Page 31 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

31
WOUND CARE

on the wound is taken into account during the initial radiotherapy planning stage.

(Hollinworth & Mann, 2010, p. 63)

A relevant systematic review is from the Cochrane library by Adderley and Smith (2011)

who reviewed the evidence from two trials (n=63) regarding the effects of topical agents and

dressings on quality of life and symptoms that affect quality of life in people with fungating

wounds. Based on the fact that “the emphasis of care of patients with fungating wounds is the

palliation of distressing symptoms, such as copious exudate, malodor and pain” [the review

acknowledged that] “it is difficult to carry out trials in palliative care settings, due to the ethical

challenges of recruiting patients who are approaching the end-stage of their lives” (p. 10). The

systematic review did not include studies where wound dressings were left in place during

radiation treatments. However, these authors’ conclusion that there is insufficient evidence to

direct practice with regard to improving quality of life or managing other wound symptoms

associated with fungating wounds further makes a case for the importance of my study.

Dressings and radiotherapy. The choice of dressing depends on the amount of exudate

while facilitating a moist wound environment to minimize the risk of pain and bleeding, during

dressing change. While a plethora of antimicrobial products are accessible, dressings with silver

are one of the most popular selections among topical agents (Sibbald, Woo, & Ayello, 2008). It

must be noted that as an efficient antimicrobial agent silver needs to have moisture for

ionization; however dressings with silver are not suitable for non-healing wounds. Sibbald,

Woo, and Ayello suggest, “Clinicians need to be aware of the mechanism of moisture balance in

the dressing to match appropriate characteristics with the clinical features of the wound bed” (p.

32). Hydrogels and hydrocolloids are useful for low exudating wounds and help with the

preservation of the surrounding skin; whereas dressing such as foams, alginates and hydro fibers