http://www.worldwidewounds.com/2009/October/Lawton-Langoen/vulnerable-sk... Reducing the Recurrence of Lower Extremity Wounds, Preventive Skin Care Strategies and Assessment of the Skin, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment, Prior damage (i.e. 7: 3, 12. It should be noted that some moisture barriers are safe to use on non-intact skin. wound fluid, sweat, urine) for prolonged periods, which can cause the skin to become soft/soggy. Cutting, K. (1999b)Glossary. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. Educational leaflet. Journal of Wound Care 8: 4, 200-210. Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire. Their use is considered controversial. Salisbury: Quay Books. Winter, G. (1962)Formulation of the scab and the rate of epithelialisation in the skin of the domestic pig. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Excoriation › Excoriation occurs when periwound skin … irritant or allergic reactions to products. Cutting KF, White RJ. Aberdeen: Wounds UK, 2005. 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. - Leg elevation and compression, as appropriate. As a clinician practicing in the outpatient and home care settings, it was not unusual for patients to have to take a "holiday" from negative pressure. 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. MAIN … It should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound. Maceration is a largely under-recognized problem and one of the causes of delayed 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. Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008:128-130. Wound Care Society. Thomas S. The role of dressings in the treatment of moisture-related skin damage. Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. 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. 20152 Source: Dowsett et al. If exudate is copious, irrespective of the type of primary dressing used, additional secondary dressings will be needed to provide supplementary absorption, or more frequent changes of dressing will be required. OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. Lower extremity wounds such as diabetic foot ulcers (DFUs), venous ulcers, and arterial ulcers have been linked to poor patient outcomes, such as patient mortality and recurrence of the wound. Source: Dowsett et al. 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. - Use compression therapy and elevation for appropriate leg ulcers. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. The arena for wound treatment is not very different. Topics in Nurse Prescribing. Figure 1: A wound which has been highly exuding. Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS, is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care. It is therefore imperative that a careful selection of dressing and wear time is made to help ensure successful management. Unfortunately, due to the fact that they make the skin surface somewhat oily, moisture barriers cannot be used with adhesive wound dressings, as the dressings will not adhere as they are meant to. Journal of Wound Care 11: 7, 275-278. Periwound issues. Previous articles have focused on the nature and causes of maceration. Clinicians should also seek to refer the patient Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. There are several prevention strategies that can be used to prevent maceration and further skin breakdown. The periwound offers key information crucial to overall wound healing. Maceration › Maceration occurs when healthy skin is in contact with moisture (e.g. Skin Care in Wound Management: Assessment, prevention and treatment. Macerated Skin: Pictures, Causes, Treatment, and Prevention Peters, J. Diabet Foot 2003;6(3):S2. Recent references in the related literature tend to focus on the effects of maceration on the peri-wound skin (Butcher, 2000; Cutting, 1999a), but it is important to remember that this phenomenon is also likely to have an impact on the wound bed. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. This model for healing emphasises a number of objectives: - To achieve a well-vascularised wound bed, - To decrease the bio-burden of the wound. The production of exudate is a normal result of the inflammatory stage of wound healing. Concentrations of Dakin's solution stronger than 1/8 strength … Nature 193: 293-294. (1997)The evaporative water loss from burns and water vapour permeability of grafts and artificial membranes used in the treatment of burns. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Ostomy Wound Management 46: 1A (suppl), 59S. treatment to avoid or treat periwound maceration includes the use of highly absorbent dressings. Loss of this seal will cause extravasation of fluid, resulting in periwound maceration and an inability of the VAC therapy device to function properly. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. Maceration of the skin and wound bed: its nature and causes. This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Not recommended use for extended amounts of time. Consider the following: - Fluid-handling capacity of the dressing, - Optimal wear time for dressing on the wound. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. A recently described concept, wound-bed preparation (Falanga, 2000; Vowden and Vowden, 2002), concentrates on the generation of an optimal healing environment and measures to overcome barriers to healing. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. World Wide Wounds. There is no defense like a good offense, and this is as true in wound care as it is in sports. To remove exudate solely because it is present does not constitute good practice. In: Miller, M., Glover, D. (eds). 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). New England Journal of Medicine 320: 850-853. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. Despite a literature search a definitive description of this occurrence does not appear to be available. For cleansing periwound skin without using water, Clean & Free ™ Rinse-Free Full Body Wash & Peri-Cleanser may be an efficient option for patients. 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. Wound Repair and Regeneration 8: 5,347-352. 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. Wound Management: Principles and Practice. The content is not intended to substitute manufacturer instructions. The management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. Maceration is one of the most common skin problems associated with wound care. However, partially occlusive dressings that rely on absorbency and moisture vapour transmission rate (MVTR) for their fluid-handling capabilities may offer a lower risk of inducing maceration. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. When managing leg ulcers they appear chiefly to be of benefit on the peri-ulcer skin when wet eczema is present (Peters, 2002). When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. Infection 2. Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. As a Director of Nursing, your assessment skills must be tiptop. Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. Overexposure of the skin to moisture can compromise the integrity of the barrier, disrupting the intricate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells (corneocytes). (1989)Pressure ulcers among the elderly. - Select dressing(s) according to exudate level, - Estimate optimal wear time according to the following general factors: volume of exudate, nature of exudate, manufacturer’s instructions, clinical setting, activity level of the patient. In acute wounds, exudate components contribute positively to the wound-healing process. Accessed March 14, 2015. 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). Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. Although some practitioners may insist that occlusive dressings which create a ‘moist wound’ environment can provoke maceration, this need not be the case under ‘normal’ conditions of use. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. Lamke, LO., Nilsson, G.E., Reitherner, H.L. Maceration occurs when skin has been exposed to moisture for too long. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). 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. 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. Nursing Times 96: 45, 35-36. Williams, C. (2001)3M Cavilon Durable Barrier Cream in skin problem management. J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. 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.