Comfort or Closure: A New Perspective on the Treatment of Fungating Breast Wounds

Introduction. Wound care practitioners have limited access to the amount of research regarding the management of fungating breast wounds (FBW). Fungating breast wounds are difficult wounds to manage and not well researched, as they only account for 2-5% of new breast cancer diagnoses per year (Rupert & Fehl, 2020). Objective. The author shares the experience of treating 3 patients with fungating breast wounds utilizing the same protocol. The results of treating these 3 patients are significant, leading one patient to 100% wound closure. The author now treats FBW’s with a goal of wound closure verses comfort care and encourages other wound care practitioners to consider the same approach.Methods. A literature search was completed to find limited data on wound management of FBW and the consensus was that treatment of fungating breast wounds is typically palliative (Adderley et al, 2014). Results. Three women ages (59-89) with a history of breast cancer and a fungating breast wound presented to the outpatient wound clinic with complaints of foul odor, copious amounts of wound drainage, and frequent dressing changes. Hypochlorous acid* was used not only as a wound cleanser, but as a primary dressing. The average time that it took to decrease the frequency of dressing changes and reduce the odor of the wound was 3-5 days regardless of wound size. All wounds were sharp debrided within a 3 week timeframe. Post sharp debridement 2 patients utilized topical antibiotic lipid gel* formulated based on PCR and NGS microbial diagnostics results*. Please note one patient was not yet using the antibiotic lipid gel because their final NGS (level 2) results were still pending at the time this abstract was written.Conclusions. In the author’s clinical experience the protocol outlined above was very effective in meeting all goals of wound therapy for the treatment of FBW. In theory, the protocol may be used to treat all fungating wounds despite anatomical location or malignant pathology. Copy and Paste link below to view wound photographs: file:///C:/Users/amandkm1/Desktop/Final%20Comfort%20vs%20Closure%20.htm