Signs    

Reason: Post Op - Wound Breakdown?Appointment Notes: ab.Presented for wound breakdownThis morning he was uncomfortable and wont weightbearO gave meloxicam, paracetamol and gabapentin which seems to helpOwner was doing BID bandage change and letting it aerate, but unsure when the wound broke down, possibly over the past few daysPESx site: ventral surface of the wound is completely opened. The SC/muscle layer closure sutures are exposed and unravelled. The wound extends to the inter digital space between the 2 pads of the digit 2 and 3, sutures are not holding any tissue. Granulation tissue appears clean and well formingTreatment: Any stray sutures were removed.Cleaned the wound with betadineApplied bandage - non adhesive melolin + soffban between toes _+soffban + vetrap + elastoplast on topDisucssed plan to continue bandaging until full granulation    Vital Signs