Optimising topical wound care outcomes for fungating breast wounds - A systematic review of current institutional practice

Background: Fungating breast wounds cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.

Aims: This review aims to evaluate current evidence regarding various wound care methodologies for fungating breast tumours on their effectiveness at targeting established fungating wound-specific complications: malodour, pain, exudates, bleeding, wound characteristics, emotional and quality-of-life outcomes.

Data sources: We conducted a systematic review of four databases (PubMed, Embase, Scopus, The Cochrane Library) and hand-search of bibliographies of relevant reviews, in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines.

Results: The search strategy yielded 1319 articles, of which, 8 studies involving 188 patients were included in the review. Studies examined the effects of wound care products such as but not limited to calcium alginate, hydrocellular dressing and metronidazole and looked at outcomes such as bleeding (6), malodour (5), exudates (3), pain (4), wound size/length (2), emotion (3) and quality-of-life (1).

Conclusion: There is a wide variety of options for wound care which is able to target the various complications of fungating breast wounds. Certain wound care methods are effective in alleviating patient morbidity. However, key barriers toward establishing evidenced-based management of patients with fungating breast wounds were identified in the paucity of studies, lack of standardisation of interventions and objective outcome measures.