Skin

Odour from wounds results from bacteria that reside in necrotic wound tissue. Odour associated with malignant fungating wounds can be upsetting and may contribute to the suffering of the patient and the family. Fungating wounds also present challenging management issues for health care providers.
 

Based on clinical practice and a review of current literature, here are some suggestions you may find helpful:
 

• Cleansing of the wound using saline via pressure from a syringe through a 19-gauge needle.[1]
• Debridement, which removes the necrotic tissue and bacteria.[1]
• Systemic (oral or IV) treatment or topical antibiotic preparations to destroy the bacteria responsible for the malodour. Anaerobic coverage such as metronidazole is commonly used, and topical treatment appears to be more successful.[2] For example, metronidazole IV solution, gel or powder may be applied to or sprinkled within the wound margin when a dressing is changed.
• Activated charcoal dressings may help to contain the odour. These include plain activated charcoal dressings or those combined with other dressing materials or impregnated with silver.[3]
• Dressings made of viscose or polyester impregnated with sodium chloride (such as Mesalt) produce a hypertonic effect on the lesion and may also help in odour management.[4]
• Optimization of the patient's personal hygiene through regular assistance with washing, skin care, and nightgown, brief and linen changes, as well as frequent laundering of soiled items.
• Optimization of the air exchange within the patient’s room or home by opening windows, or by using a fan or other ventilation system.
   

Commercial room deodorizers may make the odour worse or cause unpleasant associations with smell. Here are some options that have proven helpful for absorbing and/or masking odour in the patient’s room:
 

• kitty litter in a tray under the bed;
• bowls of activated charcoal;
• bowls of coffee beans or coffee grounds;
• cotton wool soaked in eucalyptus oil left open in a dish to evaporate (alternatives: five to six drops of vanilla oil, peppermint oil, citronella oil or lemon grass oil on a gauze swab, which is replenished three to four times a day, or a blend prepared by an aromatherapist of rosemary, grapefruit and peppermint essential oils in equal quantities and used in same way).
   

The presence of an odorous malignant wound can be a constant reminder of the cancer in a patient's body. It can be emotionally and spiritually distressing, and have a profound effect on the person's body image and quality of life.[5,6] It is important to allow the patient opportunities to share feelings, concerns, and fears; to provide information as needed; to discuss treatment options and involve the patient in decisions regarding his or her care; and to offer emotional support.
 

Other resources that you may find helpful include:
 

• The EPERC website, which has a fast facts sheet on malignant wounds and odour.
• The BC Cancer Agency website, which has a malignant wound care guideline.
   

References
 

1. O’Brien C. Malignant wounds: managing odour. Can Fam Physician. 2012;58(3):272-274.
 

2. Finlay IG, Bowszyc J, Ramlau C, Gwiezdzinski Z. The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers. J Pain Symptom Manage. 1996;11(3):158-162.
 

3. Draper C. The management of malodour and exudate in fungating wounds. Br J Nurs. 2005;14(11):S4-12.
 

4. de costa Santos CM, de Mattos Pimenta CA, Nobre MRC. Systematic review of topical treatments to control the odor of malignant fungating wounds. J Pain Symptom Manage, 2010; 39(6):1065-1076.
 

5. Lazelle-Ali C. Psychological and physical care of malodorous fungating wounds. Br J Nurs. 2007;16(15):S16-24.
 

6. West D. A palliative approach to the management of malodour from malignant fungating tumours. Int J Palliat Nurs. 2007;13(3):137-142.