8. There are several prevention strategies that can be used to prevent maceration and further skin breakdown. 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. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin. Thomas S. The role of dressings in the treatment of moisture-related skin damage. Not all wound exudates are the same. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. 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). Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. Aberdeen: Wounds UK, 2005. Patients suffering from periwound issues may experience burning, itching, tenderness, and pain. 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… 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. 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 term ‘moisture/water vapour transmission rate’ (MVTR or WVTR) should be used in reference to dressings and not to intact skin. - 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. (ed.). Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. It presents as a pale, opaque rim surrounding the wound. Manufacturer DermaRite notes Clean & Free is a mild, pH balanced, rinse-free body wash, shampoo, and perineal cleanser. The periwound offers key information crucial to overall wound healing. Ostomy Wound Management 46: 1A (suppl), 59S. Their use is considered controversial. Nature 193: 293-294. 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. 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). 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. Heavily draining wounds or the improper use of a moist dressing can lead to maceration of the periwound skin, altering tissue tolerance and damaging the wound edges. Periwound issues. Source: Dowsett et al. Macerated Skin: Pictures, Causes, Treatment, and Prevention One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. 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. Wound Management Theory and Practice. • 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. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. (1989)Pressure ulcers among the elderly. Wound exudate (type and volume) influences management decisions and dressing choice; this paper focuses on one aspect of exudate, the skin damage known as maceration. Topics in Nurse Prescribing. It occurs when skin is exposed to wet dressings or wound drainage. - Use compression therapy and elevation for appropriate leg ulcers. Journal of Wound Care 11: 7, 275-278. This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Wound Repair and Regeneration 8: 5,347-352. Refer to the Legal Notice for express terms of use. Any wound care provider is going to continuously seek new approaches to wound therapies that improve patient healing times. Journal of Wound Care 6: 7, 327-330. Treatments for more serious maceration with periwound skin include occlusive dressings and Hydrofiber dressings. Sign in or Register a new account to join the discussion. ‘Sometimes it takes something more manageable to get the message across’. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. Br J Community Nurs 2013;18(1):6–12. 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. Wound exudate, in the correct quantities and in the correct constituency, is a useful factor in the healing process. To date, there is no evidence to support their use on the wound bed, - Topical antiseptic preparations, notably impregnated dressings, such as those incorporating suitable formulations of iodine and silver. Step 1 – Cleanse the wound and periwound margins Cleanse the wound and periwound margins with 3M™ Wound Cleanser. 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. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. 20152 Source: Dowsett et al. Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. 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. Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. 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. 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. For cleansing periwound skin without using water, Clean & Free ™ Rinse-Free Full Body Wash & Peri-Cleanser may be an efficient option for patients. It should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound. - Possible adhesive damage to peri-wound skin. A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. 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. Previous articles have focused on the nature and causes of maceration. Meyers B. Concentrations of Dakin's solution stronger than 1/8 strength … Note the maceration to the peri-wound area. 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. This model for healing emphasises a number of objectives: - To achieve a well-vascularised wound bed, - To decrease the bio-burden of the wound. Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. 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. The management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. Burns 3: 159-165. Once damaged, the skin is more permeable and susceptible to irritant penetration, leadin… 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. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. Occlusive dressings are not inherently likely to provoke maceration when used correctly (White, 2000). Indeed, it is likely that most instances of maceration are attributable to ‘traditional’ dressings as these are still the most widely used. Cutting, K. (1999b)Glossary. Sources Educational leaflet. The assessment of exudate levels, choice of suitable dressing, and estimation of wear time are clinical skills that must be learned. 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). It also discusses the importance of preventing excessive moisture loss from certain wound types and describes the way in which dressings can d… J Wound Ostomy Continence Nurs 2007; 34(2): 153-7. 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 … Rogers A, Watret L. Maceration and its effect on periwound margins. Exudate production may increase - particularly if a wound becomes infected and/or deteriorates. 7: 3, 12. Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. Infection 2. Skin Care in Wound Management: Assessment, prevention and treatment. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Excoriation › Excoriation occurs when periwound skin … Barrier films are now available as alcohol-free preparations that ‘seal’ the skin and protect against maceration or excoriation (Williams, 2001). Thomas, S. (1997)Assessment and management of wound exudate. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Treatment for mild maceration includes exposing the affected area to air to dry out the skin. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. 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. Cutting KF, White RJ. What can be done to protect the vulnerable periwound? Caustic. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Wounds 8: 5 145-150. (1996)The effect of dressings on the production of exudate from leg ulcers. Salisbury: Quay Books. Maceration is defined as a softening or over-hydration of the tissue due to retention of excessive moisture (Cutting, 1999b). Van Rijswijk, L., Harding, K. (2000)Issues and clinical implications. (1999a)The causes and prevention of maceration of the skin. Maceration is a largely under-recognized problem and one of the causes of delayed wound healing. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. New England Journal of Medicine 320: 850-853. Available at: www.worldwidewounds.com/2002/april/Vowden/Wound-Bed-Preparation.html accessed 20.05.02. This will only compound the problem. 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