GuidelinesEML (Adult Hospital STG)
Malodorous Fungating Wounds/Tumours
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 the patient and family. Examples include exophytic retinoblastoma, infected bedsores, rhabdomyosarcoma, osteosarcoma or Kaposi’s sarcoma. GENERAL AND SUPPORTIVE MEASURES Supportive counselling. Set real
General and supportive measures
DESCRIPTION
- Non-healing fungating tumours that are often secondarily infected and smelly causing social ostracization and distress to the patient 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. Debride gently with gloved hand not sharp instruments.
- Consider formal surgical debridement in patient where end-of-life is not imminent.
- Topical metronidazole:
- Irrigation and cleaning of wound: 2 L saline combined with 13 crushed metronidazole 400 mg tablets (2 L 0.9% sodium chloride: 5200 mg metronidazole). Discard any remaining solution after each treatment, utilising appropriate medical waste management principles.
- Metronidazole tablet topical: Metronidazole tablet 400 mg per 35 cm2 area twice daily to ameliorate malodor.
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- Activated charcoal dressings also help to absorb odours.
- For wound pain consider using topical anaesthetics such as lidocaine/prilocaine.
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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_07 November 2024
Chapter 24: Medicines used in Palliative Care_24.6 Malodorous Fungating Wounds/Tumours