OBJECTIVE: To identify what has been published in the literature about acute and chronic skin failure and to propose a working definition of this phenomenon.
DESIGN: A systematic review of MEDLINE and CINAHL to determine what has been published in the literature on the topics of skin failure, acute skin failure, chronic skin failure, multiple organ failure, end-of-life skin deterioration, and pressure ulcers in hospice from 1984 to 2005.
MAIN OUTCOME MEASURES: Published papers were reviewed for content related to acute, chronic, and end-stage skin failure.
MAIN RESULTS: Seven articles were identified that referenced either acute, chronic, or end-stage skin failure. Additional information was identified that discussed the processes of acute and chronic skin failure and pressure ulcers in individuals in hospice care or at the end of life. Care considerations and dilemmas related to a curative versus palliative goal in wound healing were discussed.
CONCLUSIONS: Minimal literature exists on skin failure, yet caregivers and the public must be aware of, assess for, and consider this phenomenon in their care. Based on this literature review, skin failure was defined by the authors as an event in which the skin and underlying tissue die due to hypoperfusion that occurs concurrent with severe dysfunction or failure of other organ systems. Skin failure can be categorized as acute, chronic, or end stage. Pressure ulcers, a type of skin death, frequently occur in persons with a heavy disease burden, especially those at or near the end of life, despite good care.
The authors conducted a systematic review of MEDLINE and CINAHL to identify what has been published in the literature about acute and chronic skin failure and to develop a working definition of this phenomenon.
Diane K. Langemo, PhD, RN, FAAN, is Chester Fritz Distinguished Professor Emeritus of Nursing, University of North Dakota College of Nursing, Grand Forks, ND. Gregory Brown, BBA, BSN, RN, CWOCN, is a Surgical Case Manager, Dallas Veterans Medical Center, Dallas, TX.
Submitted August 19, 2005; accepted in revised form December 14, 2005.