periwound area, including periwound inflammation, bacterial infections and uncontrolled oedema. Use barrier creams and/or ointments to prevent and protect the skin from moisture, primarily from incontinence. Periwound skin management is just as important as wound bed preparation in wound healing. This type of damage is more common in chronic wounds due to exudate composition which differs from fluids produced in acute wounds or burns. Category II; A skin tear with partial tissue loss. Maintaining optimal moisture balance over the wound and periwound: effective exudate management in heavily draining wounds as well as adequate hydration of dry wounds. Infrared Skin Thermometry: Validating and Comparing Techniques to Detect Periwound Skin Infection Adv Skin Wound Care. For example, use the correct absorptive dressing to maintain a balance in moisture and avoid maceration. WoundSource.com. After the nurse conducts a thorough assessment of the wound and periwound skin, its etiology may become more evident. All periwound skin can become vulnerable and requires careful assessment and management. 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 type of dressing can affect odor as well as hygiene and the presence of nonviable tissue (Keast et al. Periwound skin damage contributes to protracted healing times, can cause pain and discomfort, and may adversely affect a patient's quality of life . Remove adhesive dressings correctly. 2nd ed. Both tears can be fully approximated. [10] Other causes include dryness of the skin due to ageing and skin or systemic disorders,[11] allergic reactions to wound care products,[12] damage that may result from poor application and removal technique of adhesive products used in wound treatment,[13] as well as exposure to infection or extrinsic contaminants at the time of wound dressing changes. Inflammation and erythema to skin with or without erosion. 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. › Develop a good skin care regimen. Neither patient nor wound characteristics were significantly different between the participants with noninfected or infected wounds. Hyperkeratosis: Callous-like tissue formation at wound edges that can extent around wound. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Chronic wounds may manifest any of the following characteristics, depending on wound type: erythema,… 4th ed. Early identification of periwound skin damage and treatment options will also be discussed. Identify and treat abnormal periwound complications as indicated. 2011;6:69–74. There is an array of products available to bolster preventive techniques and manage the periwound and surrounding skin of wounds. Use skin sealant dressings (liquid or spray) on the periwound and surrounding skin for protection and to help lessen friction forces. [8][9] Moisture-associated skin damage can also be caused by bodily fluids or other contaminants that enter the periwound areas, for example, in patients suffering from urinary or fecal incontinence, or colostomy patients. Local treatment may include wound care products that protect periwound and help maintain its healthy functionality, for example, moisture barriers (ointments, salves and films), topical corticosteroids, antiseptics and antifungal agents,[14][15][7][5] as well as moisture balancing dressings, such as self-adaptive wound dressing. [16], "Taking wound assessment beyond the edge", "The importance of the skin barrier in managing periwound areas", "The skin and periwound skin disorders and management", "Incontinence-related skin damage: essential knowledge", https://en.wikipedia.org/w/index.php?title=Periwound&oldid=927130688, Creative Commons Attribution-ShareAlike License, Chronic wounds (excessive harmful exudate), Old age (increased skin fragility, epidermal thinning, loss of elasticity). periwound integrity. 5. Your skin is less elastic. Refer to the Legal Notice for express terms of use. This can be done most effectively by pressing down on the skin near the edge of the dressing while lifting up the adhesive. Macerated skin isfragile and easily damaged. Wound Essentials. A Comprehensive Guide for the Wound Care Clinician. Skin damage relating to urine and faeces has been comprehensively reported elsewhere (Cooper, 2011; Bianchi 2012), and will not be discussed in this article. Macerated skin isfragile and easily damaged. Ongoing assessment and monitoring will help in identifying skin changes and plan of care. 2018 Jan;31(1):607-611. doi: 10.1097/01.ASW.0000527352.75716.70. 2004). Pressure ulcers have rounded, crater-like shapes with regular edges 2. The periwound should be considered the 4cm of surrounding skin extending from the wound bed. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. 2012. http://woundcareadvisor.com/measuring-wounds/. This paper focuses on the risk factors associated with vulnerable periwound skin such as wound-specific pathologies, dressing-related problems and existing dermatological problems. It is important to identify conditions and risk factors early in your wound assessment to help prevent any risk of wound progress declination. Malvern, PA: HMP Communications ; 2015. 8 Periwound skin 8 Exudate 8 Allergic reactions 8 Adherence of dressings the skin within 4cm of the wound edge as well as any skin under the dressing) are common and may delay healing, causepain and discomfort, enlarge the wound, and adversely affect the patient’s quality of life5,7,22.The amount of exudate is a key factor for increasing the risk of There are many different types of wounds so special care should be taken when treating these wounds and the periwound area. periwound skin - the skin surrounding an injury; around or near a bodily injury caused by physical means to the outer covering of the body. Wound Type and Harikrishna Periwound Skin Class Before Treatment. Problems in this area 2nd ed. View larger version. 2015. https://www.woundsource.com/blog/it-moisture-associated-skin-damage-or-p.... Accessed December 30, 2018. periwound skin - the skin surrounding an injury; around or near a bodily injury caused by physical means to the outer covering of the body. More visible lines. Periwound moisture-associated dermatitis: Wound exudate that has sustained contact with the skin and caused damage. Four Categories of Moisture-Associated Skin Damage. 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. Though treatment of the different chronic wound types varies slightly, appropriate treatment seeks to address the problems at the root of chronic wounds, including ischemia, bacterial load, and imbalance of proteases. Skin damage relating to urine and faeces has been comprehensively reported elsewhere (Cooper, 2011; Bianchi 2012), and will not be discussed in this article. Occurs wherever two skin surfaces come into close contact with each other (Black et al, 2011) Common sites include under the breasts and, in children, it can be found in the folds of the neck (Voegeli, 2016) Related to … Protection of periwound from damage, infection, and contaminants. It may need slightly different care in different areas. Epibole: Wound edge that is thickened and rolled under. Periwound skin ultrasonographic findings continuously revealed an unclear layered structure. Livingston M, Wolvos T. Scottsdale Wound Management Guide. Wound Care Advisor. [3] Healthy periwound maintains all the physical characteristics of skin: elasticity, surface integrity, color and texture. For example, skin sealants or moisture barriers can be used on periwound skin before it breaks down from exudate. This paper focuses on the risk factors associated with vulnerable periwound skin such as wound-specific pathologies, dressing-related problems and existing dermatological problems. Patient assessment includes the identification of factors that will increase the risk of periwound skin damage, such as the amount of exudate and the presence of bacteria. 7. Morgan N. Measuring wounds. Maintaining skin integrity equals... By Emily Greenstein, APRN, CNP, CWON, FACCWS. Exudate from heavily draining wounds causes irritation of the periwound that may lead to maceration, excoriation, and otherwise compromise skin integrity.[6][7]. 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. Maintaining an airtight seal with VAC therapy may be difficult for highly exudating wounds and wounds that are irregular in size. Periwound skin The periwound area has been defined as the area of skin extending to 4 cm beyond the wound (Dowsett and Allen, 2013). Your skin can crack, peel, or become itchy, irritated, or inflamed. •Skin prep to periwound skin ... damage is a linear tear or a skin- flap type tear. WoundSource Editors. [1], Healthy periwound is an immediate barrier surrounding the wound bed[2] that can perform all the regular functions of skin – the body’s largest organ – such as absorption, excretion, protection, secretion, thermoregulation, pigment production, sensory perception and immunity. A periwound is simply the area of skin surrounding a wound. If the wound is draining heavily, the periwound skin can become soaked with wound fluid and cause further wound breakdown, even in … periwound integrity. 4 Figure 4 | Using the Triangle of Wound Assessment — Periwound skin Maceration Problems of the periwound skin (i.e. References Periwound Skin Care Application Your Solutions Essential Skin Damage. [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. Moisture balance is paramount. Key Points. Edge/Perimeter. [1] The shared objective of treatment and prevention is maintenance and/or restoration of the integrity and healthy functionality of skin surrounding the wound. We must have a clear understanding of causes, treatment, and prevention strategies for periwound skin damage. 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). Skin can often become damaged when removing wound dressings and adhesive, and DermaPrep Liquid Barrier Skin Protectant can guard against pain and skin damage. Pitting edema: Fluid in tissue that can be indented. 182 were donated in November This month, we are on track to donate 188. home recent additions webmaster page banners feed a child. Periwound assessment is an important step of wound assessment before wound treatment is prescribed. All periwound skin can become vulnerable and requires careful assessment and management. 19 A periwound skin classification scale has been proposed (HPSC2015), taking into account observations of dessication, maceration, allergic reaction, inflammation, infection, and atypical features. Ordering Information: *HCPCS codes as referenced in the PSC Local Coverage Determination Surgical Dressing and Ostomy Policies. Skin debris from both the periwound area and normal skin was collected from all 17 residents. PERIWOUND SKIN Dr Michiel Bonny. https://www.woundsource.com/blog/it-moisture-associated-skin-damage-or-p... http://woundcareadvisor.com/measuring-wounds/. If the periwound skin is soft and white, thisindicates that the skin has absorbed too much fluid. Types of MASD . Take our 10-question quiz to find out! The median time to complete wound healing in all patients was 12.71 weeks (95% CI = 10.00-16.67). 6. Incontinence-associated dermatitis (IAD): Inflammation and skin erosion associated with exposure to urine and/or stool. Cutaneous wounds are formed by three different parts: bottom, border-edge and periwound skin, that must be analysed before every dressing, without overlooking all their components. Intertriginous dermatitis. WCS congres, Hasselt, 20/11/2018. The periwound is as important as the wound. Elimination of factors causing moisture-associated skin damage. The periwound (also peri-wound) or periwound skin, is tissue surrounding a wound. Intertriginous dermatitis: Intertrigo is skin-skin or skin-to-device inflammation related to perspiration, friction, or bacterial and/or fungal bioburden. contact with periwound skin. Dermatoloog. 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. Treatment included the application of silver sulfadiazine cream and a soft silicone dressing while thoroughly ensuring pressure redistribution. 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. Wound Management: Principles and Practice. VIII. Ordering Information: *HCPCS codes as referenced in the PSC Local Coverage Determination Surgical Dressing and Ostomy Policies. 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 Peristomal moisture-associated dermatitis: Inflammation surrounding a stoma resulting from sustained contact with stool or urine. Dermatoloog. You may have: Almost invisible pores. Manufacturer DermaRite notes DermaPrep forms a long-lasting waterproof film that can shield periwound skin from bodily fluids, adhesives, and frictional forces. Take into consideration a patient’s age, prior skin conditions and skin breakdown, skin allergens, and compliance with the plan of care. World Wide Wounds. The effects of modern dressings on inflammation, which represent the earliest phase of wound healing, are poorly understood. periwound skin Main treatment and prevention strategies include the following: Systemic treatment may include medication appropriate for patient’s condition. While a moist environment supports the migration of epidermal cells, the management of exuding wounds warrants barrier protection. Dermatologie Handelskaai, Kortrijk. [5], The most common cause of periwound issues is excessive moisture present in the area surrounding the wound. Contact Skin debris from both the periwound area and normal skin was collected from all 17 residents. 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. Abscess: Collection of fluid within tissue that is a result of an acute or chronic localized infection. 2. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. How much do you know about skin management? Types of exudate › Acute wound exudate This healthy exudate helps the View larger version. As clinicians, we should carefully assess the wound bed, but we need to remember also to assess the periwound and surrounding skin. Protect the periwound skin with use of skin barriers. Bacterial infections, fungal infections, contact dermatitis and other skin conditions can lead to breakdown of the periwound. St. Louis, MO: Elsevier Mosby; 2011:117. The content is not intended to substitute manufacturer instructions. 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, 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]). Many people have this type. 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. Wound edge Periwound skin Wound Tissue type 70% slough 30% granulation tissue Exudate Moderately exuding Infection No signs of infection Maceration Yes, around the whole wound leading to fragile skin Excoriation No Dry skin No Hyperkeratosis No Callus No Eczema No Maceration Yes, around the whole edge of the wound Dehydration No Undermining No Thickened/rolled edges No 8. Cooper P. Skin care: managing the skin of incontinent patients. Dermatologie Handelskaai, Kortrijk. When infection was present, the mean periwound skin temperature was elevated by more than 2° F (4.43° F [SD, 2.44° F]). Periwound skin ultrasonographic findings continuously revealed an unclear layered structure. 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 debris from both the periwound area and normal skin was collected from all 17 residents. 4 Frequent problems in the periwound area include maceration, excoriation, dry … A statistically significant relationship between increased periwound skin temperature and wound infection was identified (F = 44.238, P = .000 at a 95% confidence interval). 3. Careful patient assessment is needed to identify the source or potential source of the damage, and clarify the severity, location, moisture type and any other irritants. Contact Pressure Ulcers 1. Tears will have a partial thickness epidermal tissue loss. The tears are further classified as Manufacturer DermaRite notes DermaPrep forms a long-lasting waterproof film that can shield periwound skin from bodily fluids, adhesives, and frictional forces. The peri-wound can become soft and mushy as too much moisture is retained next to the skin or if underlying tissue is starting to decompose such as a deep tissue injury. Accessed December 30, 2018. Chronic wound exudate contains proteolytic enzymes and other components that degrade skin integrity and predispose it to inflammation. 2018. https://www.woundsource.com/blog/surrounding-area-protecting-periwound-s.... Accessed December 30, 2018. The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When infection was present, the mean periwound skin temperature was elevated by more than 2° F (4.43° F [SD, 2.44° F]). Any break is the skin is at risk for periwound breakdown and/or complications. Upper Saddle River, NJ: Pearson Prentice Hall; 2008:56–7. Secondary cutaneous infection: Most often candidiasis. 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. Sigma-Aldrich offers abstracts and full-text articles by [Chizuko Konya, Hiromi Sanada, Junko Sugama, Yukie Kitayama, Shinji Ishikawa, Hiroyasu Togashi, Shigeru Tamura]. Dull, rough complexion. 1. Visible and measurable signs include rash, erythema, discoloration, changes in skin texture and temperature. 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. Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. Certain wound types cause dermatological problems in the surrounding skin and require particular care, including venous leg ulcers, pressure ulcers and diabetic foot ulcers. A patient’s quality of life is already compromised when a wound develops, and complications such as periwound skin damage can be avoided. Despite positive characteristics, the skin is always susceptible to and at risk of injury and breakdown. Use emollients to clean the wound area. 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'. We call thismacerated skin, and it is the result of wound exudate not beingadequately absorbed by the wound dressing. The surrounding area: protecting periwound skin in chronic wounds.