TOPIC/PURPOSE: A fungating lesion develops when an underlying tumor extends through the epithelium, leaving a visible marker of the underlying malignant disease and its advancement. As the tumor size increases, vessels such as capillaries rupture with resultant tissue necrosis, infection, and odor. Fungating lesions require complex management strategies, especially when odor, excess exudate, friable tissue and pain are involved. The lack of effective management can have a tremendous negative impact on the patient, deepening the sense of helplessness, poor self-image, and isolation from family and friends. The anticipation and fear of pain with dressing changes furthers their feelings of despair.1-3

OBJECTIVE: Included in the primary wound management goals for patients with a fungating tumor is to provide topical dressing that will address exudate concerns and assist in the reduction of pain. From this poster, the reader will be able to identify management strategies that will address management of exudate and odor, and minimization of trauma to friable wound bed and fragile periwound tissue. This poster will review 3 cases that illustrate effective management strategies for fungating and painful cancerous tumors utilizing a topical antimicrobial product, hemostatic fillers and soft silicone dressings.

CONCLUSION: The Middlesex Hospital Home Care wound care team developed a dressing selection approach for fungating lesions which combined topical antimicrobial for odor as needed, calcium alginate to assist with hemostasis, soft silicone mesh or transfer dressings to minimize trauma and pain during dressing changes and absorptive gauze to manage exudate. Implementing this system of wound management provided a strategy to manage the wound exudate and odor, decrease occurrences of capillary bleeding and, minimize trauma and pain to the wound and periwound. The most important outcome to this strategy was the significant improvement in the quality of life for the 3 patients that will be described in this poster.