I recently presented this topic as a Journal Club presentation for the Association for the Advancement of Wound Care Members. Large amounts of skin debris derived from the stratum corneum and micro-organisms were found on the periwound skin. When assessing the periwound and surrounding skin, the following should be noted: Condition of the skin- Note whether the skin appears to be thin, transparent or fragile, and thus prone to tearing Hydration- Note whether the periwound tissue is dry, flakey or cracked, signalling that there is too little moisture present, or whether the periwound tissue is overly moist or macerated. Infrared Skin Thermometry: Validating and Comparing Techniques to Detect Periwound Skin Infection Adv Skin Wound Care. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. The periwound (also peri-wound) or periwound skin, is tissue surrounding a wound. 6. [4], 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. If the periwound skin is soft and white, thisindicates that the skin has absorbed too much fluid. Main treatment and prevention strategies include the following: Systemic treatment may include medication appropriate for patient’s condition. Identify and treat abnormal periwound complications as indicated. 7. Certain wound types cause dermatological problems in the surrounding skin and require particular care, including venous leg ulcers, pressure ulcers and diabetic foot ulcers. The surrounding area: protecting periwound skin in chronic wounds. •Skin prep to periwound skin ... damage is a linear tear or a skin- flap type tear. If the epidermis around the woundstarts to break down, we call this denuded skin. Epibole: Wound edge that is thickened and rolled under. 4 Figure 4 | Using the Triangle of Wound Assessment — Periwound skin Maceration Problems of the periwound skin (i.e. Periwound skin issues should be assessed and … Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela. More visible lines. [1], Patients suffering from periwound issues may experience burning, itching, tenderness, and pain. There are many different types of wounds so special care should be taken when treating these wounds and the periwound area. Holistic wound assessment that includes periwound assessment. 2015. https://www.woundsource.com/blog/it-moisture-associated-skin-damage-or-p.... Accessed December 30, 2018. In the absence of infection, the mean temperature difference between periwound skin and an equivalent contralateral control site was found to be less than 2° F (0.383° F [SD, 0.893° F]). Maceration of periwound skin First | Previous Picture | Next Picture | Last | Thumbnails | Main image menu For information on the types of products available for the treatment of all types of problem wounds take a look at 'Surgical Dressings and Wound Management'. Abscess: Collection of fluid within tissue that is a result of an acute or chronic localized infection. Utilize larger foam dressings to maximize absorption. WoundSource.com. The content is not intended to substitute manufacturer instructions. Wound Management: Principles and Practice. [3] Healthy periwound maintains all the physical characteristics of skin: elasticity, surface integrity, color and texture. B. 9) Lesions/rashes –Skin lesions should be described in terms of type, size, color, distribution, and configuration. Skin debris from both the periwound area and normal skin was collected from all 17 residents. Peristomal moisture-associated dermatitis: Inflammation surrounding a stoma resulting from sustained contact with stool or urine. Avoid repeated application and removal of adhesive dressings and tapes because this can damage the wound and/or periwound.8 This is known as medical adhesive–related skin injury (MARSI) and is defined as caused by trauma to the skin from medical adhesives. Callus A Callus strangulates the wound and prohibits healing. 8. Cooper P. Skin care: managing the skin of incontinent patients. Macerated skin isfragile and easily damaged. Early identification of periwound skin damage and treatment options will also be discussed. Excoriation Excoriation is inflammation of the skin surrounding the wound (periwound skin), caused by an irritant. A Comprehensive Guide for the Wound Care Clinician. Principes van de beste praktijk Lokale aanpak op basis van TIME/ITEM – concept ‘Goede wondzorg is meer dan het juiste gaasje plakken.’ Erik De laat. Periwound area is traditionally limited to 4 cm outside the wound’s edge but can extend beyond this limit if outward damage to the skin is present. 182 were donated in November This month, we are on track to donate 188. home recent additions webmaster page banners feed a child. WoundSource.com. The wound assessment should include the periwound and surrounding skin, extending 4cm from the wound bed.1 Assessing wound location, shape, color, edges, margins, periwound, and surrounding skin is most significant in a thorough wound evaluation.1,2, The periwound and wound margins are good indicators for identifying the wound type, infection, and moisture balance and for managing the plan of care.1,3 A periwound assessment is similar to the wound assessment; however, it is helpful to keep a few more key factors in mind:4. periwound skin Periwound skin damage contributes to protracted healing times, can cause pain and discomfort, and may adversely affect a patient's quality of life . Wound Type and Harikrishna Periwound Skin Class Before Treatment. in combination with friction at the skin surface (mechanical factors).1 There are four specific types of MASD.1 Incontinence-associated dermatitis (IAD-mild, moderate, severe),1,3,4,11,35 Intertriginous dermatitis (intertrigo), Periwound, peri-tube/drain, and peri-fistula moisture-associated dermatitis, Periwound skin The periwound area has been defined as the area of skin extending to 4 cm beyond the wound (Dowsett and Allen, 2013). WCS congres, Hasselt, 20/11/2018. › Develop a good skin care regimen. https://www.woundsource.com/blog/surrounding-area-protecting-periwound-s... http://www.worldwidewounds.com/2009/October/Lawton-Langoen/vulnerable-sk... An Itch You Can't Scratch: 10 Interesting Facts About Morgellons Disease, Pressure Injury Risk Assessments: The Importance of Standardization, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment. This paper focuses on the risk factors associated with vulnerable periwound skin such as wound-specific pathologies, dressing-related problems and existing dermatological problems. Moisture balance is paramount. All periwound skin can become vulnerable and requires careful assessment and management. Principes van de beste praktijk Lokale aanpak op basis van TIME/ITEM – concept ‘Goede wondzorg is meer dan het juiste gaasje plakken.’ Erik De laat. [5], The most common cause of periwound issues is excessive moisture present in the area surrounding the wound. In addition, micro-organisms from the wound bed, periwound, and normal skin of five residents were collected before, immediately after, and 6 hours and 24 hours after periwound cleansing using a skin … Accessed December 30, 2018. Exudate from heavily draining wounds causes irritation of the periwound that may lead to maceration, excoriation, and otherwise compromise skin integrity.[6][7]. Types of exudate › Acute wound exudate This healthy exudate helps the Consistently strong, positive correlations between clinician-assessed maceration and SD202 hydration measures were detected across all time points; however, statistical significance was reached at baseline and 2 weeks only. involving inflammation of the skin folds relating to perspiration; l Periwound MASD due to wound exudate; l Peristomal MASD caused by leakage from stoma edges. In addition, micro-organisms from the wound bed, periwound, and normal skin of five residents were collected before, immediately after, and 6 hours and 24 hours after periwound cleansing using a skin … Periwound Skin Care Application Your Solutions Essential Skin Damage. Periwound skin damage is not well documented, 3 and the exact prevalence and economic implications of periwound skin damage is not currently available. Bacterial infections, fungal infections, contact dermatitis and other skin conditions can lead to breakdown of the periwound. in combination with friction at the skin surface (mechanical factors).1 There are four specific types of MASD.1 Incontinence-associated dermatitis (IAD-mild, moderate, severe),1,3,4,11,35 Intertriginous dermatitis (intertrigo), Periwound, peri-tube/drain, and peri-fistula moisture-associated dermatitis, The wound assessment should include the periwound and surrounding skin, extending 4cm from the wound bed.1 Assessing wound location, shape, color, edges, margins, periwound, and surrounding skin is most significant in a thorough wound evaluation.1,2The periwound and wound margins are good indicators for identifying the wound type, infection, and moisture balance and for managing the plan of care.1,3 A per… 8 Periwound skin 8 Exudate 8 Allergic reactions 8 Adherence of dressings This paper focuses on the risk factors associated with vulnerable periwound skin such as wound-specific pathologies, dressing-related problems and existing dermatological problems. Skin debris from both the periwound area and normal skin was collected from all 17 residents. While a moist environment supports the migration of epidermal cells, the management of exuding wounds warrants barrier protection. 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. Click here. Visible and measurable signs include rash, erythema, discoloration, changes in skin texture and temperature. Erosion: Loss of some or all of the epidermis. Periwound skin assessed as macerated by clinicians obtained higher SD202 hydration readings than periwound skin that was not considered macerated. 4 Frequent problems in the periwound area include maceration, excoriation, dry … Periwound Skin Care Application Your Solutions Essential Skin Damage. Key Points. Given these challenges, these authors present a novel technique to address this issue and reduce the risk of periwound maceration. Contact The type of dressing can affect odor as well as hygiene and the presence of nonviable tissue (Keast et al. This can be done most effectively by pressing down on the skin near the edge of the dressing while lifting up the adhesive. World Wide Wounds. As clinicians, we should carefully assess the wound bed, but we need to remember also to assess the periwound and surrounding skin. 2018. https://www.woundsource.com/blog/surrounding-area-protecting-periwound-s.... Accessed December 30, 2018. Skin damage relating to urine and faeces has been comprehensively reported elsewhere (Cooper, 2011; Bianchi 2012), and will not be discussed in this article. Meyers B. In addition, micro-organisms from the wound bed, periwound, and normal skin of five residents were collected before, immediately after, and 6 hours and 24 hours after periwound cleansing using a skin … Skin can often become damaged when removing wound dressings and adhesive, and DermaPrep Liquid Barrier Skin Protectant can guard against pain and skin damage. Periwound skin breakdown is just one of the culprits that delay wound healing and increase pain. View larger version. All periwound skin can become vulnerable and requires careful assessment and management. Treatment included the application of silver sulfadiazine cream and a soft silicone dressing while thoroughly ensuring pressure redistribution. Most wounds do have an odor. contact with periwound skin. Consider: Location, Shape, Tissue Type, Surrounding Tissue, Characteristics and History. Disclaimer: HCPCS codes have been provided to assist you in the preparation of Medicare Part B claims. The skin is the largest organ of our body, covering 18 square feet and weighing approximately 12 pounds. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Wound Essentials. If the periwound skin is soft and white, thisindicates that the skin has absorbed too much fluid. Use emollients to clean the wound area. If the wound is draining heavily, the periwound skin can become soaked with wound fluid and cause further wound breakdown, even in … For example, skin sealants or moisture barriers can be used on periwound skin before it breaks down from exudate. 2nd ed. Dermatologie Handelskaai, Kortrijk. [1] The shared objective of treatment and prevention is maintenance and/or restoration of the integrity and healthy functionality of skin surrounding the wound. Carver C. Is it moisture-associated skin damage or a pressure ulcer? Use emollients to clean the wound area. In the absence of infection, the mean temperature difference between periwound skin and an equivalent contralateral control site was found to be less than 2° F (0.383° F [SD, 0.893° F]). The median time to complete wound healing in all patients was 12.71 weeks (95% CI = 10.00-16.67). Morgan N. Measuring wounds. 3 Nevertheless, the impact of periwound skin damage is substantial 3 as it can exacerbate pain, increase wound size, delay healing, and reduce a patient’s quality of life. Table 3 shows the median and mean time for complete wound healing in different wound types and periwound class types. It may need slightly different care in different areas. Take into consideration a patient’s age, prior skin conditions and skin breakdown, skin allergens, and compliance with the plan of care. Dull, rough complexion. Infrared Skin Thermometry: Validating and Comparing Techniques to Detect Periwound Skin Infection Adv Skin Wound Care. Use skin sealant dressings (liquid or spray) on the periwound and surrounding skin for protection and to help lessen friction forces. 2011;6:69–74. Prevention, treatment with appropriate dressings, and managing the periwound regularly will ensure that wound healing progress is moving toward the goal of wound closure. Sigma-Aldrich offers abstracts and full-text articles by [Chizuko Konya, Hiromi Sanada, Junko Sugama, Yukie Kitayama, Shinji Ishikawa, Hiroyasu Togashi, Shigeru Tamura]. Otherwise known as moisture-associated skin damage (MASD), this is based on chemical content of moisture, friction, and presence pathogenic organisms. Consider use of Skin Prep or equivalent product to protect periwound tissue Periwound-tissue around wound Viable, macerated, inflamed • Color-erythema (purple appearance on dark skin), pale • Texture-dry, moist, boggy (soft), macerated (white, soggy appearance), edema • Temperature-cool, warm 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 that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Manufacturer DermaRite notes DermaPrep forms a long-lasting waterproof film that can shield periwound skin from bodily fluids, adhesives, and frictional forces. For example, use the correct absorptive dressing to maintain a balance in moisture and avoid maceration. Malvern, PA: HMP Communications ; 2015. We must have a clear understanding of causes, treatment, and prevention strategies for periwound skin damage. Your skin is less elastic. Chronic wounds may manifest any of the following characteristics, depending on wound type: erythema,… Edge/Perimeter. Inflammation and erythema to skin with or without erosion. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Periwound skin damage contributes to protracted healing times, can cause pain and discomfort, and may adversely affect a patient's quality of life . › Develop a good skin care regimen. Any break is the skin is at risk for periwound breakdown and/or complications. Common types of wounds encountered in the acute care setting include pressure injuries, venous ulcers, arterial ulcers, skin tears, diabetic foot wounds, and moisture-associated skin damage (see Common wound types). The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. There is an array of products available to bolster preventive techniques and manage the periwound and surrounding skin of wounds. periwound integrity. 2nd ed. Maceration/denuded: Both of these terms mean inflammation and erosion of the skin caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, exudate, ostomy effluent, mucus, and saliva. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Red patches. Protection of periwound from damage, infection, and contaminants. 2004). Wound Type and Harikrishna Periwound Skin Class Before Treatment. Ensure your dressing is changed frequently enough to eliminate pooling of exudate on periwound skin. An alternative is a hydrocolloid or a polyurethane film. 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