Protecting the Wound Edge, and Surrounding Skin: Why it Matters

 
Debra Thayer MS, RN, CWOCN
Healthy wound edges facilitate healing and contribute to wound closure.1,2 Clinical progress can halt when edges become macerated and epithelial cell migration is compromised. Recent work has identified adverse effects when the surrounding skin is compromised.3 Venous insufficiency is a chronic condition often accompanied by severe edema and heavily-draining ulcers. These disease features place patients at high risk for skin injury at the wound edge and beyond.4,5
Wound Clinic
Moisture-Associated Skin Damage (MASD)5 occurs when skin is exposed to excessive wetness. Corneocytes (epidermal cells) swell and skin softens; inflammation accompanies these changes. Skin turns white or gray and normal barrier function is impaired. This presentation is described as “maceration.” Barrier disruption increases the risk of penetration by irritants, allergens, and microbes. Over-hydrated skin is also more susceptible to friction injury. Skin damage can worsen progressing to erosion and denudement.2 Exudate is the primary source of moisture leading to adverse skin changes at the wound edge. Transudate from edema can induce changes in epidermal skin integrity elsewhere on the extremity. Additionally, the presence of matrix metalloproteinases and other pro-inflammatory chemicals are considered capable of causing direct skin damage independent of moisture.6,7,8
Cavilon
Preventing Periwound Moisture-Associated Skin Damage

Attention to the wound edge and skin surrounding the wound is integral to wound bed preparation with prevention of damage being the goal of care.2
At the time of dressing change, periwound skin should be cleansed.9 A pH balanced cleanser with gentle surfactants may be required to loosen adherent crust and debris. Next, a protective barrier should be applied to the wound edge and any skin exposed to moisture.4,9 Consensus recommendations for venous ulcer management recommend barrier films to prevent or treat maceration.9 Polymer-based liquid barriers can provide an advantageous method of edge and periwound protection as compared to traditional products containing petrolatum or zinc oxide.10-12 3M™ Cavilon™ Advanced Skin Protectant provides a novel and powerful tool for skin protection. After application, the liquid dries to form a long-lasting waterproof barrier to moisture and irritants. The unique, breathable formulation is able to attach to skin even in wet, macerated areas already damaged.12 Because Cavilon Advanced Skin Protectant does not require removal, patient discomfort during dressing change can be minimized and staff time conserved.
Cavilon Advanced
Beyond skin protection, it is important to address other key factors that can impact periwound skin integrity. Characteristics of dressing materials, application technique, and change frequency can impact skin health. A primary dressing suitable to the amount of exudate and wear time should be selected. Edema must be reduced to minimize exudate and effective and sustained compression has been identified as the most effective way to reduce edema.9 3M™ Cavilon™ 2 Layer Compression System has been proven to positively impact edema while promoting patient comfort and compliance.13 Moisture-associated skin damage does not need to be an inevitable complication of a venous ulcer or any heavily draining wound. Use of Cavilon Advanced Skin Protectant in combination with carefully selected topical dressings and an effective compression system can provide a comprehensive solution to avert this troublesome complication.
To download the VLU Consensus Document, go to https://engage.3M.com/vlu.
 
Regards,
Debra Thayer MS, RN, CWOCN
Lead Technical Service Specialist
3M Medical Solutions Division
 
  1. Robson MC, Cooper DM, Aslam R, et al. Guidelines for the treatment of venous ulcers. Wound Repair Regen. 2006 Nov-Dec;14(6):640-662.
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  2. Dowsett C, Gronemann MN, Harding K. Taking wound assessment beyond the edge. Wounds International. 2015;6(1):19-23. www.woundsinternational.com. Accessed December 3, 2018.
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  3. Whitehead F, Giampieri S, Graham T, Grocott P. Identifying, managing and preventing skin maceration: a rapid review of the clinical evidence. J Wound Care. 2017;26(4):159-165.
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  4. Thomas S. The role of dressings in the treatment of moisture-related skin damage. World Wide Wounds. 2008. worldwidewounds.com/2008/march/Thomas/Maceration-and-the-role-of-dressings.html Accessed December 3, 2018.
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  5. Colwell J, Ratliff CR, Goldberg M, et al. MASD Part 3: Peristomal Moisture-Associated Dermatitis and Periwound Moisture-Associated Dermatitis. J Wound Ostomy Continence Nurs. 2011 Sep-Oct;38(5):541-553
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  6. Cutting K, White RJ. Maceration of the skin and wound bed. 1: Its nature and causes. J Wound Care. 2002 Jul;11(7):275-278.
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  7. Trengrove NJ, Bielefeldt-Ohmann H, Stacey MC. Mitogenic activity and cytokine levels in non-healing and chronic leg ulcers. Wound Repair Regen. 2000 Jan-Feb; 8(1):13-25.
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  8. Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003 Mar;11 Suppl 1:S1-28.
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  9. Harding K, Dowsett C, Fias L, et al. Simplifying venous leg ulcer management. Consensus recommendations. Wounds International. 2015.
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  10. Coutts P, Queen D, Sibbald RG. Peri-wound skin protection: a comparison of a new skin barrier vs. traditional therapies in wound management. Wound Care Canada. 2003;1(1).
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  11. Cameron J, Hoffman D, Wilson J, Cherry GJ. Comparison of two peri-wound skin protectants in venous leg ulcers. J Wound Care. 2005 May;14(5):233-6.
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  12. LaForet K, Dias J, Muhammed S. Case series using an advanced silicone-based polymer skin protectant for the clinical management of patients with moisture-associated skin damage (MASD). Poster presentation at Wounds Canada Conference. Mississauga Ontario. 2017.
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  13. Moffatt CJ, Franks PJ, Hardy D, Lewis M, Parker V, Feldman JL. A preliminary randomized controlled study to determine the application frequency of a new lymphoedema bandaging system. Br J of Dermatol. 2012 Mar;166(3):624-632.
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For more information on 3M Wound Care Solutions, please visit www.3m.com/woundcare
Debra Thayer MS, RN, CWOCN is a paid consultant for 3M.