Head and neck cancers present challenging situations to the WOC nurse.  The patient is dealing with a cancer that requires extensive use of various topical wound therapies. The outcomes may lead to either healing or palliative care. Physical changes are frequently evident to others as the head and face are completely visible.  Drainage and odor may impact social interactions and self image.

   Our team sees both in-patients and out-patients.  Radical neck dissections are performed as well as chemo-radiation therapy.  Radiation necrosis compromises the wound healing cascade.

• MN, a 43 year old male with tongue carcinoma, treated with radical neck dissection, partial glossectomy and chemo-radiation.  Patient has a fungating tumor of the jaw and neck area. Treatment is focused on controlling odor, absorption of secretions and cost containment.  Non adherent Silicone dressings were used and a dressing was constructed from an ice bag and a sanitary pad.  Outcome:  Disease progression and patient admitted to hospice for palliative care.
• DG, a 49 year old female with esophageal cancer.  Surgery was radical neck dissection, followed by chemo-radiation therapy.  She developed a neck fistula, wound dehiscence, and carotid bleed.  Emergent surgery performed to repair the bleed. Treatment was negative pressure wound therapy for wound bed preparation for skin grafting when wound bed prepared.  HBO, plus growth factor and collagen product used to fistula closure. Outcome:  Total healing of neck wounds.
• AJ, a 52 year old male with squamous cell carcinoma of the oral cavity.  He was treated with chemo-radiation followed by radical neck dissection.  He developed a neck fistula.  Treatment was HBO with silver hydrofiber.  Outcome : Wound healing.

Conclusion: Wound care requires creative approaches by the WOC nurse due to anatomical location and difficulty of securing dressings when working around the tracheostomy position.