Unna boot central gauze technique for chronic venous leg ulcers.

BACKGROUND: Venous leg ulcers generally take manyweeks to heal. Novel therapies that shorten healingtime and require less complex care are needed. PURPOSE: The purpose of this report is to presenta pilot study for a new method that can result ina faster healing time for venous leg ulcers usinginexpensive materials. METHODS: A central-gauzeprotocol was developed as described here. A three-ply gauze sponge was placed in the center of theulcer, allowing a peripheral 3-5 mm rim of ulcer toremain exposed. Saline solution was applied to thegauze sponge. A 3-layer Unna boot was applied overthe ulcer with short-stretch compression. This noveltechnique exposed only a peripheral rim of the ulcerto the zinc oxide paste, allowing the central portionof the ulcer to drain through the saline-soaked gauze.The ulcer was photographed at each clinic visit andthe wound area was estimated by finding the bestfitellipse for the ulcer area and computing the areaof the ellipse by a standard formula. RESULTS: Threepatients with small venous leg ulcers treated with thezinc rim technique showed an average healing rate of46.1% per week (range 27.8% - 50.7%). All ulcers werenearly healed by three weeks. After the ulcer size wasreduced sufficiently, patients were discharged withinstructions to apply pieces of Unna dressing to theulcer, under a conventional self-adhesive bandage,maintaining compression, without any saline-gauzein the center. CONCLUSIONS: The three patients in thispilot study showed rapid healing for venous leg ulcerswith the central gauze modification of Unna boottherapy.

Boys at Risk: Fatal Accidental Fentanyl Ingestions in Children: Analysis of Cases Reported to the FDA 2004-2013.

We analyze 25 accidental childhood fentanyl exposures reported to FDA, 2004-2013. These exposures had a case-fatality rate = 48%; male:female ratio = 7.3; 76% were within the 2-4 age range. The ability of fentanyl to kill children so quickly is explained by fentanyl's ability to suppress respiration-as quantified by the antinociceptive potency per milligram, fentanyl far and away leads all narcotics. FDA recommends for fentanyl disposal: flush all forms of fentanyl down the toilet.