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SKIN CARE TODAY
2016,Vol 2, No 1
W
hen undertaking wound
assessment, nurses are
inclined to focus on the
wound itself without taking the
condition of the periwound skin
into consideration. The integrity of
this fragile skin surrounding the
wound, however, is easily breached
if conditions within the wound are
not managed effectively. By far the
biggest challenge is the effective
management of wound exudate
(
Figure 1
), where the application
of inappropriate dressing products
can result in a deterioration and
increase wound size (Mudge et al,
2008).
This article will discuss factors
that can impact on the condition of
the periwound skin and strategies
which nurses can employ to minimise
damage to this vulnerable and
frequently overlooked area.
Managing the periwound skin
(Thompson and Stephen-Haynes,
2007; Hollinworth, 2009). In acute
wounds, these enzymes work to
break down proteins and clear
away any debris in the wound bed;
once this has been achieved and
healing is underway, the amount
of exudate gradually diminishes.
In chronic wounds, however, this
process is more prolonged, meaning
that enzymes contained within the
exudate are present for longer (White
and Cutting, 2003). As a result, the
enzymes can begin to break down
the wound bed itself, which results
in an extended inflammatory phase
and excessive exudate production
(Schuren et al, 2005).
Chronic wounds also frequently
contain a high level of bacteria, which
are also associated with increased
exudate production (Cameron, 2004).
Annemarie Brown, lecturer, BSc Adult Nursing,
University of Essex, Southend
IN BRIEF
Maceration and other conditions affecting the periwound area can
be avoided through careful assessment and product selection.
Overlooking the vulnerable area of skin around the wound can
result in trauma and pain for the patient and a deteriorating and
extending wound.
Continuous assessment is the guiding principle in managing
wounds and nurses need to be aware that exudate volume may
change over time.
It is important to select the most appropriate dressing product,
which provides the optimum environment for wound healing.
KEY WORDS:
Maceration
Skin stripping
Exudate management
Periwound skin
Dressings
Annemarie Brown
Figure 1.
Maceration as a result of poor
exudate management.
Did you know?
Maceration usually
develops when the dressing
is unable to handle the
volume of exudate produced
by the wound, which
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onto the surrounding skin.
CAUSES OF PERIWOUND
SKIN DAMAGE
Exudate
The aim of effective wound
management is to ensure that the
wound environment is conducive
to healing, however, managing
wound exudate can pose a significant
challenge.The importance of keeping
a wound moist to promote healing
was demonstrated byWinter (1962),
however, the volume of exudate within
the wound must be carefully managed
to maintain an optimummoisture
balance — not too wet and not too dry.
Exudate is produced as part
of the inflammatory phase and is
beneficial as it is rich in the enzymes
and growth factors necessary to
facilitate the wound-healing process
FOCUS ON PERIWOUND SKIN
i