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Remove Persistent Staining with a Callus Shaver

Wongkietkachorn, Apinut MD*; Surakunprapha, Palakorn MD; Luvira, Vor MD; Wongkietkachorn, Nuttapone MD§; Wongkietkachorn, Supawich MD

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Plastic and Reconstructive Surgery - Global Open: March 2019 - Volume 7 - Issue 3 - p e2140
doi: 10.1097/GOX.0000000000002140

Sir,

Removing persistent staining from the periwound area can be difficult in patients with poor hygiene. Stain removal is important because these stains can become colonized with bacteria, which can then migrate to the wound.1,2 Normally, cleaning of these stains begins with chemical removal using antiseptic soaps and solutions.3,4 If chemical removal is not successful, the stain is removed mechanically. The instruments that are usually used in mechanical removal are forceps and a scalpel.3 The forceps are used to peel the epidermis, and the scalpel is used to cut the dead skin. However, this process can sometimes be traumatic, as it is difficult to control the peeling depth and the scalpel is sharp and can easily damage the dermis.

Callus shavers, which are used by nonsurgeons to shave the soles of the feet at home, are safe and do not cause trauma (see figure, Supplemental Digital Content 1, which displays the callus shaver instrument, https://links.lww.com/PRSGO/B1). We found that a callus shaver could also be used to remove persistent stains through the removal of the keratin layer from the skin. Moreover, this tool is cheap and available in many stores.

This procedure was used on a 72-year-old man who was admitted with an infected diabetic foot. His right foot was extremely unhygienic (Fig. 1). Although various chemical solutions (ie, Hibiscrub, Betadine surgical scrub, chlorhexidine, povidone-iodine, and acetone) were used in an attempt to remove the stains in the periwound area, the stains persisted (see figure, Supplemental Digital Content 2, which displays the wound after various chemical solutions were used in an attempt to clean the periwound area, but the stains persisted, https://links.lww.com/PRSGO/B2).

F1
Fig. 1.:
An infected diabetic wound on the right foot with persistent stains at the periwound area.

However, a callus shaver was then used and was able to easily remove the remaining stains. The process is shown in Supplemental Digital Content 3, and the results are shown in Figure 2 (see video, Supplemental Digital Content 3, which demonstrates how to remove persistent staining with a callus shaver. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at https://links.lww.com/PRSGO/B3). After the cleaning, a swab culture of the periwound area found no microorganism growth.

F2
Fig. 2.:
After removal of persistent stains with a callus shaver.

A callus shaver is a simple option for the removal of persistent staining from the skin.

V1
Video Graphic 1.:
See video, Supplemental Digital Content 3, which demonstrates how to remove persistent staining with a callus shaver. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at https://links.lww.com/PRSGO/B3.

REFERENCES

1. Mustoe TA, O’Shaughnessy K, Kloeters O. Chronic wound pathogenesis and current treatment strategies: a unifying hypothesis. Plast Reconstr Surg. 2006;117(7 Suppl):35S–41S.
2. Ottolino-Perry K, Chamma E, Blackmore KM, et al. Improved detection of clinically relevant wound bacteria using autofluorescence image-guided sampling in diabetic foot ulcers. Int Wound J. 2017;14:833–841.
3. Attinger CE, Janis JE, Steinberg J, et al. Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg. 2006;117(7 Suppl):72s–109s.
4. Mrdjenovich DE, Fleck CA. Consider skin hygiene and care beyond the wound. J Am Col Certif Wound Spec. 2011;3:45–47.

Supplemental Digital Content

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.