In wound care, we usually focus nearly all of our efforts on the wound area while paying little attention to the periwound area. Although the periwound area may seem unimportant, it matters to patients. Thus, if we were to put more effort into periwound care, it could make a positive difference in terms of patient experience and satisfaction.1
Figures 1, 2 show a particularly difficult wound care case. The patient was admitted with a wound at the perianal area. Wound dressing was performed using standard wet-to-dry gauzes. In this case, the patient had several small complaints regarding the wound that had not been attended to. First, she had irritant contact dermatitis caused by Transpore and Micropore (3M, USA). It was suggested that this could be due to irritation from the adhesive substance used in the tape, which was made of acrylate adhesive (Fig. 1).2 Second, there was a mild skin maceration at the border of the wound caused by the wet-to-dry gauzes (see figure, Supplemental Digital Content 1, which displays problems from standard wound care, https://links.lww.com/PRSGO/A993). Third, she experienced significant pain during dressing change (pain score: 7/10). Finally, she had difficulty in defecation, as the feces would contaminate the external layer of gauze and later penetrate wound bed. Table 1 summarized problems found in this patient, which reflected major pitfalls in periwound care. These details may seem insignificant as they do not hinder the healing of the wound. However, if more care is taken in this respect, physicians may be able to provide a better experience for the patient and improve patient satisfaction.
In this case, we ended up switching to a different method of wound dressing. We went from using wet-to-dry gauzes for the primary dressing to a hydrofiber with silver dressing (Aquacel Ag+ Extra; ConvaTec, UK) and from gauze and Micropore as a secondary dressing to an adhesive sodium carboxymethylcellulose (Na-CMC) foam dressing (Adhesive Aquacel Foam; ConvaTec, USA). This resolved the irritant contact dermatitis, as the adhesive substance used in the adhesive Na-CMC foam was made from silicone (Fig. 2). The macerated skin was also resolved after 5 days due to the adequate absorbency of the Na-CMC foam. The foam combined with the exudate inside the wound area, becoming a soft gel that blocked the exudate from leaving the wound area.3 In addition, the patient’s pain score using visual analog scale was significantly reduced4 from 7 to 2. Finally, defecation was easier as the external top layer of the Na-CMC foam, which was made of polyurethane film, was waterproof and was able to prevent feces from penetrating the wound bed (see figure, Supplemental Digital Content 2, which displays results of wound care with careful attention to the minute details, https://links.lww.com/PRSGO/A994). The patient’s satisfaction score using visual analog scale increased from 2 to 10 (out of 10 points). Because periwound care is often neglected, therapeutic algorithm that integrates major challenges in periwound care into wound healing strategies5–7 is proposed in Figure 3.
This example shows how even small details can make a significant difference in wound care.
1. Bateman SD. 150 patient experiences with a soft silicone foam dressing. Br J Nurs. 2015;24:S16, S8–S23.
2. Widman TJ, Oostman H, Storrs FJ. Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages. Dermatitis. 2008;19:32–37.
3. Waring MJ, Parsons D. Physico-chemical characterisation of carboxymethylated spun cellulose fibres. Biomaterials. 2001;22:903–912.
4. Barnea Y, Amir A, Leshem D, et al. Clinical comparative study of aquacel and paraffin gauze dressing for split-skin donor site treatment. Ann Plast Surg. 2004;53:132–136.
5. Hollinworth H. Challenges in protecting peri-wound skin. Nurs Stand. 2009;24:53–54, 56, 58 passim.
6. Bechert K, Abraham SE. Pain management and wound care. J Am Col Certif Wound Spec. 2009;1:65–71.
7. Akhmetova A, Saliev T, Allan IU, et al. A comprehensive review of topical odor-controlling treatment options for chronic wounds. J Wound Ostomy Continence Nurs. 2016;43:598–609.