The periwound (also peri-wound) is tissue surrounding a wound. Periwound area is traditionally limited to 4 cm outside the wound's edge but can extend beyond this limit if outward damage to the skin is present. Periwound assessment is an important step of wound assessment before wound treatment is prescribed.

Function and characteristics

Healthy periwound is an immediate barrier surrounding the wound bed that can perform all the regular functions of skin – the body's largest organ – such as absorption, excretion, protection, secretion, thermoregulation, pigment production, sensory perception and immunity. Healthy periwound maintains all the physical characteristics of skin: elasticity, surface integrity, color and texture. However, periwound can become compromised and negatively affect the healing progress of the wound.

Periwound issues

Periwound issues affect the integrity and healthy functionality of the skin surrounding the wound and may include maceration, excoriation, dry (scaly) skin,

eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can ...

, callus (

hyperkeratosis Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathologi ...

), infection,

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

Signs and symptoms

Patients with periwound issues may experience burning, itching, tenderness, and pain. Visible and measurable signs include

rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, c ...

erythema Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not asso ...

, discoloration, changes in skin texture and temperature.

Causes

The most common cause of periwound issues is excessive moisture present in the area surrounding the wound. Exudate from heavily draining wounds causes irritation of the periwound that may lead to maceration, excoriation, and otherwise compromise skin integrity. This type of damage is more common in

chronic wound A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one ...

s due to exudate composition which differs from fluids produced in acute wounds or burns. Chronic wound exudate contains

proteolytic enzymes Proteolysis is the breakdown of proteins into smaller polypeptides or amino acids. Uncatalysed, the hydrolysis of peptide bonds is extremely slow, taking hundreds of years. Proteolysis is typically catalysed by cellular enzymes called protease ...

and other components that degrade skin integrity and predispose it to inflammation. Moisture-associated skin damage can also be caused by

bodily fluids Body fluids, bodily fluids, or biofluids, sometimes body liquids, are liquids within the human body. In lean healthy adult men, the total body water is about 60% (60–67%) of the total body weight; it is usually slightly lower in women (52-55%). ...

or other contaminants that enter the periwound areas, for example, in patients with

urinary The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, co ...

fecal incontinence Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...

, or

colostomy A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into ...

patients. Other causes include dryness of the skin due to ageing and skin or systemic disorders, allergic reactions to wound care products, damage that may result from poor application and removal technique of adhesive products used in wound treatment, as well as exposure to infection or extrinsic contaminants at the time of wound dressing changes.

Risk factors

Among risk factors that may contribute to degrading the periwound skin performance are: * Chronic wounds (excessive harmful exudate) * Old age (increased skin fragility, epidermal thinning, loss of elasticity) * Underlying disorders (congenital (

epidermolysis bullosa Epidermolysis bullosa (EB) is a group of rare medical conditions that result in easy blistering of the skin and mucous membranes. Blisters occur with minor trauma or friction and are painful. Its severity can range from mild to fatal. Inherited E ...

), dermatological conditions (eczema), fungal or bacterial infections,

lymphedema Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fl ...

) * Environmental damage (UV radiation) * Inadequate wound care regimens

Treatment and prevention

Treatment and prevention of periwound issues are becoming increasingly important as research continues to confirm the role of periwound in wound healing. The shared objective of treatment and prevention is maintenance and/or restoration of the integrity and healthy functionality of skin surrounding the wound. Main treatment and prevention strategies include the following: * Holistic wound assessment that includes periwound assessment. * Elimination of factors causing moisture-associated skin damage. * Maintaining optimal moisture balance over the wound and periwound: effective exudate management in heavily draining wounds as well as adequate hydration of dry wounds. * Proper patient nutrition. * Treatment of underlying conditions. * Protection of periwound from damage, infection, and contaminants. Systemic treatment may include medication appropriate for the patient's condition. Local treatment may include wound care products that protect periwound and help maintain its healthy functionality, for example, moisture barriers (ointments, salves and films), topical corticosteroids, antiseptics and antifungal agents, as well as moisture balancing dressings, such as self-adaptive wound dressing.

References

{{reflist Soft tissue Skin