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fungating facial wound

Posted

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

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....

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

MomRN0913

Specializes in ICU.

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

NC29mom, ASN, LPN, RN

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

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

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
spelling errors

NC29mom, ASN, LPN, RN

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

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

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

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

eternalsunshine

Specializes in Oncology, Palliative care.

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

NC29mom, ASN, LPN, RN

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

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?

SaoirseRN

Has 8+ years experience.

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.

eternalsunshine

Specializes in Oncology, Palliative care.

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.

isn't adaptic basically a vaseline-type guaze?

i have worked on many fungating wounds and no matter what product is used, it remains incredibly painful.

i have found that working as quickly as humanly possible, was the kindest thing we could do for these patients.

dang, i recall a cn who would take her sweet time when changing these dsgs.

the grimaces, clenched teeth, moaning was too much for ME to bear and i ended up snapping at her:

"can you pick up the pace, harriet?"

seriously, i do believe that knowing these wounds won't heal and that our goals are to prevent infection or secondary complications...

that just pretty much changing dsg at speed of light, will benefit pt the most...imo.

and yes, premedicating (with anxiolytic as well!) is critical, too.

leslie

NC29mom, ASN, LPN, RN

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

I did look into the Mepiel drsg..... I was just unsure if it would work....I will order and try....

I try to work as fast as possible but I end up stopping numerous times bc pt raises her hand. Today, I incorporated the hurricane spray. I sprayed the bottom layer of the packing in hopes it would numb for removal.....didn't see a real difference. ..

My pt has told me several times in the past, she feels god is punishing her for her sins, and this is why she suffers...breaks my heart.

I am going next week to get my wcei wound certification. ...hopefully I will learn something which will help her...

Thanks everybody!

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

We use lidocaine topically on painful wounds sometimes...or perhaps a topical morphine to the wound edges?

Who doesn't hate painful wounds in a hospice patient! So unfair it seems...

SaoirseRN

Has 8+ years experience.

I did look into the Mepiel drsg..... I was just unsure if it would work....I will order and try....

!

I actually had a patient with a fungating facial tumor similar to what you described except it didn't require packing. However it had numerous "bleeders" whenever the dressings came off and I did use the mepitel. It did help keep some of the places from sticking. I hope it helps your patient.