Management and Challenges of Fungating Wounds

Statement of Clinical Problem: Malignant, fungating tumors can present a challenge to clinicians. These types of wounds usually present with moderate to heavy foul odor drainage. The location of these wounds can be very disfiguring and patients may socially isolate themselves due to embarrassment and discomfort. Control of exudate, protection of surrounding skin, and pain reduction are the key features affecting dressing selection. Also the clinician is challenged to be creative in recommending a method to secure the dressing.  This poster will describe the use of topical dressings and unique dressing adherence techniques for longer wear time, along with odor control to help achieve these goals in the care of three patients.

Description of Past Management: The prior management of all three patients involved the use of different dressings that had caused pain, discomfort and poor wear time.  The location of the wounds of these three patients will be on different anatomical areas; face, neck and breast.  All the patients were on Hospice service. Due to the nature and location of their wounds, the patient suffered with both physical and mental anguish, especially the case of an eroding tumor of the face that invaded the patient's eye, nose and mouth.

Clinical Approach and Outcomes: Patients were managed by a Certified Wound, Ostomy Continence Nurse (CWOCN) consultant that did a weekly assessment and changed treatment as the eroding tumor took on another shape and increased foul smelling odor. Data and pictures will be provided about the dressing procedures; conformity to the wound, adherence to the wound, ease of use, management of the exudates, odor and pain.

Conclusions: The three different unique dressing techniques were well accepted by patient, family, and providers.   Patient comfort was enhanced, and decreased dressing frequency and odor management helped to provide a better quality of life.