Page 29 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

A systematic review and practice guideline by Bolderston et al. (2006) and the

Supportive Care Guidelines Group of Cancer Care Ontario (2006) on the prevention and

management of acute skin reactions related to radiation therapy concluded that there is a dearth

of strong evidence regarding the management of radiation induced moist desquamation and

therefore recommendations on the best management of radiation dermatitis cannot be made. The

review thus far, provides brief information on current practice in Canada. In order to acquire the

full picture, it is valuable to examine approaches to wound management.

Overview of wound management. Wound management involves the use of topical

agents and dressings. While primary dressings come in direct contact with the wound bed,

secondary dressings cover or hold primary dressings in place (Perry & Potter, 2010, p. 1000).

Wound dressings are beneficial as they preserve a moist environment that enhances re-

epithelialization, allow enzymes in the wound fluid to lyse necrotic tissue, and permit

inflammatory cells to phagocytize necrotic debris and bacteria. In addition to preserving a moist

environment for wound healing, dressings cover the wound and shield the area from external

contamination and infection; prevent soiling of clothing and prevent further irritation, friction or

shearing (Mendelsohn, Divino, Reis, & Kerstein, 2002). The relevant wound care products in the

context of radiation oncology include hydrocolloids, hydrogels, alginates and foam dressings.

Hydrocolloids are described as semi occlusive adhesive dressings composed of elastometric

adhesive and gelling agents; whereas hydrogel are glycerin or water based dressings that are

designed to hydrate a wound (Perry & Potter, p.1002). On the contrary, alginates are highly

absorbent nonwoven material that forms a gel when exposed to wound drainage; while foam

dressings have absorbent, non-adherent, polyurethane pad that is used to protect wounds and

maintain a moist healing environment (Perry & Potter, p. 1003).