Wound assessment utilising the triangle of wound assessment, in the treatment of static hyperkeratosis of the periwound skin
Author: Emma Scrivener DN Provide
The Triangle of Wound Assessment is a holistic wound assessment framework introducing an intuitive way to assess and manage all three areas of the wound: Wound Bed, Wound Edge and Periwound Skin1. The assessment tool goes beyond the wound edge to consider the periwound area and is important for improved decision making and viewed as an integral part of wound healing2.
A case study will show how the tool was used in clinical practice for appropriate selection of a wound management dressing on a 67-year-old female patient with chronic leg ulceration, with static Hyperkeratosis around the periwound area.
In venous disease, layers of loose, dry, scaly skin develop and become hardened to form Hyperkeratosis which, if left in situ can delay healing3. The dry skin plaques can harbour bacteria and are sometimes removed by picking with forceps. This approach is problematic as it is time consuming and may cause damage to the delicate epithelisation underneath. Legs are also typically washed, then hydrated with an emollient cream at each dressing change.
The patient has a history of Mental Health Problems, Obesity and CKD. She has self-esteem issues and currently resides in a care facility. She is involved and interested in her treatment and regularly asks questions about her wound care. Her leg ulcer is treated with modified compression, and she is dissatisfied about the chronic Hyperkeratosis of the periwound area. The framework was used to review the management plan and Comfeel was applied to the dry skin surrounding the wound (Fig.1) in a 'patchwork' formation.
Within 3 days the dry scaly skin had debrided noticeably revealing healthy epithelialized skin (Fig.2). Within 19 days (Fig.3) the periwound area was dramatically improved, giving satisfaction as a practitioner and confidence to the patient. The ulceration which was partially obscured by the Hyperkeratosis was cleaner and more defined for treatment.
DISCUSSION AND CONCLUSION
Periwound care is important and an essential part of wound assessment. Washing and emollient application alone does not effectively manage Hyperkeratosis. The use of the Comfeel Hydrocolloid dressing is an easy, inexpensive and time effective way to get exemplary results.