Fungating wounds
When a tumour infiltrates the epithelium and surrounding blood and lymphatic vessels a necrotic, crater-like wound can develop. These are prone to infection and discharge which can be purulent, causing distress and embarrassment to the patient. Some non-malignant ulcers will present similarly. Often the underlying cause of these wounds is not treatable and thus not reversible. It is important to treat concurrent infections to reduce symptoms.
When assessing a patient with a fungating wound it is important to explore which factor is most concerning to them; odour, bleeding, pain, body image, impact on relationships can all be experienced. Monitor the condition of the surrounding skin and aim to protect this from maceration if possible. Consider if there is the possibility of serious complications due to location of the wound e.g. head and neck tumours with the potential for airway compromise.
Non-drug treatment
- Aim target patient’s individual priorities
- Radiotherapy
- Clean wound regularly when exudate is present
- Regular dressing management: activated charcoal dressing may suppress odour
- Aromatherapy may improve the experience of odour
- Air fresheners
- Referral to dietician to improve/maintain nutritional status and promote wound healing
- Referral to tissue viability nurse may be appropriate in your area; they may have access to a variety of dressings which may be beneficial
Drug treatment
- Pain may respond to standard systemic medication but may require neuropathic agents
- Topical morphine can be used by mixing injectable morphine with hydrogel for application under dressings
- Breakthrough pain relief may be required for dressing changes
- Topical tranexamic acid may reduce bleeding
- Topical adrenaline 1:1000 may also reduce bleeding
- Topical metronidazole gel can improve odour where anaerobic bacteria are present in the wound
- If wound is infected systemic antibiotics may improve pain, discharge, and odour