The best way to prevent maceration in a wound is to be sure the wound is clean and dry, and to change the dressing often. Maceration happens when skin is exposed to moisture for longer than it should be. There are a few telltale signs of maceration. First, the skin is visibly soggy or white in color. It may also be soft to the touch or have a “raw” feeling. Another sign is that the wound is encased by a white ring. Any of these characteristics are a sign that the wound was exposed to too much moisture or an excessive amount of drainage.
For the most part, maceration is innocuous. If it’s mild it will resolve on its own without the need for intervention. When maceration begins to extend to the skin around a wound, that’s when treatment could be required for proper healing. If maceration remains untreated, a few things could happen and none are ideal. First, the maceration could prevent the wound from properly healing. It may also contribute to infection, either bacterial or fungal. Untreated maceration could cause irritation or pain. And, in the worst circumstances, it can lead to maladies like dermatitis, weepin eczema or damaged tissue, also called tissue necrosis. These are outcomes you don’t want to have to deal with, so, the best thing is to control and prevent maceration.
What causes Maceration in Wounds?
Maceration occurs outside of wound care. You may have experienced mild skin maceration the last time you took a long shower or bath. Perhaps your last time in the swimming pool resulted in a wrinkly, whitening of the skin – that’s a more mild form of maceration. If you’ve ever looked down at your hands and seen them pruned and wrinkled after a long time submerged in water, you’ve felt mild maceration. It can also occur when the skin is exposed to sweat, exudate, urine or feces. In fact, maceration can crop up anytime skin is exposed to moisture for long periods.
Skin maceration can be a product of the characteristics of your skin, whether it’s greasy, dry, thick or thin. It can also come about depending on where the wound formed on the body. For example, if the wound is on the inside of the arm. That’s a more moisture-ous section of the body to begin with, making it apt for maceration. Also playing a role are a person’s age, sex and physical condition. As an example, someone with obesity may develop maceration in the folds of their skin as a result of sweat or exercise. A person with incontinence might notice maceration in their genital area; a product of urine or feces on the body too long.
Maceration in Chronic Wounds
In the case of a diabetic, or someone with chronic wounds, the risk of developing maceration near the site of the wound can be common. This will usually require a visit to your health care provider or wound care specialist, because any type of chronic wound should be followed up with by a professional. Although any type of moisture sitting on a wound too long can cause maceration, for chronic wounds, maceration is usually caused by exudate, which is a fluid that comes out of wounds. In the case of a “normal” acute wound, exudate helps the healing process. On the other hand, when it comes to chronic wounds, the exudate that is expelled contains enzymes, called proteases. These enzymes create a breakdown in protein and peptides, thus causing maceration. This breakdown can occur in many types of chronic wounds, from foot ulcers, to leg ulcers, to fungating wounds. Diabetics should be especially vigilant as chronic wounds are more common for those with this health condition.
How can you prevent Wound Maceration?
The best course of action for keeping maceration under control is to prevent it from ever occurring in the first place. Of course, this can be difficult. Studies have shown that keeping a wound moist will lead to a better outcome when compared to keeping the wound dry. This is because a moist wound creates an environment of quicker healing, better contraction, controlled scaring and even less chance of infection. Another benefit of a moist wound is that it’s easier and less painful when it comes to removing bandages and surgical tape. But, of course, as we know, keeping a wound too moist for too long can lead to maceration, which can actually stop the healing process in its tracks. This is why your wound care specialist has a difficult job – they’re tasked with the challenge of preventing maceration, but at the same time keeping the wound moist enough for a speedy, healthy recovery.
So, how can this be done? The number one way is to control exudate. To illustrate how to do this, let’s examine the process for tending to a venous leg ulcer, which is a wound that will usually produce high-flow exudate. First, you need to figure out what the appropriate wound dressing is. Remember, your goal is to both prevent maceration and promote healing. So you’ll keep in mind the exudate flow. Is there a lot of drainage? If so, the bandage should be highly absorbent. An example of this type of dressing is hydrofiber. If there’s less drainage, a thinner and less absorbent bandage will work. Follow up care is just as important when it comes to the prevention of maceration. Change dressings frequently (everyday if the wound is heavily exudative.) If you leave the dressing on too long, this can lead to maceration, especially if the wound is heavy on drainage.
When it comes to preventing maceration in wounds, there are a few things you should keep in mind. Before dressing a wound, a few things should be assessed, including your medical history, what caused the wound, how much exudate is seeping from the wound, and the wound’s location on your body. Then, you or your wound care specialist should pick out the dressing based on your specific needs and the wound in general. The goal is always to keep the wound healthy and healing in a moist environment. This will help avoid the likelihood of maceration.
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Dr. Faried Banimahd is a board-certified physician specializing in emergency medicine, wound care, and pain management. Our team will work with you to create an individualized treatment plan that meets your needs and unique conditions. Our clinic includes highly trained and experienced physicians, registered nurses, and certified medical staff who work together to provide you with the highest standards of wound care treatments.