Fungating Wound Management

1)What is a fungating wound ?

Pathophysiology – tumour growing under the skin and breakthrough the skin surface to create
a wound.Appearance : cauliflower, ulcerating, skin nodules

2)Assessment –physical,psychological, psychosocial,spiritual

( how is the impact on patient from 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 -tumour increasing with damage to blood vessels

-trauma in removal of dressing

-adrenaline (Do you have this at 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 dark colour (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 tumour 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
1) 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).

2) Wilson V.Assessment and management of fungating wound.British Journal Community

Nursing 2005;10:528-534.

3) Seaman S.Management of malignant fungating wounds in advanced cancer.Seminar in

Oncology Nursing 2006;22(3):185-193.

4) Caroline D.Malignant fungating wounds: assessment and management.British Journal

Community Nursing 2002;7(8)

5) Sebastian P et al 2009. Malignant fungating wounds.European Journal of Oncology

Nursing 13;295-298.