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Wound Management Guide Update Sheet Fungating wounds Fungating malignant wounds are caused by tumour infiltration of the skin and its supporting blood and lymph vessels.The tumours may be locally advanced, metastatic or recurrent. The tumours are treated by single or combination anti-cancer treatments to prevent the fungation extending. Anaerobic bacteria are the source of the malodour and exudate that are commonly associated with these wounds. The incidence of fungating wounds is unknown.The loss and disruption to normal function of large areas of skin, the physical and psychological support required to meet patients’ needs is significant. Major Problems • Odour • Pain • Soreness • Irritation • Spontaneous bleeding • Haemorrhage • Pruritis • Infection Treatment On the whole treatment is palliative rather than curative. Common medical treatments are hormone manipulation, radiotherapy, and chemotherapy, a patient may receive one or more of these. The position of the wound may cause problems in dressing retention and selection.Many fungating wounds are associated with necrosis, slough and copious amounts of exudate. Dressing selection • Malodour Metronidazole gel or systemic metronidazole • Heavy Exudate Alginates & absorbent pads • Capillary Bleeding Careful dressing removal & soak off if needed Alginate dressing Adrenaline 1 in 1000 to stop bleeding • Necrosis and slough Alginate, amorphous hydrogel or hydrocolloid Wound Management Guide April 2002