Caring for Patients With Malignant Fungating Wounds

Abstract

PURPOSE: The aim of this scoping literature review was to identify current knowledge related to management of malignant fungating wounds (MFWs), gaps in this knowledge, and areas for future research. METHODS: This was a scoping literature review. SEARCH STRATEGY: Six electronic databases (Embase, MEDLINE, Cochrane (CENTRAL), CINAHL, Scopus, and Web of Science) were searched spanning the years 1987 and 2022. The initial electronic database search retrieved 6041 studies. The search is based on 60 articles published between 1987 and 2022, along with 14 additional studies were based on search of reference lists of key articles. FINDINGS: Studies were divided into 2 main domains; the vast majority (65 of 72, 87.8%) focused on symptom impact, measurement, and management. The remaining articles (n = 9, 12.2%) focused on caring for patients with MFW; these studies focused on nursing care experiences and competencies, along with lay caregiver experiences. Findings indicated that instruments have been developed to evaluate symptoms of MFW but only a few have been validated. Most of the studies reviewed evaluated the influence of MFW on physical and psychosocial function. Local and systematic symptom managements such as modern dressings, wound care strategies, surgery, and radiotherapy as well as chemotherapy were found to be effective in alleviating symptoms. Findings also indicated that families and nurses encounter obstacles and burdens when caring for patients with MFW; limited studies were retrieved that investigated the competence and needs of nurses in their caring journey. IMPLICATIONS: Future studies should focus on: (1) using better designs to evaluate and compare topical agents and dressings to control odor, (2) validating assessment tools specific to MFW, (3) qualitative studies designed to enhance understanding family and nurses' experiences, and (4) improving the nurse's ability to care for patients with MFWs and their responses to managing these challenging patients.

Examination of the Odor-Eliminating Effect of a Deodorizing Spray on the Volatile Odorants of Malignant Wounds

“…Treatment of MWs is challenging 10,12,19. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds 20.…”

“…The main odor components of MWs are dimethyl disulfide, dimethyl trisulfide, phenol, indole, and 3-methylbutanal, which are reportedly produced by bacteria present in the wound 13. Therefore, metronidazole ointment, clindamycin ointment, and iodine-containing preparations are used as topical agents to control bacterial growth in MWs in some cases; when necessary, systemic administration of antibacterial agents is also used 19,22…”

“…Treatment of MWs is challenging. 10,12,19 Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. 20 In this study, volatile components of MWs before and after DS application were subjected to quantitative analysis and assessment via sniffing.…”

“…13 Therefore, metronidazole ointment, clindamycin ointment, and iodine-containing preparations are used as topical agents to control bacterial growth in MWs in some cases; when necessary, systemic administration of antibacterial agents is also used. 19,22 Findings from this study suggest that the deodorizing effect of the DS we selected reduced typical odor components of MWs such as sulfur compounds (dimethyl disulfide and dimethyl trisulfide), fatty acids (isovaleric acid and butyric acid), and aldehydes (octanal). Nevertheless, the magnitude of this reduction was not sufficient to create a clear deodorizing effect based on sniff testing.…”