Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. Periwound issues. Caustic. 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… As a Director of Nursing, your assessment skills must be tiptop. Ostomy Wound Management 46: 1A (suppl), 59S. venous ulcers, diabetic ulcers, pressure ulcers), Fistula or stoma drainage (often causes damage to the surrounding skin if the area is not prepared and dressed properly), Increased wound exudate (i.e. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. 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. Cutting, K. (1999b)Glossary. Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). Maceration › Maceration occurs when healthy skin is in contact with moisture (e.g. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. 7. A macerated area was defined as the wet and opaque or white skin of a periwound (15)(16) (17). © 2008-2020 Kestrel Health Information, Inc. All rights reserved. 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. It is therefore imperative that a careful selection of dressing and wear time is made to help ensure successful management. London: Emap Healthcare. 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. as a result of infection), Sensitivities (i.e. 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. MAIN … Consider the following: - Fluid-handling capacity of the dressing, - Optimal wear time for dressing on the wound. 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. 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. 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. The production of exudate is a normal result of the inflammatory stage of wound healing. - Possible adhesive damage to peri-wound skin. 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. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. (2002)Caring for dry and damaged skin (Chapter 14) In: While, A. Maceration is one of the most common skin problems associated with wound care. 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). 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. 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. Maceration occurs when skin has been exposed to moisture for too long. - 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. Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. Cutting, K.F. Diabet Foot 2003;6(3):S2. 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. INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). 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. One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. 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 … For cleansing periwound skin without using water, Clean & Free ™ Rinse-Free Full Body Wash & Peri-Cleanser may be an efficient option for patients. Wound Repair and Regeneration 8: 5,347-352. Although precise recurrence rates can be difficult to... By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. 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. Skin Care in Wound Management: Assessment, prevention and treatment. Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. 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). Topics in Nurse Prescribing. The area of maceration was also assessed by measuring each photograph using Image J software. 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. Allman, R.M. 20152 Source: Dowsett et al. White, R J. Excess wound exudate can be reduced by eliminati… Infection 2. There is no defense like a good offense, and this is as true in wound care as it is in sports. Protect periwound skin. The periwound offers key information crucial to overall wound healing. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Despite a literature search a definitive description of this occurrence does not appear to be available. Thomas S. The role of dressings in the treatment of moisture-related skin damage. But the action on the periwound or the wound sidelines can make a difference in how rapidly the patient may heal. noted to be macerated.There were 1,332 VLU which became the focus of the current study. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Note the maceration to the peri-wound area. Refer to the Legal Notice for express terms of use. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. Salisbury: Quay Books. The management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. 1 Patients with wounds, irrespective of their etiology, have the propensity for developing vulnerable periwound skin that may be associated with disease processes or their treatment regimens. Aberdeen: Wounds UK, 2005. 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. Thomas, S. (1997)Assessment and management of wound exudate. About The Author Skin barrier creams/ointments, skin protective wipes, or skin barrier wafers can be used to protect the periwound … 8. Sources Accessed March 14, 2015. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. Wound Management Theory and Practice. Occlusive dressings are not inherently likely to provoke maceration when used correctly (White, 2000). A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Published October 2009. (1989)Pressure ulcers among the elderly. Meyers B. Treatment for mild maceration includes exposing the affected area to air to dry out the skin. Journal of Wound Care 8: 4, 200-210. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. Wound Care Society. 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). • 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. Cutting, K., White, R.J. (2002)Maceration of the skin and wound bed 1: its nature and causes. Thomas, S., Fear, M., Humphreys, J. et al. Source: Dowsett et al. Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? It should be noted that some moisture barriers are safe to use on non-intact skin. It presents as a pale, opaque rim surrounding the wound. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. 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. Rogers A, Watret L. Maceration and its effect on periwound margins. Sign in or Register a new account to join the discussion. 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 … Although exuding chronic wounds (deep burns, diabetic foot ulcers, leg ulcers, pressure sores and fungating tumours) are most likely to develop maceration, this phenomenon may manifest in any type of wound if the conditions are right. 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. Maceration of the skin and wound bed: its nature and causes. The term ‘moisture/water vapour transmission rate’ (MVTR or WVTR) should be used in reference to dressings and not to intact skin. (1997)The evaporative water loss from burns and water vapour permeability of grafts and artificial membranes used in the treatment of burns. 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