fungating facial wound

Specialties Hospice

Published

Specializes in Hospice, Geriatrics, Wounds.

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

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Specializes in ICU.

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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are you thinking of Dermaplast?

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Specializes in Hospice, Geriatrics, Wounds.

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

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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...

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Specializes in Hospice, Geriatrics, Wounds.

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

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

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

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Specializes in Oncology, Palliative care.

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

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Specializes in Hospice, Geriatrics, Wounds.

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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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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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.

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