Define a periwound?

The periwound (also peri-wound) is easy to define; the importance of the periwound is less easily explained.

The periwound is the tissue surrounding the wound itself. This tissue ideally provides a barrier to the wound, which protects it and confines the area of healing, ideally, so that the wound does not spread. Complications to this ideal function come because periwound tissue can be adversely affected in terms of texture, strength and integrity, and moistness or dryness.

Texture: Edema, or tissue swelling, is a continual potential problem because fluids or blood may accumulate in the periwound area surrounding the actual wound and cause a change in skin thickness and other texture changes. According to Continuing Education for Health Professionals (atrainceu.com), texture classifications might be "moist or dry, warm or cold, rough or smooth, thick or thin." This various changes in the periwound may indicate such things as reduction or hyper-action in the vascular blood supply or unbalanced or excessive pressure points or excessive lymph fluid.

Strength and Integrity: Periwound skin has not got the skin strength and integrity that mature scar and uninjured skin has, so extension of the wound to soft periwound tissue is highly possible as is independent injury to the periwound tissue. Since wounds surrounded by periwound tissue heal by secondary intention, without benefit of surgical closure, but with the gradual filling from the outer edges inward with connective tissue in the process of granulation, the strength of the new connective tissue and the integrity of the unity of the connective tissue may be compromised (atrainceu.com).

Moisture and Dryness: An initial wound, one surrounded by periwound tissue, releases fluid excudate that contains blood, water, proteases, and sweat, which all have the effect of breaking down skin, especially in the periwound area. The process of excessive moisture accumulation, called maceration, begins with the secondary intention healing process itself. Inflammation begins the process, triggers the process of healing but also triggers local edema (also oedema) because the release of histamine in the inflammation causes the release of plasma from local blood vessels. Initially a clear serum, the plasma, over time, if healing is retarded, takes on a different aspect since it then contains "leucocytes and other constituents such as albumin, macrophages and cellular debris" (Keith F. Cutting, nursingtimes.net). Ideal healing conditions keep the wound dry and control moisture while facilitating prompt healing through granulation of new connective tissues.

An indication of maceration that might pose a threat to periwound tissue is seen in the margin of the wound. If the periwound tissue has a swollen appearance and if the tissue beyond the periwound takes on an overly moist white coloration, then maceration has spread past the periwound barrier to the surrounding tissue indicating threat to the integrity of the periwound, due to its lesser tissue strength, and thus to the wound itself as an injury to the periwound increases the size and severity of the original wound. This discussion of the importance of the periwound helps to illustrate the definition of the periwound--i.e., the tissue the surrounds the wound--by illustrating its critical role and function as a barrier around and a protector to the original wound.