By Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

• Pressure ulcer: Remove source of pressure. Use appropriate pressure support surface on bed, chair and heels (static air preferred). Dress wound with moist wound dressing.
• Shear: Remove cause of shear. Arrange care such that shear does not recur or is minimized.
• Arterial/Ischemic: Use betadine (povidone iodine) to keep wound dry, clean and disinfected. Control pain. If individual is ambulatory, consider vascular consult for endovascular therapy. Manage odor from ischemic tissue.
• Venous stasis: If individual will allow, elevate legs and use compression wraps (if ABI >0.7). If individual will not allow, then just keep absorbent pads under feet to collect drainage.
• Tumor: Can use infant diapers or other incontinent containment products for drainage, especially helpful for breast tumors. A spray of viscous lidocaine/normal saline with several drops of oil of wintergreen makes a soothing aid for odor—spray on as needed. Can use alum to staunch bleeding. Use dark towels in case of bleeding. Maggot therapy may be helpful in reducing odor and necrotic tissue.
• Fistula: If unable to use usual drain techniques, apply thick layer of zinc oxide around fistula opening and place plastic bag over it, pressed into the ointment, to collect drainage. Commercial pouches (ostomy or fistula) are available that may also be used to collect drainage.
• Gangrene: If dry, paint with betadine and do not disturb. It will autolytically debride. If it is wet, maggots are the first choice to debride and eliminate infection. Conservative debridement may also be a consideration.
• Intertriginous rash: Keep skin folds clean and dry, put cloth in folds. Antiperspirant is sometimes helpful.
• Incontinence dermatitis: Treat incontinence if possible (foley catheterization, toileting); use zinc oxide ointment, open diaper or incontinence product under individual when in bed. Can add open infant diaper to increase absorbency.

As shown in the above strategies, knowing what type of wound you are managing is the key to choosing the correct strategy. Also, bear in mind that how a wound is dressed is not nearly as important as removing the cause of the wound, if possible.

Alternative therapies, if appropriate, may be sought to help meet the objectives of the individual and wound care provider. In implementing a wound care strategy, discuss the treatment program with the individual and his or her family and educate them about the options.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.