Health care professionals working in wound care face numerous challenges when managing the periwound area. Maintaining periwound skin integrity is critical to ensuring rapid wound healing and preventing complications. Excessively harsh medical adhesives, moisture-associated skin damage (MASD) and other issues can cause periwound trauma, increase the cost of treatment and lead to further complications. In order to effectively manage periwound skin and ensure optimal wound healing, it is important for health care professionals to adopt best practices in assessment, dressing and treatment.1
The Importance of Medical Adhesives
Medical adhesives play a major role in dressing security and improving wear time. In addition to remaining securely in place, dressings need to be easily removable in order to reduce periwound trauma. This is especially important for patients that are at higher risk for skin stripping, skin tears, or are sensitive to medical adhesives.1
Difficulties of Periwound Management
The periwound area is the tissue surrounding a wound, generally extending four centimeters from the wound boundary. Periwound trauma can delay wound healing and lead to complications such as skin damage, infection and sepsis. Maintaining periwound skin integrity is important to preventing additional pain and discomfort for patients, lowering the cost of treatment and improving efficiency in wound care. Unfortunately, health care professionals face many challenges when working to prevent periwound trauma. Difficult to dress wounds, excess exudate and incontinence can all cause significant challenges. This can impact patient outcomes and increase the costs of wound treatment.1, 2
Dressing Securement – Wound dressings must be secure in order to prevent foreign material from entering the periwound area, keep wounds moist, and promote rapid healing. Difficult to dress wounds present problems in all these areas, as it is often challenging to adequately secure the dressing and ensure a proper seal. This can ultimately lead to MASD or other problems that may cause pain, infection, or necessitate more frequent dressing changes. Difficult to dress areas such as feet and areas of incontinence pooling can present additional difficulties and exacerbate this problem.1, 2
Patient Compliance – Ensuring that patients are effectively caring for their periwound skin can be challenging, particularly in outpatient settings. Dressings may be kept on for too long, fall off or be improperly secured by the patient. This can lead to contamination of the wound area, increased risk of infection, or damage to wound and surrounding area, such as periwound maceration or skin injury.1, 3
Weak or Irritating Medical Adhesives – Choosing the right medical adhesive is one of the greatest challenges of periwound management. Harsh, excessively strong or irritating adhesives can cause periwound trauma, damaging the skin. Weak medical adhesives can come off and allow the area to be exposed to moisture, incontinence or other foreign substances. Many medical adhesives are ineffective when exposed to excess exudate or incontinence.1, 4
Effective Periwound Management
In order to overcome the challenges associated with periwound management, it is critical that health care professionals take a proactive assessment approach, follow wound care best practices and choose medical adhesives that are gentle, strong and effective. This will help prevent damage to the periwound area and ensure an optimal healing environment for the wound.
Assessment – Wounds and the surrounding area should be regularly assessed for signs of irritation or trauma. Redness, raised temperature and edema are early signs of periwound trauma. Skin that is thin or shiny may also indicate lowered vascular circulation in the area and calluses or corns can indicate excess pressure or friction. These signs may indicate that the wound is not being optimally treated or that the wound dressing or adhesive is damaging the skin. Patients that are incontinent or have mobility issues are at particular risk and should be assessed regularly. It is also important to use wound dressings that manage any excess exudate in order to promote rapid healing, ensure the dressing is secured and reduce exposure to moisture in the periwound area.1, 2
Securement Best Practices – In order to minimize the potential problems associated with difficult to dress wounds, nurses and other health care practitioners must use strong, waterproof medical adhesives and often use non-traditional dressing methods. Adhesive tapes, patches, and strips are available in different shapes and can be cut to address the specific needs of the wound location. By following best practice recommendations, nurses can help mitigate the risk of periwound trauma and reduce the frequency of dressing reapplication.
Avoiding Damage – Chafing, pressure, moisture, impacts and punctures in the periwound area can exacerbate wounds and delay wound closure. It is critical that health care professionals take steps to ensure that at-risk individuals are protected from these factors. This means positioning wounds so that they are not subject to excessive pressure, frequently cleansing the wound area and choosing a dressing and medical adhesive that protects the wound area from foreign substances. It is also important to apply skin protectant prior to dressing application in at-risk patients.1, 2, 3
Choosing the Right Medical Adhesive – Dressings and medical adhesives can have a major impact on periwound health. Medical adhesives that are not easily removed can damage the underlying skin, potentially leading to pain and delayed wound healing. Dressings that contain irritants can also damage the skin, causing discomfort. It is important to choose adhesives that are gentle but effectively hold the dressing in place, even when exposed to moisture. This will ensure that the dressing remains secure and does not cause periwound trauma.
How Hy-Tape Can help
Hy-Tape is the leading surgical adhesive, helping to make wound dressings more secure, less damaging, more effective, and less costly. By framing or covering dressings with Hy-Tape, nurses can reduce the risk of periwound trauma and peeling corners and create a longer lasting dressing that will stay on for the entirety of the prescribed time.
Hy-Tape makes dressings more secure – Hy-tape is very secure and lasts up to seven days. That means that it can help dressings stay on for longer. It is also waterproof, so it is not affected by drainage fluids, urine, feces, or other liquids that might normally compromise the integrity of the dressing.
Hy-Tape protects the wound – Hy-tape does not break down and does not allow fecal matter and urine to infect the wound. It is also completely washable, allowing foreign substances to be cleared away without damaging the dressing. This could help reduce the risk of infection and may even help wounds heal faster in certain conditions.
Hy-Tape is gentle – Despite its ability to stay secure even in the most trying circumstances, Hy-Tape is gentle and easily removed. It will never cause new wounds or cause periwound trauma. Its zinc-oxide based adhesive is soothing to delicate skin and prevents irritation and skin breakdown.
Hy-Tape is nurse approved – In a recent study involving patients with Stage 2, 3, and 4 pressure ulcers treated with a hydrocolloid dressing secured by Hy-Tape, Hy-Tape was given an “Excellent” rating by nurses. They cited its strength, gentleness, and easy application as primary reasons for the high rating.5
Periwound management is a critical component of effective wound care. Periwound trauma can delay wound healing, cause discomfort and pain, and lead to other complications. It is critical that healthcare professionals follow best practices when treating wounds and choose the right dressings and medical adhesives. Using a gentle, strong, waterproof medical adhesive such as Hy-Tape can significantly reduce the likelihood of periwound trauma, helping to improve patient outcomes and control costs.
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- Gray, Mikel, and Dorothy Weir. “Prevention and Treatment of Moisture-Associated Skin Damage (Maceration) in the Periwound Skin.” Journal of Wound, Ostomy and Continence Nursing, vol. 34, no. 2, 2007, pp. 153–157., doi:10.1097/01.won.0000264827.80613.05.
- Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010 Mar;89(3):219-29.
- Fife CE, Carter MJ, Walker D, Thomson B. Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry. Wounds. 2012 Jan;24(1):10-7.
- Faecal Incontinence and Its Effect on Wound Care. Continence Essential. Volume 1 2008. http://www.continence-uk.co.uk/essentials_2008/Continence_Essentials_2008_Faecal_Incontinence_Wound_Care.pdf
- Securing Hydrocolloid Dressing. Hy-Tape. http://www.hytape.com/pdfs/HT-Case-Studies-Ostomy-Wound%20Care2.pdf. Accessed May 2015.