Few studies have addressed the effects of dressings on malignant
wounds. A 20-month (May 2010 to January 2011) descriptive, prospective cohort study was conducted by the
Wound Care Unit of Institute Curie, Paris, France to evaluate the use of various local care procedures and characteristics of malignant
wounds. Symptoms and
wound management methods were observed over a period of 42 days in 32 patients (all women, mean age 60 years, range 30-96 years, most with infiltrating
ductal carcinoma). After cleansing (with either sterile saline or water), a variety of
wound treatments were used based on specific
wound characteristics, including
calcium alginate, hydrocellular, interface, and active
charcoal and superabsorbent dressings.
Wound size, color (red, pink, black, yellow), periwound condition, surface
wound organisms (number of species and quantity), and signs of
infection, along with
wound-related
pain (rated on a verbal rating scale), odor,
bleeding (spontaneous or induced), and exudate (rated on a four-level scale as none, slight, moderate, intense) were assessed at baseline and on days 21 and 42 of treatment. The degree to which each symptom was managed was scored as controlled, partly controlled, or not controlled. Mean initial
wound size did not change over the evaluation period; most (74%)
wounds were characterized as being inflamed. No infectious episodes were observed during the duration of the evaluation. Exudate and
bleeding were generally controlled with
hemostatic dressings,
calcium alginate dressings, or
absorbent pads. Odor was not completely controlled with
charcoal dressing and was noted to be significantly greater in patients with >105/g bacterial counts and/or with one or more anaerobic bacteria (P = 0.05). At day 0, 13 out of 25 patients (50%) had uncontrolled
pain;
pain ratings did not change over the course of the study. Clinical research on specific clinical practice (eg, topical
morphine for
pain) and to assess the comparative efficacy of different care approaches on controlling the local symptoms of malignant
wounds is warranted to improve the quality of care, which may affect patient quality of life.