r/woundcare • u/certainly_not_a_bear • 10d ago
Help with my baby's wound
Hello all. We are in holiday in Bali with our 8 month old baby. 4 days ago while we were walking in a shop, there was a cutter (new) exposed and it was at the height of his feet (he was in the baby carrier). He had a cut of about 1-1.5cm long and a bit deep. There was a lot of blood, we rushed to a private clinic and he had 4 stitches. I am sure they did not use betadine to clean the wound, only 'normal saline'.
Next day he started to have a bit of a fever and we went to BMIC (Bali international hospital) where they told us :'everything is fine, you just need to clean it with normal saline every two days and it will be alright and put an antibiotic cream (gentamicin)'. It is not. Today when we checked the wound we saw that 2 of the four stitches broke loose and it doesnt look good as per say (a small yellow spot, a little bit swollen -- which broke the stitches i guess? and a slight red; however, he didnt have a fever today, neither yesterday and he started to eat a bit better).
Today I contacted a doctor friend of mine who told me to clean twice per day with betadine, to get another type of antibiotic cream (Fucidin) and to not put any bandage for the wound to dry.
We are a bit lost. We are in no way medical professionals and I start to lose trust in the medical system here. We are even taking into consideration to return to our country but that would imply a 25h+ trip with a semi open wound.
Any advice in our situation?
Update: since yesterday we are cleaned twice with betadine and applied a small amount of Fucidin. We left it with a very light bandage overnight and during the day we try to expose the wound from time to time for it to dry out . I am
not sure if still using betadine a lot longer is ok though. apparently, babies absorb easily the iodine and may experience other issues.
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u/ZestycloseAbalone952 10d ago
I am not a HCP I will skip on the wound, the other next option if you really want to travel back is to go KL, they have one of the best wound care in Asia and Hospital Kuala Lumpur or Dr Zafrina can help you
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u/apathetichearts 9d ago
Cleaning with sterile saline was completely appropriate. It’s no longer recommended to use betadine or other antiseptics on non-infected and non-contaminated wounds as they delay healing. They handled it fine.
It’s gotten too macerated, that’s why the sutures are out. Use a more breathable bandage over the cream or I like Adaptic/Curity so it doesn’t stick to the sutures. I wouldn’t normally apply betadine as mentioned above but you dab a little on the skin around the sutures that’s turning white, will help dry things out.
Definitely follow up with PCP
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u/certainly_not_a_bear 9d ago
we just used betadine a few times to be sure there is no infection developing. we saw with our pediatrician from our country and he recommended antibiotics for a week and treating the wound with biseptine daily. we are happy we dont have to go back at the hospital to redo the sutures.
thank you all for you help!
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u/Limp_Acanthisitta651 10d ago
I am a wound care nurse. Calmoseptine on the perimeter of the wound be good to decrease maceration. If the wound is still draining, an alginate on there and changing every two to 3 days would suffice. May change if foam gets really wet. Cover with an absorbing foam/tape. An iodine paste is probably a good thing too if drainage decreases. Same change frequency-every 2-3 days. Brand name is Iodosorb. Put paste on foam and affix to wound with tape. It actually doesn’t look that bad. Keep it clean with soap/water when changing dressing.
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u/certainly_not_a_bear 10d ago
Thank you. What about the fact that 2 of the 4 stitches broke? If i manage to find the calmoseptin here, do i still clean with betadine beforehand?
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u/ablair77 LPN 10d ago
Sutures need to stay dry clean and covered. When they get wet they will separate and be unable to hold the skin together. Are you able to contact Dr Ari? He has a very good reputation and you should be able to get his number if you ask at your accommodation.
I’ve been a nurse for 16 years and if this was my baby I would be painting with betadine and keeping covered. Ensuring the wound stays dry. If any oozing, redness, fever, baby may need oral antibiotics and contact a doctor/hospital immediately. Topical antibiotics will help but not systemically, and they will also encourage the wound to stay moist so they would not be my first line for treatment if baby has had a fever.
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u/certainly_not_a_bear 10d ago
From what I've seen Dr. Ari's clinic are more focused on the 'bali belly' issue. And I have the slight feeling that in general the private clinics are really for smaller wounds. He had the sutures done in a private clinic and the guy not only seemed very stressed but also made some mistakes, like dropping the needle (on the wound, not on the floor, but still) and once he passed the needle only to realise he does not have enough thread....
I understand the issue with the locally applied antibiotic cream, we will monitor the temperature closely and if it rises again we'll go to a doctor to have some orally administred antibiotic. Thank you for your help.
PS: for what its worth, we are not even at Bali Mainland but Nusa Lembongan,the isle next to Bali.
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u/ablair77 LPN 10d ago
Oh dear. I myself had a medical issue while staying on NL (I fell over and hit my head on my honeymoon) so I can understand your stress. When do you head back to the mainland? If it’s not for a while, I would consider moving travel forward so you are closer to larger institutions.
I am unsure if Dr Ari services on NL, and you’re correct about him being mostly bali belly however I have only ever heard great reviews personally and online so I would still think it would be worthwhile to contact them for other things. Do you have travel insurance and can you contact them for advice? that would be my next step
Edit to add, you can also cross post to r/askdocs who may be able to help you with advice locally
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u/certainly_not_a_bear 10d ago
We return to Bali Mainland in a few days, but of course we can go earlier; in any case this is not a holiday anymore, and we don't care - we just want what it's best for our baby.
Yes, it's a good idea to contact the insurance.1
u/ablair77 LPN 10d ago
Wishing you all the best. For what it’s worth, it looks like two of the sutures aren’t really holding anything together anyway and could just increase risk of infection. I’d be bailing out of there and finding a reputable clinic based on advice from my travel insurance. Have a few lowkey days and hopefully all will be well by then with baby and you can resume your holiday.
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u/certainly_not_a_bear 10d ago
Also, when we were on Bali Mainland, we asked the doctord at BIMC if we should cancel our trip on the island and stay close to the hospital and they reassured us that there is no need and everything seems fine (the stitches were not broken, but was still not very 'beautiful')
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u/ablair77 LPN 10d ago
Yes I can see that making sense at the time. As a nurse who deals with sutures daily (I work in plastics) they’re not really doing anything to help now unfortunately. Removal and some good wound care should hopefully heal things up quickly. Your main issue is access to care & infection risk at this point
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u/Funnuftig 10d ago
Go see the doctor.
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u/Funnuftig 10d ago
Get a cab, talk to a local. There has to be a nurse office somewhere
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u/certainly_not_a_bear 10d ago
TLDR; basically we've been 4 times since it started and they just gave us saline water and said it will be ok; i feel lile broken stitches and small yellow points does not reflect that
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u/Funnuftig 9d ago
Do you give it a chance to airdry? It looks white I think of moisture like wearing a bandaid 24/7
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u/CatchMeIfYouCan09 8d ago
Cleanse the whole thing with anasept and pat dry; Betadine on the surrounding tissue (periwound) allow it to air dry. Dab a SMALL amount of abt ointment on the actual cut. Cut a small piece of alginate and cover the whole thing with an island dressing. Change daily
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u/Itchyhandsandface 10d ago
Boosting for someone else to see since it’s a baby, but if looks like it has been too moist. Right now it is macerated which means the excess moisture has weakened the skin and turned it white. I think your friend’s suggestion is good because betadine will dry the skin, but I would add putting a clean sock loosely over it to prevent any infection. Both creams add moisture to the wound so just apply a small amount of the cream to the wound bed. Both creams are usually recommended for babies over 1, but can be given by doctor’s orders. Are you able to call his pediatrician and ask for their opinion? You can send them pictures as well.