periwound maceration treatment

Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. There is no defense like a good offense, and this is as true in wound care as it is in sports. Maceration is defined as a softening or over-hydration of the tissue due to retention of excessive moisture (Cutting, 1999b). One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin. Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). Source: Dowsett et al. 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 is often a contributing factor for slow wound healing. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. Thomas, S. (1997)Assessment and management of wound exudate. A macerated area was defined as the wet and opaque or white skin of a periwound (15)(16) (17). 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. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. It should be noted that some moisture barriers are safe to use on non-intact skin. Caustic. There is both an art and a science to choosing the correct wound dressing, one that will maintain just the right amount of moisture in the wound bed without allowing the periwound to become macerated. It also discusses the importance of preventing excessive moisture loss from certain wound types and describes the way in which dressings can d… Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… (1996)The effect of dressings on the production of exudate from leg ulcers. Infection 2. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. 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). 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. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. The periwound offers key information crucial to overall wound healing. 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. Sign in or Register a new account to join the discussion. 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. 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. White, R J. wound fluid, sweat, urine) for prolonged periods, which can cause the skin to become soft/soggy. Rogers A, Watret L. Maceration and its effect on periwound margins. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. 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 … Skin barrier creams/ointments, skin protective wipes, or skin barrier wafers can be used to protect the periwound … There is, at present, no evidence that moist wound healing is related to the development of maceration (van Rijswijk and Harding, 2000). - 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. Voegeli D. Moisture-associated skin damage: an overview for community nurses. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. This article, produced by a panel of clinical experts who met to discuss moisture as an etiologic factor in skin damage, focuses on peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis. 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. Wound Management: Principles and Practice. MAIN … Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. Rinsing is … The management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. Aberdeen: Wounds UK, 2005. Skin Care in Wound Management: Assessment, prevention and treatment. OUTCOME MEASURES: The mean outcome measures were a decrease in periwound and ulcer size. (2000)The Management of Exuding Wounds. The production of exudate is a normal result of the inflammatory stage of wound healing. 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. Principal Lecturer, Buckinghamshire Chilterns University College, Chalfont St. Giles, Buckinghamshire. as a result of infection), Sensitivities (i.e. In wounds, maceration can prevent healing, contribute to infection, and cause irritation, pain, and tissue damage. Figure 1: A wound which has been highly exuding. Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. To remove exudate solely because it is present does not constitute good practice. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. 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. 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). This can be a tricky balance between maintaining just the right amount of moisture in the wound bed- too dry and the wound bed becomes desiccated, too wet and maceration soon follows. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). 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. Cutting KF, White RJ. Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. Cutting, K.F. Wounds 8: 5 145-150. 2nd edition. Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. Topics in Nurse Prescribing. Can damage periwound skin. Treatments for more serious maceration with periwound skin include occlusive dressings and Hydrofiber dressings. Nursing Times 96: 45, 35-36. Thomas, S., Fear, M., Humphreys, J. et al. Winter, G. (1962)Formulation of the scab and the rate of epithelialisation in the skin of the domestic pig. About The Author J Wound Care 2002;11(7):275–8. Any wound care provider is going to continuously seek new approaches to wound therapies that improve patient healing times. Peters, J. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. Maceration occurs when skin has been exposed to moisture for too long. Their use is considered controversial. 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. Cutting, K. (1999b)Glossary. Not all wound exudates are the same. It occurs when skin is exposed to wet dressings or wound drainage. The area of maceration was also assessed by measuring each photograph using Image J software. Note the maceration to the peri-wound area. When managing leg ulcers they appear chiefly to be of benefit on the peri-ulcer skin when wet eczema is present (Peters, 2002). 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. 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. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Excessive amounts of wound exudate can cause the periwound (within 4 cm of wound edge) skin to become macerated and even break down. Excess wound exudate can be reduced by eliminati… Vowden, K., Vowden, P. (2002)Wound bed preparation. Refer to the Legal Notice for express terms of use. 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. However, in chronic wounds, proteolytic enzymes such as MMP8s are produced in excess of the level required to lyse devitalised tissue, debris and dead micro-organisms. Maceration › Maceration occurs when healthy skin is in contact with moisture (e.g. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. International Journal of Cosmetic Science 8: 253-264. Journal of Wound Care 11: 7, 275-278. Wound exudate can be channelled away from the wound through appliances such as fistula drainage bags or by applying negative pressure to the wound area (Young, 2000). Wound Repair and Regeneration 8: 5,347-352. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. This will only compound the problem. Protecting the peri-wound skin from enzymes in chronic wound exudate may be achieved through a variety of simple measures. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. Educational leaflet. Published October 2009. Step 1 – Cleanse the wound and periwound margins Cleanse the wound and periwound margins with 3M™ Wound Cleanser. As a Director of Nursing, your assessment skills must be tiptop. 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. There are many conditions which may render the periwound skin more susceptible to breakdown, including: Identifying these conditions and creating a wound care plan that takes these factors into account can prevent damage of the fragile periwound skin. The arena for wound treatment is not very different. Wound Management Theory and Practice. Nature 193: 293-294. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. 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