Wound dressings for maceration of the skin

Todays wound dressings can also help decrease or eliminate pain, reduce the need for dressing changes, and provide autolytic debridement. 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. 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. It was first described by jeanmartin charcot in 1877. Foam wound dressings are usually made up of semipermeable polyurethane with small, open cells that are capable of holding fluids. 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. Pairing advanced wound care therapy with npwt todays wound.

Diabetic foot ulcers plantar ulcers are particularly vulnerable to maceration. For example, it is important not to exceed the wear time beyond which the dressing. Sep 12, 2017 the macerated skin can very readily be infected with fungi and bacteria. 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. Types of wound dressings currently used to promote optimal. It can be applied anywhere on the body and adheres to wet skin, while keeping the wound. There are two distinct kinds of wound dressings used in preventing and treating macerated skin. Preventing maceration associated with npwt dressings.

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. Areas of macerated skin turn a white or grayish color, and usually line the edges of the wound. Dec 16, 2016 the skin around the wound is soggy and soft. It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection.

Choosing the right dressing depends on your wound assessment and characteristics of the wound bed. 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. The skin is soft and can easily break and exposes the deep layer of the tissue. 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. Treatment for macerated skin usually depends on the main cause and severity of maceration. It takes in a remarkable amount of wound fluid, even under compression, and locks it away to help prevent maceration.

Remove the old bandage around the wound and look for signs of maceration such as decaying skin. Proper dressings and proper technique when performing dressing changes reduces the risk of developing macerated skin at the edge of the wound. In addition, always follow the manufacturers instructions and make sure the you use products appropriate for the wound. At times, this macerated skin leads to soreness and pain and reveals the underlying tissue layers. 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. 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. Healthy skin has normal flesh color, and a healthy wound bed looks beefyred. Given these challenges, these authors present a novel technique to address this issue and reduce the risk of periwound maceration. The skin around the wound gets macerated when the bandage is kept too tight for many hours. This results in maceration of the skin and wound bed. 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.

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. This skin condition is also linked to wounds, more so the wound dressings which are not changed often enough. The skin directly below the wound is at greatest risk of maceration owing to the gravitational effect of wound exudate drainage. Maceration of the skin around wounds is a common wound care problem. Dry areas of the wound stay properly hydrated, fluid from exuding areas is absorbed and locked in, and periwound skin is protected from maceration. Preventing maceration associated with negative pressure wound therapy dressings skin protectant products to prevent periwound maceration.

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. 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. Managing wound exudate and controlling maceration are key to wound healing. Triad hydrophilic wound dressing offers a unique approach to wound management and wound treatment. They create a moist wound healing environment by letting the moisture in but keep the bacteria and other. Optilock nonadhesive super absorbent wound dressings. Describe wound edges approximated, rolled, calloused describe periwound skin indurated, erythematous, macerated. 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. The causes and prevention of maceration of the skin nursing.

Adherence of dressing material to the wound bed and periwound skin can damage newly forming cells and cause distress to the patient. The macerated skin can very readily be infected with fungi and bacteria. The optimal wound dressing keeps the wound moist and absorbs exudate, locking it inside the dressing to prevent maceration. Use barrier products to protect from adhesives and moisture. Identifying, managing and preventing skin maceration. This article discusses the efficacy of these treatment modalities and offers product recommendations for the wound care clinic. Available in a range of sizes, shapes and fluid handling capacities, we have the solutions needed to help you manage wounds with confidence. Macerated skin is often associated with wounds, particularly wound dressings. Pressure ulcers pressure ulcers of the sacrum are vulnerable due to the presence of urine and feces that may cause maceration. The skin under the bandage becomes wet from perspiration, seepage of fluids from wound and even urine in patients who are completely bed ridden. This is a good habit to practice every time you use hydrogel as a treatment. The causes and prevention of maceration of the skin journal of wound care.

The type of dressing can affect odor as well as hygiene and the presence of nonviable tissue keast et al. Skin maceration is a term used to describe the oversaturation of the skin due to prolonged exposure to moisture. 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. Skin and periwound care part 2 wound care certification.

I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy. Exudate and maceration in wound care nursing in practice. 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. Best management of exudate and maceration nursing in practice. 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. In addition, be sure to apply a moisture barrier, like skin prep, around the wound edges to prevent maceration. Because healing wounds all ooze fluid called exudate, the wound area may be moist. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including. Management of maceration is frequently attempted with the use of absorbent foams, alginates, and hydrogels. 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. Transparent film dressings provide a moist, healing environment.

Alternative dressing techniques for small, deep wounds. Jul 27, 2017 a macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound. The role of dressings in the treatment of moisturerelated. Dressings for exuding wounds we recommend the biatain dressing range, which provides superior absorption faster healing 5,6 of low to high exuding wounds. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more vulnerable to infection. The skin also becomes soft, making it more susceptible to bacterial or fungal infections. Exuderm satin hydrocolloid wound dressings medline at home. Maceration of the skin around wounds is a common wound care. Wound management for patients living with venous insufficiency often involves multiple complexities.

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. Jan 22, 2018 skin maceration is often associated with improper wound care. However, periwound can become compromised and negatively affect the healing progress of the wound. Thus, moisture levels must be reduced and monitored. Hydrogels can only absorb a minimal amount of fluid. The skin under the bandage becomes wet from perspiration, seepage of fluids from wound. 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. Hydrogel wound dressings are 80% to 99% waterorglycerinbased wound dressings that are available in sheets, gels, or impregnated gauzes. If the dressing is highly absorptive then more frequent dressing.

How to treat a macerated wound and what does it look like. When applied to the skin or wound, they feel cool and. But since they contain high waterglycerin content they are able to donate moisture to dry wounds. Mild cases of maceration are often reversed by simply exposing the affected skin area to air. These variations require providers to consider a spectrum of strategies. 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. Skin maceration is often associated with improper wound care. Avoidance and management of periwound maceration of the skin. Macerated skin pictures, treatment, causes, symptoms. 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. 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.

Martyn butcher, rgn, diphsw, certmhs, is tissue viability clinical nurse specialist, plymouth hospitals nhs trust. Interventions to avoid maceration of the skin and wound bed. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. These are sterile gauze pads and bandages that absorb extra moisture. The surface that comes in contact with the wound is nonadherent and allows for traumafree removal.

Remove any old bandages around the wound and inspect for signs of maceration. Fluid retention under the dressing may lead to periwound maceration. The nurse irrigates the wound until there is a clear flow of solution to remove any debris from the wound. 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 leg ulcer example shows how fluid is locked into the dressing. The causes and prevention of maceration of the skin journal of wound. 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. 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. In some cases, macerated skin can cause pain and exposes a layer of skin tissue.

Triad is a sterile coating that can be applied directly onto the wound or peri wound skin. A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds. Change dressings at appropriate intervals to avoid pooling of exudates. Treatment was often put on hold for several days to allow. Pairing advanced wound care therapy with npwt todays. This entry was posted on thursday, july 21st, 2016 at 3. Best management of exudate and maceration nursing in. How to prevent periwound maceration with vac therapy. Health economic burden that wound impose on the national health service in the uk. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more. Maintaining an airtight seal with vac therapy may be difficult for highly exudating wounds and wounds that are irregular in size. Remove the backing, place over the wound or other dressing allowing fro a 2.

Factors that may damage vulnerable periwound skin include tissue maceration, traumatic insult due, for example, to wound dressing adherence and wound related dermatological disease. Achieving the right moisture balance can be a challenge. In common with all adhesive products, some cases of irritation andor maceration of the skin surrounding the wound have been reported. Maceration of the skin surrounding a wound may occur if a dressing with a low absorptive capacity is used on a heavily exuding wound. Skin damage can be reduced by pushing the skin away from the tape while pulling the adhesive from the skin.

The moist environment that heals the wound is provided by dressing the wound. However, these dressings either lose integrity when saturated. 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. The causes and prevention of maceration of the skin journal. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound. Optilock is a super absorbent polymer core dressing. If managed appropriately, wound exudate should begin to decrease as healing progresses. Wound maceration is a condition which occurs in the surrounding skin of wound. These dressings are available in a variety of sizes and shapes.

Macerated skin is often associated with wounds, particularly wound dressings that are not regularly changed. Skin and periwound care part 1 wound care certification. The hydrofiber dressing, similar to the sterile gauze pads, promotes healing and absorbs moisture. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Manages drainage 1 to help maintain a moist wound healing environment. While these skin changes may be partly due to maceration, which predisposes the affected area to traumatic injury which may also be caused by some types of adhesive dressings, a second and potentially more important factor is the presence within chronic wound fluid of proteolytic enzymes.

Avoiding maceration from dressings occlusive therapy is often blamed for maceration andor infection. Maceration is often a contributing factor for slow 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. However, some of the newer transparent films have absorption properties.

Even more, this wound dressing is nonadhesive, meaning minimal disruption to the wound and gentle, painfree removal. 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. 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. 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. Decaying skin, putrefaction, or foul odors are signs of an infection that should be evaluated and treated by a medical professional. Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. However, maceration is a complication of moist wound healing only if the dressing regimen is used inappropriately. Most transparent dressings dont absorb moisture and arent indicated for draining wounds.