C NewsWounds update linical innovations Skin integrity update


Wounds International clinical updates present recent developments in the field of leg ulcers, pressure ulcers, skin integrity and diabetic foot, including the latest from associations, clinicians and industry. If you use an innovative technique in your practice that you would like us to feature in future issues, please email the editor at: scalne@woundsinternational.com


Innovations in callus and hyperkeratosis management


T


his short report describes an innovative method for managing callus and


hypekerotoses to maintain skin integrity in vulnerable patients. All healthcare professionals have a


duty to assess, maintain and restore skin integrity as part of their daily contact with patients. The skin is


one of the largest organs in the body, serving a vital role as a protective barrier, a thermal and hydration regulator, a sensory, excretory and metabolic organ and an emotional communication tool. Skin structure varies markedly across anatomical


regions of the body, the density of hair follicles, sweat and sebaceous glands, sensory organs and the thickness of the dermis and epidermis changing to reflect the specific function of an area of skin. Skin structure also changes with ageing, as a response to recurrent trauma and with exposure to environmental hazards such as sunlight[1,2]


.


Maintaining adequate hydration Levels of skin hydration affect the efficiency of the skin barrier function and its ability to resist trauma. For example, excessive moisture causes maceration while dehydration causes cracking and both can increase the risk of bacteria penetrating the skin, cellulitis and spreading sepsis[3, 4]


Preventing build up of callus Skin normally provides a supple, elastic and conformable surface. Accumulation of callus, the build-up of skin preparations such as emollients, keratosis (an excessive growth of the top layer of skin cells), or dried secretions on the skin surface decrease the ability of the skin to move freely, stretch and conform. This can result in dry cracks or fissures and the development of focal pressure damage under areas of callus, both of which can be a significant problem in the foot of a diabetic patient, especially in the presence of a peripheral autonomic neuropathy[6]


.


Accumulations of callus and other materials should be managed by debridement in the case of callus formation, possibly combined with off-loading of the affected area. Where dry skin on the heel is a problem, careful removal of excessive heel callus by sharp debridement and the use of emollients and urea-based preparations is effective. Where lower limb hyperkeratosis is a problem, careful skin cleansing using emollients as a soap substitute or Debrisoft® (Activa Healthcare) as a gentle mechanical debriding agent can be effective[7]


. Debrisoft comes in the form of a pad


with a soft fleecy appearance and feel, bound edges and a knitted outer surface coated with polyacrylate. The contact layer consists of soft inert flexible polyester fibres with angled tops. The fibres loosen necrotic tissue, keratoses and adherent exudate from the wound and surrounding skin, absorbing and binding the debris within the pad. After an initial treatment, ongoing maintenance debridement may be required. Pressure ulcer


. Maintenance of skin hydration


and the prevention of moisture damage, whether from exudate exposure, urine and faecal contamination or prolonged exposure to liquid is, therefore, an essential element of care requiring the careful use of emollients, the application of barrier products such as Cavilon™ No Sting Barrier Film (3M™)[5]


and


the selection of appropriate dressings to contain and remove excessive exudate from the wound and the peri-wound area.


prevention is one of the key quality indicators of the care clinicians provide. At first contact, all patients should undergo a pressure ulcer risk assessment to ensure the provision of both appropriate care and the necessary equipment to


Figure 1: Bottom of foot demonstrating build-up of callus.


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