Periwound Management

Cathy Wogamon-Harmon's picture

by Cathy L. Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

The periwound is generally defined as the area from the wound edge to 4 cm beyond circumferentially. Breakdown of the periwound can adversely affect wound healing even if the wound itself is doing well. After the initial assessment of the wound bed and edges, one should direct their assessment to the periwound. Generally speaking, there are three major conditions (other than intact) in which you may find the periwound: damaged from trauma, too moist, or in an inflammatory state.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

An appropriate timeline to initiate biofilm-based wound care (BBWC) has been a topic of question since the incorporation of biofilm therapy was introduced. In hard-to-heal delayed wounds, it is largely agreed upon that biofilms are a significant barrier to healing, and that removal is essential. By definition, hard-to-heal wounds are wounds that have failed to respond to evidence-based standard of care and contain biofilm. Biofilms are polymicrobial communities residing in an extracellular matrix produced by bacteria, which is well-hydrated and resistant against antimicrobial agents and host defenses. Biofilm can form within hours, can reach maturity within 48-72 hours, and has the ability to regrow within 24-48 hours. A first critical step to BBWC is debridement, though it requires additional suppression methods, as well as considerations of a patient’s risk factors. Risk factors include peripheral vascular disease, infection, diabetes, and pressure off-loading, which encourage biofilm development by delaying wound healing. Risks and costs with early BBWC are most likely less than those associated with biofilm-related wound complications. Thus, in March 2019, a panel of nine experts met in London for an Advisory Board Meeting, where they developed solutions to barriers preventing early BBWC and methods of appropriate “wound hygiene” for all health professionals. They reconvened in the summer of 2019 to create a clinical consensus document published in the Journal of Wound Care supported by ConvaTec Limited.

WoundSource Practice Accelerator's picture
Complex Wounds

By the WoundSource Editors

Complex wounds pose a significant challenge for many health care providers. These wounds are often multifaceted, making treatment tremendously difficult. They represent a substantial burden on the health care industry, with annual costs in North America alone estimated at $10 billion annually. They often also result in patient discomfort and pain, caregiver frustration, individual economic losses, and diminished quality of life.

WoundSource Practice Accelerator's picture

by the WoundSource Editors

Periwound skin management is just as important as wound bed preparation in wound healing. The goal of periwound management is to maintain an optimal moist wound healing environment while preventing skin breakdown and infection. Skin is more vulnerable in patients with certain comorbidities and conditions. Periwound skin breakdown is just one of the culprits that delay wound healing and increase pain. It is important to identify conditions and risk factors early in your wound assessment to help prevent any risk of wound progress declination.

Susan Cleveland's picture
Moisture-Associated Skin Damage Prevention

by Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

Part 2 in a two-part series looking at the basics of preventing and managing moisture-associated skin damage in the long-term care setting. For Part 1, click here.

WoundSource Practice Accelerator's picture
Periwound skin

By the WoundSource Editors

The periwound is as important as the wound. As clinicians, we should carefully assess the wound bed, but we need to remember also to assess the periwound and surrounding skin. The periwound should be considered the 4cm of surrounding skin extending from the wound bed. Chronic wounds may manifest any of the following characteristics, depending on wound type: erythema, induration, epibole, ecchymosis, hyperkeratosis, and changes in shape.1,2

WoundSource Practice Accelerator's picture
Necrotic Foot

by the Wound Source Editors

Chronic non-healing wounds affect millions of patients each year and contribute significantly to their morbidity and mortality. These wounds have a substantial impact because of their economic burden and the significant effect on the reduction in quality of life, as well as the increased risk of death for those patients affected by them.1 A 2014 study of Medicare data showed that chronic non-healing wounds and associated complications affect nearly 15% or 8.2 million Medicare beneficiaries. The study also estimated the cost to treat these wounds at between $28.1 billion and $31.7 billion annually.2 The highest costs were associated with infected or reopened surgical wounds, and outpatient care had the highest site-of-service costs. In addition to being older, most of these patients have obesity and diabetes. Underlying causes often include diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. The list of complications contributing not only to chronicity but also to further deterioration is quite lengthy.

WoundSource Practice Accelerator's picture
moisture-associated skin damage

by the WoundSource Editors

It has long been known in clinical practice that long-term exposure of the skin to moisture is harmful and can lead to extensive skin breakdown. The term moisture-associated skin damage was coined as an umbrella term to describe the spectrum of skin damage that can occur over time and under various circumstances. To have a moisture-associated skin condition, there must be moisture that comes in contact with that skin.

WoundSource Practice Accelerator's picture
skin assessment and moisture-associated skin damage

by the WoundSource Editors

The performance of an accurate and complete skin assessment is of utmost importance to obtaining and maintaining healthy skin. Understanding the structure and function of the skin is key to the differentiation of normal from abnormal findings. Having this baseline knowledge aids in determining the patient's level of risk, how skin is damaged, the impact of moisture on the skin, the resulting type of moisture-associated skin damage (MASD), and whether current skin care protocols are effective and adequate.