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MALIGNANT WOUNDS Connie Sarvis RN, BN, MN, CON(C), IIWCC, CWS

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Presentation on theme: "MALIGNANT WOUNDS Connie Sarvis RN, BN, MN, CON(C), IIWCC, CWS"— Presentation transcript:

1 MALIGNANT WOUNDS Connie Sarvis RN, BN, MN, CON(C), IIWCC, CWS
Skin and Wound Consultant Seven Oaks General Hospital

2 Malignant Wound. Fungating Wound. Cutaneous Malignancy
Malignant Wound? Fungating Wound? Cutaneous Malignancy? Malignant Cutaneous Ulcer? Tumor Necrosis?

3 Wound Care Designed to afford Relief without Cure
How Common Are They? 5-10% of patients with metastatic cancer will develop a malignant wound! Wound Care Designed to afford Relief without Cure

4 Most Common Sites Breast Head/Neck Back/Trunk/Abdomen Groin/Axilla
Genital

5 How do they develop?

6 From a Primary Skin cancer left untreated.
Ie. Basal cell ca Squamous cell ca

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9 A Primary Tumor invading up into and through the skin.
Ie. Breast tumor

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11 Tumor has invaded blood or lymph vessels
– small skin capillaries trap malignant cells

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14 During Surgery – seeding of malignant cells in the dermis occurs

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18 Malignant wound develops in another chronic ulcer/scar tissue
Conversion: Malignant wound develops in another chronic ulcer/scar tissue

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20 Starts as discrete, non tender nodules
PATHOPHYSIOLOGY! Starts as discrete, non tender nodules Can be skin tone, pink, red, violet, blue, black or brown! As malignant cells grow and divide, the nodules enlarge – interfere with skin capillaries and lymph vessels

21 Tumor very disorganized
Tumor very disorganized! – poor skin perfusion, edema and necrosis occurs Tumors often extend into deeper structures – sinus and fistula formation

22 TREATMENT

23 SURGERY Used occasionally to reduce tumor mass but may not always be possible due to bleeding, infection, etc.

24 Chemotherapy Can decrease tumor mass Depends on tumor response

25 RADIOTHERAPY Can reduce the size of mass – controlling exudate, bleeding and pain Adding radiotherapy reactions to wound

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29 ASSESSMENT Location of Wound Size, Depth and Shape
Amount and Nature of Exudate Presence and Level of Malodor Type of Tissue Present Signs and Symptoms of Infection Nature and Type of Pain Condition of Peri-wound Bleeding

30 ASSOCIATED PROBLEMS WHAT DOES THE PATIENT THINK IS THE MOST IMPORTANT?

31 ODOR!! Anaerobic Bacteria infecting or colonizing necrotic tissue-Putrescine, Cadaverine Klebsiella, Pseudomonas & Proteus Necrotic Tissue Odor Stale Exudate

32 Presence of Infection Tissue Degradation Malodor Tissue Necrosis Anaerobic Bacterial Colonization

33 Remove necrotic tissue where bacteria are
Debridement Remove necrotic tissue where bacteria are Sharp? Mechanical? Autolytic?

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35 SYSTEMIC ANTIBIOTICS Control Odor from Bacteria’s Metabolic End Products Bacterial Resistance Adverse Effects

36 FLAGYL (Metronidazole) Anaerobes only – Binds their DNA
gel - .75% -displacement tablets crushed in gel oral tablets ( mg. TID) IV/irrigation

37 SILVER/IODOSORB Reaches the Gram positive cocci and gram negative rods – Pseudomonas No bacterial resistance Longer to control odor

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39 CHARCOAL DRESSINGS Absorbs volatile malodorous chemicals from wound before they pass into air Needs to be an airtight seal

40 Pouching? Increase Frequency of Drsg. Changes Room Sprays – Nausea!! Mentholatum applied to Nostrils Kitty Litter, Charcoal, Baking Soda, Vinegar Distraction Techniques

41 EXUDATE

42 Tumor Cells can secrete Vascular Permeability Factor – vessels become more permeable to plasma colloids and fibrinogen Inflammatory reaction - Histamines

43 Cloudy Serous Amber Exudate Purulent Hemo-purulent Sanguinous

44 THE 5 C’S OF EXUDATE MANAGEMENT
CAUSE CONTROL COMPONENTS CONTAINMENT COMPLICATIONS

45 CAUSE Drug-related Lymphedema Infection Decreased se albumin
Heart Failure

46 Is systemic and or local control possible?

47 COMPONENTS VISCOSITY? BACTERIA? NECROTIC MATERIAL?

48 Capillary Action Dressings Bacterial Control Dressings
CONTAINMENT Collection Devices VAC Capillary Action Dressings Bacterial Control Dressings Absorptive Dressings

49 COMPLICATIONS

50 BLEEDING

51 Very fragile, friable tissue!!!
Spontaneous bleeding if tumor erodes into a blood vessel – profuse Bleeding can be compounded by decreased platelet function Infection?

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53 PREVENT TRAUMA!! Paraffin/tulle? Gauze? Telfa? Silicone?

54 Control Bleeding Alginates Silver Nitrate Gel Foams
Fibrinolytic Inhibitors Topical Adrenaline Sucralfate

55 PRESSURE? OR ICE?

56 PAIN Tumor pressing on nerve endings During dressing changes
Exposure of Dermis to air

57 PAIN Avoid Trauma Gentle Cleansing- without gauze No cold irrigations No H2O2, Iodine, Chlorhexidine, Eusol!! Morphine gel (1 mg./1 ml hydrogel or metronidazole gel)

58 Peri-Wound Skin Excoriation Pruritis

59 EXCORIATION Barriers – No Sting Hydrocolloid Frames Zinc Oxide
Avoid Tape – Netting/garments Pouching Diaper Technology

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61 PRURITIS Antihistamines? Cool Hydrogel Sheets Menthol Cream TENS?
Avoid vasodilation!! Moisturizers (Avoid Lanolin)

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66 QUESTIONS?


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