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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. This damage to the peri-wound skin reduces its protective function as a barrier to water and increases the likelihood of maceration occurring (Cutting and White, 2002). Indeed, it is likely that most instances of maceration are attributable to ‘traditional’ dressings as these are still the most widely used. Can damage periwound skin. Overexposure of the skin to moisture can compromise the integrity of the barrier, disrupting the intricate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells (corneocytes). But the action on the periwound or the wound sidelines can make a difference in how rapidly the patient may heal. Among many vital functions, the skin functions as a barrier to protect the body against mechanical trauma, noxious irritants, infectious pathogens, and excessive fluids. 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. Source: Dowsett et al. It should be noted that some moisture barriers are safe to use on non-intact skin. Consider the following: - Fluid-handling capacity of the dressing, - Optimal wear time for dressing on the wound. A macerated area was defined as the wet and opaque or white skin of a periwound (15)(16) (17). - Possible adhesive damage to peri-wound skin. Although a ‘moist’ environment is the ideal, accomplishing this to the correct degree consistently provides a challenge to the practitioner. Clinicians should also seek to refer the patient 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. This type of skin damage is call periwound moisture-associated dermatitis.The chemical composition of the wound exudate greatly affe… Caustic. 2nd edition. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008:128-130. 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). 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. 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. Voegeli D. Moisture-associated skin damage: an overview for community nurses. Wound exudate, a plasma derivative, is a vital component of the wound-healing process. Lamke, LO., Nilsson, G.E., Reitherner, H.L. Cutting, K., White, R.J. (2002)Maceration of the skin and wound bed 1: its nature and causes. One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. About The Author 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. Figure 1: A wound which has been highly exuding. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. Macerated Skin: Pictures, Causes, Treatment, and Prevention 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. Wounds that tend to be ‘wet’ may benefit from alginate, foam, hydrofibre or hydropolymer dressings. Manufacturer DermaRite notes Clean & Free is a mild, pH balanced, rinse-free body wash, shampoo, and perineal cleanser. It is therefore imperative that a careful selection of dressing and wear time is made to help ensure successful management. There has been extensive research on how to prevent skin care-related skin breakdown, and most research agrees on a few main components. Butcher, M. (2000)The management of skin maceration. However, the advent of moist wound healing has brought with it an understanding that moisture balance is the key to optimal outcomes. ‘Sometimes it takes something more manageable to get the message across’. Published October 2009. Wound edge Periwound skin Maceration dration Undermining Rolled edges Wound ed Assessment Peround sn Assessment • Maceration • Dehydration • Undermining J Wound Care 2002;11(7):275–8. Dressings with a super-absorbent component provide effective protection (Langoen and ... periwound skin is the treatment of choice for allergic reactions. Cutting, K. (1999b)Glossary. Br J Community Nurs 2013;18(1):6–12. Maceration is one of the most common skin problems associated with wound care. New England Journal of Medicine 320: 850-853. (1996)The effect of dressings on the production of exudate from leg ulcers. 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. The management and prevention of maceration must focus on the reason the skin is coming into contact with excess moisture. Falanga, V. (2000)Classifications for wound-bed preparation and stimulation of chronic wounds. 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. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. 8. Wound Infection is caused by multiplying pathogenic bacteria which cause a reaction in the patient. burns or ultraviolet damage), Specific wound types (i.e. 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. 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. Rinsing is … It should not be confused with the pale, whitish appearance of the new epithelial tissue in a healing wound. Nursing Times 96: 45, 35-36. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. 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. There is no defense like a good offense, and this is as true in wound care as it is in sports. Health-care professionals need to be aware of maceration and the implications it may have for wound healing. Loss of this seal will cause extravasation of fluid, resulting in periwound maceration and an inability of the VAC therapy device to function properly. Salisbury: Quay Books. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. 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. Wound Management: Principles and Practice. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. International Journal of Cosmetic Science 8: 253-264. MAIN … The production of exudate is a normal result of the inflammatory stage of wound healing. (1997)The evaporative water loss from burns and water vapour permeability of grafts and artificial membranes used in the treatment of burns. treatment to avoid or treat periwound maceration includes the use of highly absorbent dressings. 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. wound fluid, sweat, urine) for prolonged periods, which can cause the skin to become soft/soggy. Topics in Nurse Prescribing. Prevention of maceration includes treatment of underlying disorders and selection of dressings that maintain an ideal moisture balance in the wound. Cutting KF, White RJ. Maceration of the skin and wound bed: its nature and causes. Certed ( FE ) is important to treat the condition especially in elderly and immobile patients or... 2 ): S2 may have for wound healing be achieved through a variety of simple measures to the! 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