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The outer layer of the skin, the epidermis, is the body's physical barrier to the environment. This barrier is compromised when moisture or trauma damages the epidermis. Frequently, moisture or adhesives can damage the skin and cause painful injuries. The damaged area is then more susceptible to infection and delayed healing.

Overexposure to moisture can compromise the skin's integrity by disrupting the delicate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells or corneocytes. The term moisture-associated skin damage (MASD) encompasses a spectrum of injuries characterized by denudation (inflammation and erosion) of the epidermis resulting from prolonged exposure to various sources of moisture or irritants such as wound exudate, perspiration, urine, stool, or ostomy effluent.

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Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and cause inflammation through the release of cytokines that trigger an immune response leading to symptoms of dermatitis (i.e., moisture-associated skin damage [MASD]). Incontinence-associated dermatitis (IAD) is one type of MASD, and the external factors that contribute to IAD include microclimate (water, temperature, pH), mechanical forces (friction, pressure, shear), and biochemical factors (fungi, irritants, bacteria, enzymes).

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Human skin is home to many types of bacteria, fungi, and viruses that compose the skin microbiota or microbiome. As with microorganisms in the gut, these organisms have an important role in protecting from pathogens and breaking down natural products. The sheer quantity of life found in the skin microbiome is staggering. It often contains up to one billion microorganisms on a single square centimeter.

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Urinary incontinence is a relatively common condition marked by loss of control of the bladder. In severe cases, it can have a detrimental impact on the quality of life of patients with this condition. Because of the sensitive and embarrassing nature of the topic, urinary incontinence tends to be underreported.

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Absorbent briefs: Briefs used to absorb urine and stool and to help prevent moisture-associated skin damage in patients with incontinence issues. Briefs with high breathability and wicking help to maintain the skin microclimate.

Barrier products: Creams, sprays, wipes, or other products used to seal the skin and protect it from breakdown caused by moisture or incontinence.

Cyanoacrylates: A skin sealant that bonds to the skin surface and integrates with the epidermis. Cyanoacrylates are strong and resistant to washing off.

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Sharp debridement is by far the fastest way to remove non-viable tissue from a wound bed. This modality must be performed by a licensed skilled practitioner using sharp instruments or tools to remove unhealthy tissue. It is reimbursed by most payers when documentation and medical necessity support its use. There are times when sharp debridement is contraindicated, however. This blog reviews the contraindications and alternatives to sharp debridement.

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Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic lower-limb amputations in the US. Although already high, the rate of amputation is increasing.

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Complex and hard-to-heal chronic wounds impact millions of people globally. In the United States, care for these types of wounds exceeds $25 billion annually. Wound healing naturally progresses through the overlapping phases of hemostasis, inflammation, proliferation, and remodeling. With chronic and complex wounds, the natural biological healing process stalls in the inflammatory phase, thereby preventing both the proliferative phase and further advancement toward wound closure.

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Tissue viability is crucial in managing all types of wounds, including surgical wounds, traumatic wounds, pressure injuries, lower-extremity ulcers, and skin tears. Accurate assessment and wound diagnosis are important in treating symptoms and understanding the underlying pathophysiology of the wound.

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Collagenase: An enzymes that breaks the peptide bonds in collagen. Collagenases aid in destroying extracellular structures. Collagenase is one of the most frequently used enzymatic debridement agents.

Enzymatic debridement: A topical treatment that uses naturally occurring proteolytic enzymes or proteinases, which break down and remove devitalized tissue by digesting and dissolving this tissue in the wound bed.

Keratotic tissue: Keratotic tissue is the development of horny growths (keratomas). These growths can appear at the edges of wounds and hinder healing. They are removed by debridement to promote healing.

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