Malodorous Fungating Wounds/ Tumours - Paediatric Palliative Care
Description General and supportive measures Medicine treatment DESCRIPTION Non-healing fungating tumours that are often secondarily infected and smelly causing social ostracization and distress to child and family. Examples include exophytic retinoblastoma, infected bedsores, rhabdomyosarcoma, osteosarcoma or Kaposi’s sarcoma. GENERAL AND SUPPORTIVE MEASURES Supportive counselling. Set realistic
General and supportive measures
DESCRIPTION
Non-healing fungating tumours that are often secondarily infected and smelly causing social ostracization and distress to child and family. Examples include exophytic retinoblastoma, infected bedsores, rhabdomyosarcoma, osteosarcoma or Kaposi’s sarcoma.
GENERAL AND SUPPORTIVE MEASURES
- Supportive counselling.
- Set realistic goals: may not include wound healing but could include odour eradication.
- Regular wound cleaning and dressing changes.
- Adequate ventilation.
- Disguise smell by placing a bowl of vanilla essence in the room, burn incense or place kitty litter under the bed to absorb smell.
- Air-fresheners and perfumes do not work.
- Change bedding and clothing regularly.
MEDICINE TREATMENT
- Provide good procedural pain management (see: Pain Control) and use distraction/relaxation techniques before and during dressing changes.
- Irrigate wounds with warmed normal saline. Gentle debridement with gloved hand, not sharp instruments.
- Consider formal surgical debridement in a patient who still has some life expectancy.
- Topical metronidazole:
- Irrigation and cleaning of wound: 2 L of saline combined with 13 crushed metronidazole 400 mg tablets (2 L 0.9% sodium chloride: 5200 mg metronidazole).
- Metronidazole crushed tablet topical: Crushed metronidazole tablet 400 mg per 35 cm2 area twice daily to ameliorate malodour.
- Activated charcoal dressings also help to absorb odours.
- For wound pain consider using topical anaesthetics such as lidocaine/prilocaine.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.4 Dermatological Symptoms, 21.1.4.2 Malodorous Fungating Wounds/tumours