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fungating facial wound

Hospice   (5,040 Views 16 Comments)
by NC29mom NC29mom (New Member) New Member

NC29mom has 10 years experience and works as a RN.

9,528 Visitors; 320 Posts

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I have a pt with a large, deep fungating wound which basically encompasses the entire right side of her face (eye swollen shut for months now). There is an area of tunneling which extends from beside her nose, probably into her sinus cavity, and draining into her oral cavity. Presently the trmt is silvidene impregnated guaze packing/adaptic dressing. Of course, presently we are just trying to maintain comfort, as its a nonhealing wound. Any better ideas for dressing material? And, the pt has severe pain anytime the dressing is changed .... even with morphine prior. I remember from a wound clinic, there being an aerosol spray you could spray to the wound bed to numb the area when changing the drag or debriding the wound bed. Anybody know what that spray is ... or another which would do the same job? Thanks in advance....

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roseonye works as a RN.

6,693 Visitors; 253 Posts

its something like the numbing agent used in the perianal area after an episiotomy.

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19,292 Visitors; 1,131 Posts

Our pharmacy compounds a lidocaine/ acetaminophen /ketamine spray which really seems to help for many things, the main one being wounds.

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Twinmom06 works as a RN.

16,023 Visitors; 1,155 Posts

are you thinking of Dermaplast?

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NC29mom has 10 years experience and works as a RN.

9,528 Visitors; 320 Posts

I don't think its dermaplast.....this wound is deep with several areas if bone exposed. Stage IV

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540 Visitors; 1 Post

Hi I saw your post.... I work in LTACHs and have seen several very challanging cranial patients get very good results with an autologous biologic. I am not sure how it could be used in regard to palliative care but I can send a study if you like... Good Luck...

Edited by charles501
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NC29mom has 10 years experience and works as a RN.

9,528 Visitors; 320 Posts

Yes please send to me....because I'm not familiar with it. Thanks so much!

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tewdles has 31 years experience.

30,600 Visitors; 3,156 Posts

We often put lidocaine on the painful wound margins...

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eternalsunshine works as a Hospice Nurse.

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Could you use a topical opioid? I have used these in the past with very good results.

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NC29mom has 10 years experience and works as a RN.

9,528 Visitors; 320 Posts

I did consider a topical opioid.....however, my patient is a resident of an ALF, so keeping up with a gel or spray opioid would be difficult (narcotic count). Of course, they wouldn't be able to use an injectable topically. Currently, I go daily and change dressing. Its horrible. The tunneling has basically just opened into a hole beside her nose. There's educate draining from her nose and mouth almost constantly. ... so sad. I'm using regenecare 2% lidocaine and flagyl gel (mixed) impregnated guaze to pack, covered with adaptic and foam drsg. My newest problem is the packing is sticking to good tissue...making it a tedious task to remove...even with NS. IMits very painful too. I ordered hurricane spray to use when removing old packing but I'm scared to use thinking it wk born and cause more pain. The packing isn't drying out...don't know why it's sticking so bad....any ideas?

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SaoirseRN has 8+ years experience and works as a Registered Nurse.

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We use something called mepitel which is I believe an inert silicone-type material that is kind of like a post-it note in that it stays where you put it but is easy to remove. Use it directly on the wound bed with the packing material on top. Helps keep other dressings from sticking to the wound and you don't have to remove it each time the dressing is changed. It has holes in it that let exudate out and saline in for cleansing. Something like that might help with the problem of dressings adhering to the wound bed.

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eternalsunshine works as a Hospice Nurse.

3,272 Visitors; 162 Posts

Oh my gosh, poor lady, must be so awful for her :( What about using some Vaseline gauze? i had the exact same problem with a fungating wound on a leg recently, and it was causing it to bleed when removing dressings, this worked fantastic and the dressings just came off very easily with no discomfort for the patient.

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