A wound that is too moist can be as detrimental to wound healing as a wound that is too dry. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size.

What can be done to protect the vulnerable periwound? There are several prevention strategies that can be used to prevent maceration and further skin breakdown.

Identify Patients with a High Vulnerability to Periwound Skin Breakdown

Vulnerable skin may be susceptible to damage at the microscopic or the macroscopic level. There are many conditions which may render the periwound skin more susceptible to breakdown, including:

• Age
• Skin disease (i.e. psoriasis or eczema)
• Prior damage (i.e. burns or ultraviolet damage)
• Specific wound types (i.e. venous ulcers, diabetic ulcers, pressure ulcers)
• Fistula or stoma drainage (often causes damage to the surrounding skin if the area is not prepared and dressed properly)
• Increased wound exudate (i.e. as a result of infection)
• Sensitivities (i.e. irritant or allergic reactions to products

Identifying these conditions and creating a wound care plan that takes these factors into account can prevent damage of the fragile periwound skin.

Choose the Correct Dressing

There is both an art and a science to choosing the correct wound dressing, one that will maintain just the right amount of moisture in the wound bed without allowing the periwound to become macerated. Moisture-retentive dressings are used to achieve a moist, but not wet, wound environment. Many are able to decrease the amount of fluid pooling under the wound dressing, thus decreasing the risk of skin breakdown. Many have the ability to wick moisture away from the skin, similar to a baby’s diaper. However, some are better than others at performing these functions, and it is important for wound care professionals to know their wound care management tools inside and out, so that choosing the correct dressing is a simple affair.

Use Skin Sealants and Moisture Barriers

Skin sealants are alcohol-based wipes that are used on intact skin, making the skin surface slightly sticky, creating a better surface for adhesive dressings to stick to, while at the same time providing the skin with some protection from the adhesive. Spray skin sealants are available for use over stage 1 pressure ulcers to provide protection to skin that is intact. The alcohol contained in skin sealants can cause a mild stinging or burning sensation when applied to areas of open skin.

Moisture barriers are creams or ointments that contain dimethicone, petrolatum or zinc oxide. They can be used on intact skin, but are most commonly used to prevent further skin breakdown in areas of incontinence. Unfortunately, due to the fact that they make the skin surface somewhat oily, moisture barriers cannot be used with adhesive wound dressings, as the dressings will not adhere as they are meant to. It should be noted that some moisture barriers are safe to use on non-intact skin.

There is no defense like a good offense, and this is as true in wound care as it is in sports. When presented with a wound, you should identify risk factors that may lead to periwound damage or breakdown and plan your care accordingly, taking care to choose an appropriate dressing and apply a skin sealant or moisture barrier as necessary. Taking these steps will go a long way towards the prevention of skin breakdown in the periwound area due to excess moisture from any cause.

Sources
Lawton S, Langoen A. Assessing and managing vulnerable periwound skin. World Wide Wounds. http://www.worldwidewounds.com/2009/October/Lawton-Langoen/vulnerable-s…. Published October 2009. Accessed March 14, 2015.
Meyers B. Wound Management: Principles and Practice. 2nd edition. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008:128-130.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS, is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.