Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. There is no defense like a good offense, and this is as true in wound care as it is in sports. 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. Despite a literature search a definitive description of this occurrence does not appear to be available. 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. The content is not intended to substitute manufacturer instructions. Peters, J. Figure 1: A wound which has been highly exuding. Caustic. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. 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. Topics in Nurse Prescribing. 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. London: Emap Healthcare. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. Aberdeen: Wounds UK, 2005. noted to be macerated.There were 1,332 VLU which became the focus of the current study. 20152 Source: Dowsett et al. (ed.). Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. 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 … Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. 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. In: Miller, M., Glover, D. (eds). (1989)Pressure ulcers among the elderly. 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. Periwound issues. A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Note the maceration to the peri-wound area. Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). 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. Nursing Times 96: 45, 35-36. Wound edge Periwound skin Maceration dration Undermining Rolled edges Wound ed Assessment Peround sn Assessment • Maceration • Dehydration • Undermining - 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. Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. Vowden, K., Vowden, P. (2002)Wound bed preparation. Educational leaflet. 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. The production of exudate is a normal result of the inflammatory stage of wound healing. (1996)The effect of dressings on the production of exudate from leg ulcers. 8. By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. British Journal of Nursing 10: 7, 469-472. Nature 193: 293-294. Additional approaches to managing exudate include the use of: - Topical corticosteroids (anti-inflammatory and vasoconstrictive in action). Maceration › Maceration occurs when healthy skin is in contact with moisture (e.g. Wound Management: Principles and Practice. 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). 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. Journal of Wound Care 8: 4, 200-210. 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. Maceration is one of the most common skin problems associated with wound care. Thomas, S., Fear, M., Humphreys, J. et al. 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. 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. 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. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. Clinicians should also seek to refer the patient - Use compression therapy and elevation for appropriate leg ulcers. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Wound Repair and Regeneration 8: 5,347-352. Voegeli D. Moisture-associated skin damage: an overview for community nurses. Cutting, K. (1999b)Glossary. 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This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… - Possible adhesive damage to peri-wound skin. 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. Patients suffering from periwound issues may experience burning, itching, tenderness, and pain. But the action on the periwound or the wound sidelines can make a difference in how rapidly the patient may heal. Occlusive dressings are not inherently likely to provoke maceration when used correctly (White, 2000). Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. In acute wounds, exudate components contribute positively to the wound-healing process. 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. Thomas, S. (1997)Assessment and management of wound exudate. World Wide Wounds. Maceration of the skin around a wound is a common feature and most practitioners are advised to carry out interventions to avoid it. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. 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. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? INTERVENTION: The intervention compared the experimental product (Remedy Nutrashield; Medline Industries, Mundelein, Illinois) versus Cavilon Moisturizing Lotion (3M, St Paul, Minnesota). Cutting, K., White, R.J. (2002)Maceration of the skin and wound bed 1: its nature and causes. Treatment for mild maceration includes exposing the affected area to air to dry out the skin. In wounds, maceration can prevent healing, contribute to infection, and cause irritation, pain, and tissue damage. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. 7. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. 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. Can damage periwound skin. 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. Butcher, M. (2000)The management of skin maceration. 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. Wound Care Society. (1999a)The causes and prevention of maceration of the skin. 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. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Managing exudate production effectively requires achieving a balance between the extremes of wound desiccation and wetness. Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. 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. Manufacturer DermaRite notes Clean & Free is a mild, pH balanced, rinse-free body wash, shampoo, and perineal cleanser. 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 … - Leg elevation and compression, as appropriate. Falanga, V. (2000)Classifications for wound-bed preparation and stimulation of chronic wounds. Not all wound exudates are the same. The eyes of the care providers tend to go direct to the center of the wound, the wound bed. The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin. The arena for wound treatment is not very different. 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). To remove exudate solely because it is present does not constitute good practice. Any wound care provider is going to continuously seek new approaches to wound therapies that improve patient healing times. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. International Journal of Cosmetic Science 8: 253-264. The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. The causes of maceration other than exudate include excessive sweating, the presence of urine or faeces and high local moisture due to prolonged occlusion combined with high exudate and transepidermal water loss (TEWL). 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