Periwound Management

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

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.

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
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.

Margaret Heale's picture
dressing removal

By Margaret Heale RN, MSc, CWOCN

Wounds are dressed every day, and much goes into the choices that are made to properly apply wound dressings. The condition of the periwound skin should be a major factor in the decisions made, as injuring this area can extend the wound and cause considerable pain. Tape removal is one of the most painful areas of wound care.1

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Laurie Swezey's picture
maceration of periwound skin

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

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.