Periwound

Healthy periwound is an immediate barrier surrounding the wound bed{{cite journal |last=Patel |first=G |date=2011 |title=The importance of the skin barrier in managing periwound areas |url=http://www.woundsinternational.com/journal-content/view/the-importance-of-the-skin-barrier-in-managing-periwound-areas|journal= Wounds International |volume=2 |issue=1 }} 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.{{cite journal |last= Fore-Pfliger |first= J |date=November–December 2004 |title= The epidermal skin barrier: implications for the wound care practitioner, part II |journal= Advances in Skin & Wound Care |volume=17 |issue=9 |pages= 480–488 |doi= 10.1097/00129334-200411000-00015 |pmid=15632742 }} Healthy periwound maintains all the physical characteristics of skin: elasticity, surface integrity, color and texture. However, periwound can become compromised and negatively affect the healing progress of the wound.{{cite journal |last1= Bishop |first1=SM |last2=Walker |first2=M |last3=Rogers |first3=AA |last4=Chen |first4=WY |date=April 2003 |title= Importance of moisture balance at the wound-dressing interface |journal= Journal of Wound Care |volume=12 |issue=4 |pages=125–128 |pmid=12715483 |doi= 10.12968/jowc.2003.12.4.26484 }}

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.

Patients with periwound issues may experience burning, itching, tenderness, and pain. Visible and measurable signs include rash, erythema, discoloration, changes in skin texture and temperature.{{cite journal |last1=Woo |first1=KY |last2=Ayello |first2=EA |last3=Sibbald |first3=G.|date= 2009 |title= The skin and periwound skin disorders and management |url= http://www.woundhealingsa.co.za/index.php/WHSA/article/view/58/79 |journal= Wound Healing Southern Africa |volume=2 |issue=2 }}

The most common cause of periwound issues is excessive moisture present in the area surrounding the wound. Exudate from heavily draining wounds causes irritation of the periwound that may lead to maceration, excoriation, and otherwise compromise skin integrity.{{cite journal |last=Cutting |first=KF |date=February 2003 |title=Wound exudate: composition and functions|journal=British Journal of Community Nursing |volume=9 |issue=9 Suppl |pmid= 14685963 |doi= 10.7748/ns2004.10.19.7.62.c3737 |pages=suppl 4–9}}{{cite journal |last=Cameron |first=J |date=October–November 2004 |title= Exudate and care of the peri-wound skin|journal=Nursing Standard |volume=19 |issue=7 |pmid= 15551919 |doi= 10.7748/ns2004.10.19.7.62.c3737 |pages=62–68}}

This type of damage is more common in chronic wounds due to exudate composition which differs from fluids produced in acute wounds or burns. Chronic wound exudate contains proteolytic enzymes and other components that degrade skin integrity and predispose it to inflammation.{{cite journal |last1= Wysocki |first1= AB |last2= Staiano-Coico |first2=L |last3= Grinnell |first3=F |date=July 1993 |title= Wound fluid from chronic leg ulcers contains elevated levels of metalloproteinases MMP-2 and MMP-9 |journal= The Journal of Investigative Dermatology |volume=101 |issue=1 |pmid=8392530 |doi=10.1111/1523-1747.ep12359590 |pages=64–8|doi-access=free }}{{cite journal |last1=Okan |first1=D. |last2=Woo |first2=K. |last3=Ayello |first3=EA |last4=Sibbald |first4=G.|date=January 2007 |title= The role of moisture balance in wound healing |journal= Advances in Skin & Wound Care |volume=20 |issue=1 |pmid=17195786 |pages=39-53; quiz 53-5|doi=10.1097/00129334-200701000-00013 }} Moisture-associated skin damage can also be caused by bodily fluids or other contaminants that enter the periwound areas, for example, in patients with urinary or fecal incontinence, or colostomy patients.{{cite journal |last=Gray |first=M |date=December 2007 |title= Incontinence-related skin damage: essential knowledge |url= http://www.o-wm.com/content/incontinence-related-skin-damage-essential-knowledge |journal=Ostomy Wound Management |volume=53 |issue=12 |pmid=18184980 |pages=28–32}} Other causes include dryness of the skin due to ageing and skin or systemic disorders,{{cite journal |last=Barr |first=JE |date=May 2006 |title= Impaired skin integrity in the elderly |url=http://www.o-wm.com/content/impaired-skin-integrity-elderly|journal=Ostomy Wound Management |volume=52 |issue=5 |pmid=16773751 |pages=22–4, 26–8}} allergic reactions to wound care products,{{cite journal |last1=Conway |first1=J |last2=Whettam |first2=J |date=July 2002 |title=Adverse reactions to wound dressings |journal=Nursing Standard |volume=16 |issue=44 |pmid=12219515 |doi=10.7748/ns2002.07.16.44.52.c3232 |pages=52–4, 56, 58 passim}} damage that may result from poor application and removal technique of adhesive products used in wound treatment,{{cite journal |last=Bryant|first=RA |date=February 1988 |title=Saving the skin from tape injuries |journal=The American Journal of Nursing |volume=88 |issue=2 |pmid=3341395 |pages=189–91}} as well as exposure to infection or extrinsic contaminants at the time of wound dressing changes.

Among risk factors that may contribute to degrading the periwound skin performance are:

• Chronic wounds (excessive harmful exudate)
• Old age (increased skin fragility, epidermal thinning, loss of elasticity)
• Underlying disorders (congenital (epidermolysis bullosa), dermatological conditions (eczema), fungal or bacterial infections, lymphedema)
• Environmental damage (UV radiation)
• Inadequate wound care regimens

Treatment and prevention of periwound issues are becoming increasingly important as research continues to confirm the role of periwound in wound healing. The shared objective of treatment and prevention is maintenance and/or restoration of the integrity and healthy functionality of skin surrounding the wound.

Main treatment and prevention strategies include the following:

• Holistic wound assessment that includes periwound assessment.
• Elimination of factors causing moisture-associated skin damage.{{cite journal |last1=White |first1=RJ |last2=Cutting |first2=KF |date=November 2003 |title=Interventions to avoid maceration of the skin and wound bed |journal=British Journal of Nursing |volume=12 |issue=20 |pmid=14685125 |doi=10.12968/bjon.2003.12.20.11841 |pages=1186–201}}
• Maintaining optimal moisture balance over the wound and periwound: effective exudate management in heavily draining wounds as well as adequate hydration of dry wounds.
• Proper patient nutrition.
• Treatment of underlying conditions.
• Protection of periwound from damage, infection, and contaminants.

Systemic treatment may include medication appropriate for the patient's condition. 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,{{cite journal |last1=White |first1=RJ |last2=Cutting |first2=KF |date=September 2002 |title= Avoidance and management of peri-wound maceration of the skin |journal=Professional Nurse |volume=18 |issue=1 |pmid=12238719 |pages=33, 35–36}} as well as moisture balancing dressings, such as self-adaptive wound dressing.{{cite journal|last1=Reyzelman |first1=A.|last2=Vartivarian |first2=M. |date= August 2015 |title= Evidence of Intensive Autolytic Debridement With a Self-Adaptive Wound Dressing |journal=Wounds|volume=27|issue=8| pages=229–235|pmid=26284377 }}

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Category:Soft tissue

Category:Skin