Ford Medical Associates Ltd

Fungating wounds

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Fungating Wounds

 

The high glycerine content of Novogel gives it bacteriostatic and fungistatic properties which prevent the bacteria from growing thus decreasing the odour associated with these wounds. The 30 x 30cm size dressing is ideal for covering large areas and the conformity allows it to be cut and used on the difficult to dress areas i.e. chest round to the axilla. The dressing is soothing and comfortable offering relief and a cushioning/padding effect. Novogel absorbs 2-3 times its own weight of exudate. As the dressing does not stick to moist wounds changes are easier and less stressful.

It is well recognised that fungating lesions are friable and pre-disposed to bleeding because of their prolific and abnormal vasculature. Observations during various studies have led us to the conclusion that there are four sources of bleeding. Removal of adherant dressings was one of these sources.                                                             

  Novogel is only mildly adherant to dry skin and does not adhere at all to moist skin. Therfore the non adherent property would be well demonstrated in these cases.

 It should be noted however that the dressing does not absorb blood and a bleed would require an extra dressing change

The presence of necrotic tissue is also usual with fungating lesions and leads to problems with discomfort, odour and uncontrolled exudate. Novogel does not contain a debriding agent but the occlusive nature of Novogel will facilitate effective debridement. The Novogel dressing alone will soften the slough but a secondary dressing will be required. 

Odour is one of the hardest areas to control and has severe psychological effects on the patient. Due to the dressings bacteriostatic and fungistatic properties this problem can be alleviated but not solved. Studies have been undertaken in which patients (and their families) with severe fungating lesions have been able to tolerate dressing changes. 

Patients with these types of lesions will have repeat dressings for the rest of their lives therefore it is essential that everything possible is done to prevent the skin from maceration and stripping due to tape/film removal  

Fungating breast wounds are perhaps the most difficult of areas to address. This is largely due to the position of the wound and the very delicate surrounding tissue.  When a nurse is considering her dressing options she should be thinking of a system as opposed to merely a dressing, as the method of securing novogel will play a big part in the success of the dressing.   

Fixation of the Novogel sheets can be difficult especially when the larger sizes are used. Therefore it is important to consider the dressing as a system, and to give considerable thought to the method of fixing Novogel. A study conducted by Patricia Grocott at kings college London found the most effective method to be the use of semi-permeable film roll. The film adhered well to the skin but with the right technique did not cause trauma with repeated removal and re-application.   

Dressing fit is a difficult area to address but due to the conformable properties of novogel this problem is solved. The novogel sheets can be cut to any required shape. Which for example solves the problem of dressing the axilla.   

As with all wounds, technique is as important as the dressing. 

Control of exudate is another factor in the management of these lesions. Novogel will absorb 2.5 – 3 times its own weight in exudate, which makes it suitable for use on low to moderate exuding fungating lesions. For highly exuding lesions an additional absorbent dressing would be required, as well as increased dressing changes. 

Taking all these factors into consideration Novogel dressings do not have to be changed as frequently as others and can be reduces by perhaps one of two daily changes.

 

Palliative wound management:

the use of a glycerine hydrogel

June Burns,MerlanieStephens

British Journal of Nursing2003,Vol12,No6