Maintaining an airtight seal with vac therapy may be difficult for highly exudating wounds and wounds that are irregular in size. Use barrier products to protect from adhesives and moisture. Interventions to avoid maceration of the skin and wound bed. Factors that may damage vulnerable periwound skin include tissue maceration, traumatic insult due, for example, to wound dressing adherence and wound related dermatological disease. Jan 22, 2018 skin maceration is often associated with improper wound care. Remove the backing, place over the wound or other dressing allowing fro a 2. Some require an advanced knowledge of skin conditions and differential diagnosis while others are dependent on tricks of the trade for dressing changes and the understanding of different dressing. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. Maceration of the skin surrounding a wound may occur if a dressing with a low absorptive capacity is used on a heavily exuding wound. Identifying, managing and preventing skin maceration. The use of npwt is further bolstered when its coupled with certain advanced wound care dressings that, when used together, have further quickened healing rates and improved the patient care experience.
It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection. Managing wound exudate and controlling maceration are key to wound healing. If there is too much exudate in a wound, the surrounding skin becomes macerated and starts to break down under attack from the released enzymes, leaving a worse wound than when you started. Skin and periwound care part 1 wound care certification. The hydrofiber dressing, similar to the sterile gauze pads, promotes healing and absorbs moisture. If managed appropriately, wound exudate should begin to decrease as healing progresses. How to prevent periwound maceration with vac therapy.
When caring for a patient with a wound, healthcare professionals should take a detailed history of the patients skin and assess it regularly at dressing. This article discusses the efficacy of these treatment modalities and offers product recommendations for the wound care clinic. A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds. Maceration is a largely underrecognized problem and one of the causes of delayed wound healing. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including. However, maceration is a complication of moist wound healing only if the dressing regimen is used inappropriately. Nov 28, 2015 originally nylon derived film dressings were not used for highly exudating wounds due to their limited absorption capacity and caused maceration of the wound and the healthy tissues around the wound.
It takes in a remarkable amount of wound fluid, even under compression, and locks it away to help prevent maceration. Preventing maceration associated with npwt dressings. Too much moisture can lead to periwound maceration and skin breakdown, while too little moisture can impede cellular activities and promote eschar formation, resulting in poor wound healing. The moist environment that heals the wound is provided by dressing the wound.
It was first described by jeanmartin charcot in 1877. Skin and periwound care part 2 wound care certification. How to treat a macerated wound and what does it look like. Optilock nonadhesive super absorbent wound dressings. When applied to the skin or wound, they feel cool and. Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. Wound management for patients living with venous insufficiency often involves multiple complexities. Dec 16, 2016 the skin around the wound is soggy and soft. These are sterile gauze pads and bandages that absorb extra moisture. Pairing advanced wound care therapy with npwt todays wound. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound. It should be noted that inappropriate use or too frequent dressing changes, particularly in patients with fragile skin, can result in skin. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Prevent maceration of surrounding skin by controlling wound exudates with absorbent dressing, such as, foams or hydrocolloid dressings are important to prevent further damage of the.
Although the wound surface must be kept moist, the dressing must be capable of absorbing any excess exudate, otherwise periwound skin maceration, irritation, soreness or unpleasant odour. Maceration of the skin around wounds is a common wound care problem. Fluid retention under the dressing may lead to periwound maceration. The skin around the wound gets macerated when the bandage is kept too tight for many hours. Decaying skin, putrefaction, or foul odors are signs of an infection that should be evaluated and treated by a medical professional. Dykes and heggie 2003 found repeated application and removal of adhesive dressings can lead to damage to the skin s surface and can strip the stratum corneum. Hydrogel wound dressings are 80% to 99% waterorglycerinbased wound dressings that are available in sheets, gels, or impregnated gauzes. Maceration of the skin around wounds is a common wound care. 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. It may be caused by keeping the skin under the water for a long time bathing, swimming or preventing the escape of moisture from the skin, such as wearing a bandage for too long or wearing nonbreathable materials. This leg ulcer example shows how fluid is locked into the dressing. Remove the old bandage around the wound and look for signs of maceration such as decaying skin or foul odor which are the indications of an infection. The causes and prevention of maceration of the skin. Maceration is often a contributing factor for slow wound healing.
May 11, 2015 one way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. At times, this macerated skin leads to soreness and pain and reveals the underlying tissue layers. Management of wounds with dressings ensure the underlying disease etiology is known or there is an understanding of the disease processes understanding the underlying disease etiology and comorbid conditions helps define dressings and the plan of care be familiar with dressings. Healthy skin has normal flesh color, and a healthy wound bed looks beefyred. Macerated skin is often associated with wounds, particularly wound dressings.
Choosing the right dressing depends on your wound assessment and characteristics of the wound bed. Preventing maceration associated with negative pressure wound therapy dressings skin protectant products to prevent periwound maceration. Foam wound dressings are usually made up of semipermeable polyurethane with small, open cells that are capable of holding fluids. Macerated skin is often associated with wounds, particularly wound dressings that are not regularly changed. In common with all adhesive products, some cases of irritation andor maceration of the skin surrounding the wound have been reported. Wound maceration is a condition which occurs in the surrounding skin of wound. The causes and prevention of maceration of the skin nursing. Dressings are classified in a number of ways depending on their function in the wound debridement, antibacterial, occlusive, absorbent, adherence, 60 type of material employed to produce the dressing e.
Todays wound dressings can also help decrease or eliminate pain, reduce the need for dressing changes, and provide autolytic debridement. 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. Types of wound dressings currently used to promote optimal. Because healing wounds all ooze fluid called exudate, the wound area may be moist. A wound dressing must be able to manage the rate and amount of exudate from the wound without drying it out or causing maceration of the surrounding skin. Skin maceration is often associated with improper wound care. The surface that comes in contact with the wound is nonadherent and allows for traumafree removal. In addition, always follow the manufacturers instructions and make sure the you use products appropriate for the wound.
At best it can cause patient discomfort and irritation, at worst it can lead to ulceration and the extension of damage into previously unaffected tissues. Assessment at each dressing change involves looking for changes in tissue type and exudate volume and type, any reduction in odour, changes in wound size, and reduction of pain. 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. The causes and prevention of maceration of the skin journal of wound care. Exuderm satin hydrocolloid wound dressings medline at home. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. Pairing advanced wound care therapy with npwt todays. For example, it is important not to exceed the wear time beyond which the dressing. Mild cases of maceration are often reversed by simply exposing the affected skin area to air. Triad is a sterile coating that can be applied directly onto the wound or peri wound skin.
Thus, the dressing dynamically balances the evolving moist wound environment and provides hydration or absorption depending on the instantaneous needs of wound and periwound skin. It can be applied anywhere on the body and adheres to wet skin, while keeping the wound. Achieving the right moisture balance can be a challenge. Management of maceration is frequently attempted with the use of absorbent foams, alginates, and hydrogels. Describe wound edges approximated, rolled, calloused describe periwound skin indurated, erythematous, macerated. Manages drainage 1 to help maintain a moist wound healing environment.
Adherence of dressing material to the wound bed and periwound skin can damage newly forming cells and cause distress to the patient. They create a moist wound healing environment by letting the moisture in but keep the bacteria and other. If the dressing is highly absorptive then more frequent dressing changes may be needed, in addition to investigation and management of the cause of the exudate such as infection. Sep 12, 2017 the macerated skin can very readily be infected with fungi and bacteria. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more. Best management of exudate and maceration nursing in. This results in maceration of the skin and wound bed. Areas of macerated skin turn a white or grayish color, and usually line the edges of the wound.
However, clinicians should ensure that the foam dressing is never overlapping wound margins and that its cut to fit the wound appropriately in order to minimize maceration. Alternative dressing techniques for small, deep wounds. Martyn butcher, rgn, diphsw, certmhs, is tissue viability clinical nurse specialist, plymouth hospitals nhs trust. The skin is soft and can easily break and exposes the deep layer of the tissue. The role of dressings in the treatment of moisturerelated. Avoidance and management of periwound maceration of the skin. These variations require providers to consider a spectrum of strategies. Maceration occurs when too much moisture is trapped between the wound and its bandagesometimes the exudate seepage of biological waste from the wound escapes and gets trapped under the bandage, and sometimes the wound. Treatment was often put on hold for several days to allow. Available in a range of sizes, shapes and fluid handling capacities, we have the solutions needed to help you manage wounds with confidence.
Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Diabetic foot ulcers plantar ulcers are particularly vulnerable to maceration. Dry areas of the wound stay properly hydrated, fluid from exuding areas is absorbed and locked in, and periwound skin is protected from maceration. Avoiding maceration from dressings occlusive therapy is often blamed for maceration andor infection. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more vulnerable to infection. The skin under the bandage becomes wet from perspiration, seepage of fluids from wound and even urine in patients who are completely bed ridden. If the dressing is highly absorptive then more frequent dressing. But, these dressings are highly elastic and flexible, and can conform to any shape and do not require additional tapping. Thus, moisture levels must be reduced and monitored. There are two distinct kinds of wound dressings used in preventing and treating macerated skin.
Transparent film dressings provide a moist, healing environment. Remove the old bandage around the wound and look for signs of maceration such as decaying skin. Remove any old bandages around the wound and inspect for signs of maceration. Because theyre flexible, these dressings can conform to. Best management of exudate and maceration nursing in practice. Skin damage can be reduced by pushing the skin away from the tape while pulling the adhesive from the skin. Jul 27, 2017 a macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. If there is too little exudate retained in a wound, the dressings will start to adhere to the wound bed, causing pain and damage to the granulation tissue. However, some of the newer transparent films have absorption properties. Pressure ulcers pressure ulcers of the sacrum are vulnerable due to the presence of urine and feces that may cause maceration.
But since they contain high waterglycerin content they are able to donate moisture to dry wounds. The type of dressing can affect odor as well as hygiene and the presence of nonviable tissue keast et al. Treatment for macerated skin usually depends on the main cause and severity of maceration. The skin directly below the wound is at greatest risk of maceration owing to the gravitational effect of wound exudate drainage. Change dressings at appropriate intervals to avoid pooling of exudates. Hydrogels can only absorb a minimal amount of fluid. Most transparent dressings dont absorb moisture and arent indicated for draining wounds.
Optilock is a super absorbent polymer core dressing. This is a good habit to practice every time you use hydrogel as a treatment. However, these dressings either lose integrity when saturated. The use of a superabsorbent dressing to manage periwound. Given these challenges, these authors present a novel technique to address this issue and reduce the risk of periwound maceration. Pressure ulcers sacral ulcers are particularly at risk of maceration because of the presence of urinary andor faecal incontinence or the presence of skin folds in obese patients. Exudate and maceration in wound care nursing in practice. This skin condition is also linked to wounds, more so the wound dressings which are not changed often enough. The causes and prevention of maceration of the skin journal. The skin also becomes soft, making it more susceptible to bacterial or fungal infections. Health economic burden that wound impose on the national health service in the uk. In some cases, macerated skin can cause pain and exposes a layer of skin tissue. Macerated skin pictures, treatment, causes, symptoms.
This entry was posted on thursday, july 21st, 2016 at 3. However, periwound can become compromised and negatively affect the healing progress of the wound. Triad hydrophilic wound dressing offers a unique approach to wound management and wound treatment. Even more, this wound dressing is nonadhesive, meaning minimal disruption to the wound and gentle, painfree removal. I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy. Skin maceration is a term used to describe the oversaturation of the skin due to prolonged exposure to moisture. These dressings are available in a variety of sizes and shapes. The optimal wound dressing keeps the wound moist and absorbs exudate, locking it inside the dressing to prevent maceration. In relation to wound management, the authors advocate the removal of moisture away from the wound or skin, either through superabsorbent dressings, or by allowing the excess moisture to evaporate through semipermeable dressings to reduce maceration. Dressings for exuding wounds we recommend the biatain dressing range, which provides superior absorption faster healing 5,6 of low to high exuding wounds. 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. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound.
The skin under the bandage becomes wet from perspiration, seepage of fluids from wound. Bedding traps moisture next to the skin, and because the person lays immobile in bed for much of the day, the skin becomes macerated and prone to bed sores and infection. In addition, be sure to apply a moisture barrier, like skin prep, around the wound edges to prevent maceration. Proper dressings and proper technique when performing dressing changes reduces the risk of developing macerated skin at the edge of the wound. The nurse irrigates the wound until there is a clear flow of solution to remove any debris from the wound. The macerated skin can very readily be infected with fungi and bacteria. If there is too little exudate retained in a wound, the dressings will start to adhere to the wound. The use of a superabsorbent dressing to manage periwound maceration and odor in chronic wounds introduction periwound maceration has been associated with slow healing of wounds. 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. Martyn butcher, rgn, diphsw, certmhs, is tissue viability clinical nurse specialist, plymouth hospitals nhs trust maceration of the skin around wounds is a common wound care problem. These are nonabsorbent and waxcoated, making them both airtight. What you need to know about transparent film dressings. The causes and prevention of maceration of the skin journal of wound.738 1240 373 880 1070 1551 518 286 1117 480 360 193 248 542 487 1264 1408 20 807 1301 1140 1113 1061 752 1177 84 357 1290 464 765 802 888 941 1359