Periwound Challenges Improve Patient Satisfaction in Wound Care

Abstract

In wound care, we usually focus nearly all of our efforts on the wound area while paying little attention to the periwound area. Although the periwound area may seem unimportant, it matters to patients. A female patient was admitted with a wound at the perianal area. Wound dressing was performed using standard wet-to-dry gauzes. The patient had several small complaints including irritant contact dermatitis, skin maceration, pain during dressing change, and fecal contamination to the wound. In this case, we ended up switching to a different method of wound dressing. We went from using wet-to-dry gauzes for the primary dressing to a hydrofiber with silver dressing and from gauze and Micropore as a secondary dressing to an adhesive sodium carboxymethylcellulose foam dressing. This resolved all complaints. The patient's satisfaction score using visual analog scale increased from 2 to 10 (out of 10 points). This example shows how even small details can make a significant difference in wound care. Because periwound care is often neglected, therapeutic algorithm that integrates major challenges in periwound care into wound healing strategies is proposed.

Fig. 1.

Standard wound care. The secondary dressing was gauze and Micropore, which caused irritant contact dermatitis and allowed feces to contaminate the wound bed.

Fig. 2.

Wound care with careful attention to the minute details. The secondary dressing was a Na-CMC foam dressing (Adhesive Aquacel Foam). The irritant contact dermatitis was resolved.

Fig. 3.

Therapeutic algorithm for major challenges in periwound care.