Management of Macerated Wounds
For macerated wounds, use absorbent dressings that control excess moisture while maintaining a moist wound environment, such as foam dressings or alginates, and avoid occlusive dressings that can worsen maceration. 1
Dressing Selection for Macerated Wounds
- Select dressings primarily based on exudate control, comfort, and cost for macerated wounds 1
- For wounds with heavy exudate causing maceration, use absorbent dressings that draw moisture away from the wound and periwound skin 1
- Foam dressings are excellent for moderate to heavy exudate and can help manage maceration 2, 3
- Alginates are highly absorbent and appropriate for heavily exuding wounds with maceration 3, 4
- Avoid occlusive dressings in macerated wounds as they promote a moist wound environment that can lead to further skin maceration 1
Wound Care Protocol for Macerated Wounds
- Clean the macerated wound regularly with clean water or saline to remove debris from the wound surface 1
- Debride the macerated wound when possible to remove slough and necrotic tissue that may impede healing 1
- Monitor the wound daily for signs of infection, which can be exacerbated by maceration 1
- Change dressings frequently enough to prevent exudate buildup that contributes to maceration 4, 5
- Protect periwound skin with skin barriers or protectants to prevent further maceration 6
Advanced Considerations
- Consider negative pressure wound therapy (NPWT) for heavily exuding wounds that have led to maceration, especially after revascularization or minor amputation 1
- For diabetic foot ulcers with maceration, ensure proper pressure offloading in addition to appropriate moisture management 1
- Evaluate the need for more frequent dressing changes in heavily exuding wounds to prevent maceration 3, 7
Common Pitfalls and Caveats
- Failing to address the underlying cause of excess exudate (e.g., infection, edema) will result in continued maceration despite appropriate dressing selection 1, 6
- Using dressings with inadequate absorption capacity can worsen maceration and delay healing 4, 7
- Changing from a moist wound healing approach to a dry approach is not recommended, even with maceration; instead, focus on balancing moisture levels 5
- Antimicrobial dressings should not be used with the goal of improving wound healing or preventing secondary infection in macerated wounds unless there are signs of clinical infection 1