Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. Maceration of the skin and wound bed: its nature and causes. 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. 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). Keith F. Cutting, MN, RMN, RN, DipN (Lond), CertEd(FE). Degradation of the wound bed may result from protease activity together with excoriation of the peri-wound skin. Nursing Times 96: 45, 35-36. It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection. 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. Concentrations of Dakin's solution stronger than 1/8 strength … Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. Wounds 8: 5 145-150. (1996)The effect of dressings on the production of exudate from leg ulcers. (ed.). One way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions. Can damage periwound skin. 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. In: Miller, M., Glover, D. (eds). 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. Batt, M.D., Fairhurst, E. (1986)Hydration of the stratum corneum. Protect periwound skin. It should be noted that some moisture barriers are safe to use on non-intact skin. Voegeli D. Moisture-associated skin damage: an overview for community nurses. (1989)Pressure ulcers among the elderly. 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. 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. - Leg elevation and compression, as appropriate. 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. Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. icipants included a retrospective group of 50 patients and a prospective group of 28 patients. - Possible adhesive damage to peri-wound skin. Cutting, K.F. 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. Skin barrier creams/ointments, skin protective wipes, or skin barrier wafers can be used to protect the periwound … 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. Excessive amounts of wound exudate can cause the periwound (within 4 cm of wound edge) skin to become macerated and even break down. 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. Associated with wound care as it is therefore imperative that a careful selection of dressings that maintain an ideal balance. 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