12 OSTOMY WOUND MANAGEMENT SEPTEMBER 2011 www.o-wm.com

SKIN MATTERS

Skin Matters is made possible through the support of Medline Industries, Inc., Mundelein, IL. The opinions and statements of the clinicians providing material for Skin Matters are specific to the respective authors and are not necessarily those of Medline Industries, Inc., OWM, or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.

Skin Damage Management: Trends in Technology with CyanoacrylatesDebashish Chakravarthy, PhD, FAPWCA; and Margaret Falconio-West, BSN, RN, APN/CNS, CWOCN

Skin Matters will run as an occasional column that addresses the multidisciplinary challenges of maintaining skin integrity.

Skin barrier function, a major concern in all healthcare settings, can be compromised by many factors. In the el-

derly, skin tear incidence (often resulting from shear, friction, or blunt trauma),1-3 ranges from 0.9 to 2.7 per person per year1 in the long-term care population and 14% to 24% in acute care.2 Friction can occur when skin rubs against itself, bed linens, or absorbent products; wet skin is more likely to be damaged than dry skin.4 Patients with mixed urinary and fecal incontinence or frequent fecal incontinence have been shown to be at high risk for skin breakdown.5,6 Patients with ostomies often experience compromised skin barrier func-tion in the peristomal area.7-9 Some type of peristomal skin problem has been reported in up to 55% of individuals with an ostomy.10,11 Mechanical and chemical factors are implicat-ed in these skin complications because leakage of urine and feces can be caustic to the skin, leading to peristomal skin irritation.8,11 Add adhesive tape trauma, including tension blisters and skin tears,12-15 to these factors and the challenges become increasingly evident.

One of the ways to manage at-risk or damaged skin is by applying polymer-based, film-forming materials, such as topical skin protectants, that are barriers to moisture,

friction, and other environmental elements.16,17 Such non-spreading, film-forming polymer barriers may be less messy than ointment barriers. These polymer-based, film-forming barriers may contain volatile solvents that many clinicians and patients do not want to use.16 Liquid Skin Protectant (Medline Industries, Inc., Mundelein, IL),18 avoids the use of solvents altogether. These products bond to the external layer of the skin at a molecular level and cannot be peeled off easily after application. They will slough off as the top layer of the skin is shed naturally, within 3 days during nor-mal skin turnover.19

An increasing body of evidence supports cyanoacrylate safety in contact with human skin.19-25 Clinical experience with cyanoacrylate skin protectants (or any medical grade cyanoacrylate) shows they are easily applied to skin; the monomer liquid requires approximately 1 minute to “set” and forms a tough, resilient, flexible barrier that cannot be easily washed off. The following scenarios represent clini-cal cases where a cyanoacrylate skin protectant product was used successfully :

• Skintearmanagementintheelderly20

(see Figure 1);

Figure 1. Examples of skin tears in the elderly: A) skin tear, Payne-Martin Category II; B) 7 days after cyanoacrylate application.

A B

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14 OSTOMY WOUND MANAGEMENT SEPTEMBER 2011 www.o-wm.com

SKIN MATTERS

• Heelulcerpreventioninthelderly21;• Periostomy skin management in adults and neo-

nates22-24 (see Figures 2 and 3); • PreventionofmacerationinNPWT25;• Managementofheelfissures.19

Cyanoacrylates as skin protectants are new in the field of skin care. Further research is needed to ex-plore the limits of use of cyanoacrylates under vary-ing clinical conditions. n

References1. Ratliff CR, Fletcher KR. Skin tears: a review of the evidence

to support prevention and treatment. Ostomy Wound Manage. 2007;53(3):32–40.

2. McTigue T, D’Andrea S, Doyle-Munoz J, Forrester DA. Effi-cacy of a skin tear education program: improving the knowl-edge of nurses practicing in acute care settings. J WOCN. 2009;36(5):486–492.

3. LeBlanc K, Baranoski S. Prevention and man-agement of skin tears. Adv Skin Wound Care. 2009;22(7):325–332.

4. Fiers S, Thayer D. Management of intractable in-continence. In: Doughty D (ed). Urinary and Fecal Incontinence: Nursing Management, 2nd ed. St. Louis, MO: Mosby;2000:183–207.

5. Nix DH. Validity and reliability of the Perine-al Assessment Tool. Ostomy Wound Manage. 2002;48(2):43–49.

6. Andersen PH, Bucher AP, Saeed I, Lee PC, Davis JA, Maibach HI. Faecal enzymes: in vivo human skin irritation. Contact Dermatitis. 1994;30(3):152–158.

7. Rolstad B, Erwin-Toth P. Peristomal skin compli-cations: prevention and management. Ostomy Wound Manage. 2004;50(9):68–77.

8. Ratliff CR, Scarano KA, Donovan AM, Colwell JC. Descriptive study of peristomal complications. J WOCN. 2005;32(1):33–37.

9. Herlufsen P, Olsen AG, Carlsen B, Nybaek H, Karlsmark T, Laursen TN, Jemec GB. Study of peristomal skin disorders in patients with perma-nent stomas. Br J Nurs. 2006;15(16):854–862.

10. Colwell JC, Goldberg M, Carmel J. The state of the standard diversion. J WOCN. 2001;28(1):6-17.

11. Ratliff CR, Donovan AM. Frequency of peristomal com-plications. Ostomy Wound Manage. 2001;47(8):26–29.

12. Cutting KF. Impact of adhesive surgical tape and wound dressings on the skin, with reference to skin stripping. J Wound Care. 2008;17(4):157–162.

13. Collier M, Hollinworth H. Pain and tissue trauma during dressing change. Nurs Stand. 2000;14(40):71–73.

14. Lund CH, Nonato LB, Kuller JM, Franck LS, Cullander C, Durand DJ. Disruption of barrier function in neonatal skin associated with adhesive removal. J Pediatr. 1997;131(3):367–372.

15. Jester R, Russell L, Fell S, Williams S, Prest C. A one-hospital study of the effect of wound dressings and other related factors on skin blistering following total hip and knee arthroplasty. J Orthop Nurs. 2000;4(2):71–77.

16. Shannon RJ, Chakravarthy D. Effect of a water-based, no-sting, pro-tective barrier formulation and a solvent containing similar formula-tion on skin protection from medical adhesive trauma. Int Wound J. 2009;6(1):82–88.

17. Gallagher SM. Morbid obesity: a chronic disease with an impact on wounds and related problems. Ostomy Wound Manage. 1997;43(5):18–27.

18. Coover HW, McIntire JM. Cyanoacrylate adhesives. In: Skeist I (ed). Handbook of Adhesives, 2nd ed. New York, NY: Van Nostrand, Reinhold Co;1977:569–580.

19. Vlahovic TC, Hinton EA, Chakravarthy D, Fleck CA. A review of cyano-

acrylate liquid skin protectant and its efficacy on pedal fissures. J Am Coll Cert Wound Spec. 2010;2:79–85.

20. Milne CT, Valk D, Mamrosh M. Evaluation of a cyanoacrylate protectant to manage skin tears in the acute care population. Poster presentation at the Symposium on Advanced Wound Care. Orlando, FL. April 2010.

21. Milne CT. The role of cyanoacrylates in the prevention of superficial tis-sue injury. Poster presentation at the Symposium on Advanced Wound Care. San Diego, CA. April 2008.

22. Milne CT, Saucier D, Trevellini C, Smith J. Evaluation of a cyanoacrylate protectant to manage peristomal skin irritation under ostomy skin barri-er wafers. Poster presentation at the Clinical Symposium on Advanced Wound Care. Orlando, FL. September 2010.

23. Ratliff CR, Dixon M. What to do if an ostomy pouch won’t stick? Poster presentation at the Wound Ostomy Continence Nurses Society. New Or-leans, LA. June 2011,

24. Neiswender L. Cyanoacrylates in neonatal and infant peristomal skin dam-age. Poster presentation at the Symposium on Advanced Wound Care. Dallas, TX. April 2011.

25. Van Gils CC, Anderson N. The use of cyanoacrylate skin protectant to treat periwound maceration in combination with negative pressure wound therapy in the treatment of neuropathic foot ulcers. Poster presentation at the Symposium on Advanced Wound Care. Dallas, TX. April 2011.

Figure 2. Neonatal peristomal complication. Note the de-crease in peristomal erythema and denudation in approxi-mately 1 month.

Figure 3. Newly created stoma in a 77-year-old woman. Note the im-provement of the peristomal skin in 7 days.

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