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Protecting the Periwound

Practical Techniques to Reduce Skin Breakdown

The periwound—the 4–6 cm of skin surrounding a wound—is essential for maintaining moisture balance, providing barrier protection, and ensuring dressing adhesion. Yet studies show that up to 80% of chronic wounds develop measurable periwound irritation or maceration at some point during treatment (Wounds International, 2022). When this skin breaks down, clinicians face higher infection risks, delayed epithelialization, dressing failure, and increased patient discomfort.

This guide outlines the causes of periwound damage, how to assess early warning signs, step-by-step protection techniques, and the latest best practices for safeguarding dressing edges.

Why the Periwound Matters in Every Dressing Change

Healthy periwound tissue directly influences the wound’s ability to progress through healing. Research published in Journal of Wound Care (2023) found that periwound compromise can delay healing by 50% or more due to moisture imbalance, dressing disruption, and increased inflammation.

When the periwound deteriorates, clinicians often see:

Exudate leakage
Dressing adherence issues
Increased pain
Maceration or denudement
Higher infection probability
Prolonged treatment time

Recent reviews continue reinforcing the same message: preserving skin integrity is a cornerstone of modern wound management.

1. Common Causes of Periwound Breakdown

Moisture and Exudate Overload (Maceration)

Maceration affects nearly 70% of chronic wounds (Wounds UK, 2022). Prolonged moisture contact causes the skin to appear pale, boggy, and fragile—conditions that increase the likelihood of breakdown and cause adhesives to fail.

A new 2025 review highlights that exudate overload significantly weakens adjacent periwound barrier function, adding measurable risk to both tissue integrity and dressing stability (Mervis et al., 2025).

Adhesive Trauma (MARSI)

Medical adhesive–related skin injury affects 15–20% of hospitalized patients and is more common in those with fragile or aging skin (MARSI Consensus Panel, 2020).

Infection and Inflammation Spread

Up to 60% of chronic wounds contain biofilm, which can extend into periwound tissue when unmanaged (EWMA, 2023). This presents as erythema, warmth, tenderness, or swelling.

Shear and Friction

Movement, repositioning, and rolling dressing edges create shear forces that compromise the skin. High-mobility anatomical sites are particularly at risk.

Chemical Irritation

Urine, stool, harsh cleansers, or incompatible topical agents can cause dermatitis and weaken superficial tissue.

2. How to Assess Early Warning Signs

Periwound assessment should occur at every dressing change. Watch closely for:

Color changes (persistent redness, blanching, pallor)
Texture changes (boggy, overly dry, flaky, or waterlogged skin)
Pain or tenderness (especially new onset)
Adhesive imprints (stripping, skin tears, shiny patches)
Edema or firmness
Heat or odor indicating early infection
Sudden increases in moisture around the dressing edge

A 2024 integrative review in Wound Practice & Research emphasizes that gentle cleansing with mild, non-alkaline, pH-balanced products supports skin resilience and reduces periwound irritation (O’Brien et al., 2024).

3. Step-by-Step Periwound Protection Techniques

Step 1: Use Gentle, Non-Cytotoxic Cleansers

Use sterile saline or a mild, pH-balanced cleanser. Avoid scrubbing. Pat dry.

Step 2: Manage Exudate Proactively

Exudate is one of the strongest predictors of periwound breakdown. Proper dressing selection and frequent reassessment are essential.

Recent 2025 evidence notes that silicone foam dressings can help maintain moisture balance and reduce periwound maceration in wounds with moderate-to-heavy exudate (Mervis et al., 2025). Maintaining an airtight seal prevents pooling toward the periwound.

Step 3: Apply Barrier Film or Protectant Layer

Barrier films reduce MARSI incidence by nearly 27% (Journal of Wound Care, 2023). Apply uniformly and allow it to dry before the dressing is placed.

Step 4: Add Protective Cushioning if Needed

Use silicone interfaces or foam layers in high-friction zones to minimize shear.

Step 5: Reduce Adhesive Trauma

Silicone adhesives significantly reduce stripping compared to acrylic. Remove dressings slowly, supporting the skin as you lift.

Step 6: Fit Dressings Correctly for a Secure Seal

A properly sized dressing or NPWT drape protects against leaks, shear, and moisture exposure.

4. Best Practices for Protecting Dressing Edges

Dressing edges are one of the most common sources of periwound failure.

To protect this vulnerable interface:

Smooth all edges to prevent rolling
Avoid stretching adhesives during placement
Add supplemental silicone tape for high-motion areas
Trim any lifted sections early
Monitor seal integrity frequently—especially with NPWT

Rotate adhesive placement when possible to reduce repeated trauma