You understand tumor wounds?

What is a tumor wound?

Tumor wounds refer to open wounds formed by the direct invasion and ulceration of the skin by malignant tumors, or wounds caused by local tissue necrosis and impaired blood circulation due to tumor growth. These wounds differ fundamentally from ordinary wounds; they originate from abnormal cell proliferation, typically fail to heal spontaneously, and may continue to progress. Common manifestations include irregular ulcers with raised or inverted edges, often with necrotic tissue, exudate, or bleeding at the base, and may be accompanied by a foul odor. These wounds are not isolated but rather a local manifestation of systemic disease; therefore, their management requires a comprehensive consideration of the patient's overall tumor condition and treatment goals.

What are the typical characteristics of tumor wounds?

Identifying the characteristics of tumor wounds helps distinguish them from ordinary chronic wounds. These wounds are typically irregular in shape, with hard, everted, or rolled-in edges, giving them a crater-like appearance. The base of the wound shows necrotic tissue of mixed colors, sometimes yellowish-gray, accompanied by a foul odor; this is the result of tissue necrosis and bacterial action. There is a marked tendency to bleed; even slight touch can cause bleeding or oozing. Pain can be very intense and varied in nature, including persistent dull pain, intermittent stabbing, or burning pain. The skin around the wound may show induration, pigmentation, or satellite nodules. Most importantly, tumor wounds usually respond poorly to conventional wound care, healing slowly or even continuing to enlarge.

How to deal with the odor problem of tumor wounds?

Odor is one of the most common problems associated with tumor wounds, primarily stemming from the decomposition of necrotic tissue and infection by specific bacteria. Controlling odor requires a multi-pronged strategy. Thorough debridement is crucial; regularly removing necrotic tissue from the wound surface reduces odor sources. Topical application of dressings containing activated charcoal can absorb odor molecules, reducing odor emission. Silver-containing dressings or topical metronidazole gel can inhibit the growth of anaerobic bacteria, the main cause of foul odors. Good ventilation and air purifiers can also improve indoor odor. In severe cases, short-term oral metronidazole may be considered, but should only be used under the guidance of a physician. Simultaneously, keeping the wound clean and dry, changing dressings promptly, and preventing the accumulation of exudate are essential.

How to effectively control bleeding from tumor wounds?

Tumor wounds are prone to bleeding due to abnormal angiogenesis and tumor invasion of blood vessel walls. Bleeding management requires caution and prompt action. For minor oozing, calcium alginate dressings can be used; these form a gel upon contact with blood, helping to stop the bleeding. For more significant bleeding, apply hemostatic materials such as gelatin sponges or styrofoam, along with gentle pressure bandaging. Avoid directly wiping the wound with rough gauze to prevent worsening the bleeding. If bleeding is heavy or frequent, it is necessary to assess the need for local radiotherapy, interventional embolization, or surgery. Simultaneously, check the patient's coagulation function and platelet count, and provide systemic supportive care if necessary. In daily care, avoid trauma and friction, and use non-adhesive dressings to reduce damage during dressing changes.

How to manage pain from tumor wounds?

Pain from tumor wounds is often complex and severe, requiring a comprehensive management strategy. The first step is a thorough pain assessment to understand the nature, intensity, pattern, and influencing factors of the pain. Local management includes using non-adhesive dressings to reduce pain during dressing changes, and considering the use of soft silicone contact layers to protect the wound. Dressings or gels containing local anesthetics can be applied directly to the wound to relieve pain. For deep pain, oral or patch-based analgesics may be necessary, following the World Health Organization's three-step analgesic ladder. Non-pharmacological interventions are also important, such as relaxation techniques, distraction, and adjusting to a comfortable position. Pain management requires regular reassessment and adjustment, as pain characteristics may change as the wound evolves.

What type of dressing should be chosen for tumor wounds?

Dressing selection is crucial for the management of tumor wounds. An ideal dressing should manage significant exudation, reduce odor, control bleeding, alleviate pain, and not damage newly formed tissue. Alginate dressings are suitable for wounds with moderate to severe exudation, offering high absorption and hemostasis. Silver-containing dressings help control bacterial load, reducing odor and the risk of infection. Soft silicone dressings, acting as a contact layer, can reduce trauma and pain during dressing changes. For wounds with foul odors, dressings containing activated charcoal may be considered. Foam dressings are suitable for situations requiring cushioning and protection. Dressing selection is not static and needs to be adjusted promptly according to changes in the wound condition; sometimes, a combination of multiple dressings is necessary.

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Editor: kiki Jia