Fungating Wound Management Topic guide

Fungating Wound Management

1)What is a fungating wound?

Pathophysiology – tumor growing under the skin and break through the skin surface to create a wound. Appearance: cauliflower, ulcerating, skin nodules

2)Assessment –physical, psychological, psychosocial, spiritual

( how is the impact on the patient from the fungating wound, can use case study )

3)-Goals of care

-Principles of wound care

(good symptom control, promote comfort, improve quality of life)

4)Management

a)Pain- give analgesic 30 minutes prior to dressing

-gentle cleaning and dressing change

-soak dressing before removing

b)Malodour- charcoal, topical metronidazole, green tea, shower

c)Bleeding  – a tumor increasing with damage to blood vessels

-trauma in the removal of the dressing

-adrenaline (Do you have this in your country?)

-alginate dressing

-soak dressing and gentle in removal dressing

-if bleeding, direct pressure for 10 to 15 minutes till bleeding stop

-cool saline in cleaning wound

-change bed sheet or cloth to the dark color (reduce anxiety)

– ?role of radiotherapy  to stop bleeding

 

d)Infection-related to bacteria growth and exudate

-systemic antibiotic                -keep wound clean

e)Pruritus – related to tumor stretching caused irritation, local inflammation, heavy exudate

-use cool aqueous cream

-keep short nails, good hygiene, good skin care

-medication –antihistamine

f)Exudate

– alginate dressing        -absorbent dressing

 

g)maggots –ensure wound is clean, cover the wound well with dressing

-turpentine, topical honey

5)Product knowledge – what do you use in your country? Cost-effective?

 

References

• Siew BL et al 2014.Comparing the effectiveness of green tea versus topical metronidazole powder in malodorous control of fungating malignant wounds in a controlled randomized study.Proceedings of Singapore Healthcare,volume23(1).
• Wilson V.Assessment and management of fungating wound.British Journal Community Nursing 2005;10:528-534.
• Seaman S.Management of malignant fungating wounds in advanced cancer.Seminar in Oncology Nursing 2006;22(3):185-193.
• Caroline D.Malignant fungating wounds: assessment and management.British Journal Community Nursing 2002;7(8)
• Sebastian P et al 2009. Malignant fungating wounds.European Journal of Oncology Nursing 13;295-298.