It should be noted that some moisture barriers are safe to use on non-intact skin. British Journal of Nursing 10: 7, 469-472. Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. The wound assessment should include the periwound and surrounding skin, extending 4cm from the wound bed.1 Assessing wound location, shape, color, edges, margins, periwound, and surrounding skin is most significant in a thorough wound evaluation.1,2The periwound and wound margins are good indicators for identifying the wound type, infection, and moisture balance and for managing the plan of care.1,3 A per… Journal of Wound Care 8: 4, 200-210. Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. Their use is considered controversial. Note: it is prudent when estimating wear time to err on the side of caution, - Recognise and treat any infections promptly and appropriately, - Avoid topical antibiotics and antiseptic solutions, - Consider impregnated (iodine and silver) dressings, - Do not use hydrogels on wet wounds. Clinicians should also seek to refer the patient Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire. The area of maceration was also assessed by measuring each photograph using Image J software. Allman, R.M. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Any wound care provider is going to continuously seek new approaches to wound therapies that improve patient healing times. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. In acute wounds, exudate components contribute positively to the wound-healing process. Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. When presented with a wound, you should identify risk factors that may lead to periwound damage or breakdown and plan your care accordingly, taking care to choose an appropriate dressing and apply a skin sealant or moisture barrier as necessary. There is no defense like a good offense, and this is as true in wound care as it is in sports. A number of elements that may be found in exudate have been identified (Box 1) and although this box does not provide an exhaustive list, the reader will appreciate the diverse nature of these components. J Wound Care 2002;11(7):275–8. Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. Williams, C. (2001)3M Cavilon Durable Barrier Cream in skin problem management. However, some are better than others at performing these functions, and it is important for wound care professionals to know their wound care management tools inside and out, so that choosing the correct dressing is a simple affair. Cutting, K. (1999b)Glossary. By Beth Hawkins Bradley RN, MN, CWON I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy (NPWT). Patients suffering from periwound issues may experience burning, itching, tenderness, and pain. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. Cutting, K.F. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? Regular applications of liquid paraffin/soft paraffin (50/50 proportions) or zinc oxide cream or ointment BP to the peri-ulcer skin are often soothing as well as protective in function. Salisbury: Quay Books. World Wide Wounds. Voegeli D. Moisture-associated skin damage: an overview for community nurses. 20152 Source: Dowsett et al. • Periwound skin Accurate and timely wound assessment is important to ensure correct diagnosis and for developing a plan of care to address patient, wound and skin problems that impact healing. Wounds 8: 5 145-150. Diabet Foot 2003;6(3):S2. Sign in or Register a new account to join the discussion. Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. MAIN … Caustic. Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. Infection 2. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Dressings that combine a variety of absorptive materials and that possess a high MVTR have the potential of avoiding maceration, of providing increased wear time and hence decreased number of dressing changes. Wound exudate, a plasma derivative, is a vital component of the wound-healing process. Educational leaflet. Accessed March 14, 2015. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. Journal of Wound Care 6: 7, 327-330. It presents as a pale, opaque rim surrounding the wound. The periwound area has been defined as the area of skin extending to 4 cm beyond the wound (ie, the surrounding skin extending from the wound bed). In wounds, maceration can prevent healing, contribute to infection, and cause irritation, pain, and tissue damage. (1989)Pressure ulcers among the elderly. 7. The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. Negative pressure wound therapy (NPWT) has grown to be an important adjunctive therapy in any wound care setting due to its ability to promote wound healing in different types of wounds with granulation tissue formation. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. London: Emap Healthcare. Thomas S. The role of dressings in the treatment of moisture-related skin damage. They generally provide protection for up to 72 hours before re-application is necessary. Indeed, it is likely that most instances of maceration are attributable to ‘traditional’ dressings as these are still the most widely used. There is, at present, no evidence that moist wound healing is related to the development of maceration (van Rijswijk and Harding, 2000). Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. Published October 2009. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). Maceration is often a contributing factor for slow wound healing. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. 8. noted to be macerated.There were 1,332 VLU which became the focus of the current study. Butcher, M. (2000)The management of skin maceration. Although precise recurrence rates can be difficult to... By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. Periwound issues affect the integrity and healthy functionality of the skin surrounding the wound and may include maceration, excoriation, dry (scaly) skin, eczema, callus (hyperkeratosis), infection, inflammation.. Signs and symptoms. Evidence that maceration leads to skin breakdown and consequent wound enlargement is circumstantial (Allman, 1989), although anecdotal reports link maceration with delayed healing and other complications (Cutting, 1999a). Skin sealants are alcohol-based wipes that are used on intact skin, making the skin surface slightly sticky, creating a better surface for adhesive dressings to stick to, while at the same time providing the skin with some protection from the adhesive. VLU that were seen during 8 or more weekly clinic visits were identified;35 who had periwound maceration noted during 4 or more visits were compared with 35 matched controls who demonstrated maceration on 0 … Managing exudate production effectively requires achieving a balance between the extremes of wound desiccation and wetness. A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. About The Author Taking these steps will go a long way towards the prevention of skin breakdown in the periwound area due to excess moisture from any cause. If urinary continence problems are the main issue, bladder and bowel function need to be improved or mechanical methods such as indwelling catheters should be used. Those of serous consistency (clear aqueous) will be more likely to pass into an absorbent dressing and be lost by MVTR than those of a more viscous nature. Nursing Times 96: 45, 35-36. Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. Loss of this seal will cause extravasation of fluid, resulting in periwound maceration and an inability of the VAC therapy device to function properly. Although acute wounds may confront the practitioner with challenges to healing, this paper will focus on maceration and chronic wounds, as they represent the majority of wounds encountered that present problems to the nurse. The arena for wound treatment is not very different. Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. Journal of Wound Care 11: 7, 275-278. This article describes the importance of controlling the moisture content of wounds and areas of vulnerable tissue, with particular emphasis on the use of dressings that provide protection to periwound skin, which may be damaged by proteolytic enzymes present in exudate from chronic wounds. Not recommended use for extended amounts of time. Thomas, S. (1997)Assessment and management of wound exudate. Periwound issues. 2nd edition. The eyes of the care providers tend to go direct to the center of the wound, the wound bed. (1999a)The causes and prevention of maceration of the skin. The Use of Cyanoacrylate Skin Protectant* to Treat Periwound Maceration in Combination with Negative Pressure Wound Therapy in the Treatment of Neuropathic Foot Ulcers Negative Pressure Wound Therapy (NPWT) has been proven to be an effective and valuable tool for … The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). What can be done to protect the vulnerable periwound? Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Documentation of the periwound condition should include measuring the periwound size, noting the skin condition, the exudate presence and characteristics, and the presence of pruritus. Maceration occurs when too much moisture is trapped between the wound and its bandage--sometimes the exudate (seepage of biological waste from the wound) escapes and gets trapped under the bandage, and sometimes the wound itself becomes overly moist. New England Journal of Medicine 320: 850-853. Although many other factors are implicated in exudate management, it is vital to apply these skills to every wound at every dressing change; only by doing this will maceration be avoided and healing optimised. Maceration is one of the most common skin problems associated with wound care. Wound Management Theory and Practice. 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