Why does my wound smell

Wounds can range from cuts, scrapes and bruises to deep lacerations of the skin and ulcers. No matter how simple or severe a wound is, the goal is always to have the wound heal as quickly as possible and without complication.

While wounds vary in the time they take to heal, be cautious of the following signs that your wound is not healing properly, and medical attention may be needed:

1)    Increasing Pain. As the wound heals, the amount of pain you experience should decrease, not increase.

2)    Discharge. If the discharge is thick and yellow, this typically indicates an infection has occurred. Gently clean the wound with warm soapy water, and seek medical attention. Never scrub a wound.

3)    Foul Odor. The presence of odor in a wound might be a sign of decaying or dead tissue. Do not use scented creams or other scented toiletries to try to hide the smell, because this could worsen the condition of the wound.

4)    Redness or Swelling. Slight swelling or redness around a wound is normal at the beginning of the healing cycle, but it should begin to subside after a few days. If redness or swelling is still present or worsens with time, the wound is likely not healing as it should.

5)    Thirty days without Improvement. While not all wounds will have healed at the 30-day mark, they should be well on their way. If a wound has not improved in this timeframe, advanced medical care is needed.

If you are experiencing any of these symptoms, you should seek care from an experienced wound healing center trained in treating complex wounds. Without proper care, infection of a wound can be dangerous and lead to loss of a limb, illness or even death.

There are many reasons why a wound might not heal correctly. However, certain conditions such as diabetes, heart disease, high cholesterol, lymphedema and venous insufficiency can increase the chances you will develop a non-healing wound. So, can smoking. Maintaining a healthy lifestyle with good nutrition and regular exercise can help ensure that your body heals properly.

Edward Forster, MD, is board-certified in Family Medicine and is a faculty member at the TMH Family Medicine Residency Program.

Foul-smelling non-healing wounds are common in patients nearing the end-of-life, whether from pressure ulcers, vascular disease, or tumors. Strong wound odors can lead to social and physical isolation, altered patient body image and self-worth, and can challenge caregivers. Most wound odors are thought to be due the metabolic processes of anaerobic bacteria, which colonize devitalized tissue. Deeper infection (e.g., cellulites, necrotizing infections) are not necessary for significant odor generation. While it should be addressed, treatment of the underlying cause of the wound is often limited in patients with advanced illnesses. In all circumstances, attempts at ameliorating wound odor are important – whether by treating the cause of the odor or hiding the odor.

Addressing the cause of the odor

Remove the wound bed contaminants (e.g., debride the wound of necrotic tissue).

Control infection. There are several approaches, all aimed at controlling anaerobic growth.

- Topical metronidazole is available as a commercially produced gel. Metronidazole gel is applied directly to the wound once or twice daily. Studies have shown decreases in wound odor in 2-3 days, and application is usually continued for up to 2 weeks. Courses can be repeated if needed. In one study, 63% of patients had complete eradication of odor after a course of metronidazole gel, with the remainder reporting improvements. Metronidazole tablets can also be broken and the powder contents sprinkled into the wound. Applying dressings soaked in a mixture of normal saline and metronidazole has also been reported as helpful for controlling odor.

- Systemic metronidazole can be used if there is evidence of deep tissue infection causing foul odor. 500 mg 3 or 4 times daily IV or orally is used, instead of or in addition to topical metronidazole. Systemic side effects such as nausea and diarrhea can occur.

- Topical silver sulfadiazine has been shown to be helpful in controlling odors of superficial wounds.

- Cadexomer iodine is an antimicrobial agent containing slow-release iodine and has been shown to decrease bacterial counts and odor from venous ulcers. Ointment, powder, and impregnated bandage forms are available. Cadexomer iodine has the added benefit of absorbing exudate and can be particularly helpful when exudate absorption and odor control are both needed. It can cause a burning sensation upon application.

Hiding the odor

- Adsorbents. Charcoal adsorbs aromatic molecules. A basket of charcoal (briquettes) can be placed discreetly in a patient's room. Various commercially available charcoal dressings are also available, although expensive. These dressings are applied over the primary dressing and may be re-used as long as they remain dry. Baking soda can be applied between dressing layers to help absorb odor. Cat litter can also be used similarly to charcoal briquettes.

Adapted from Patel B and Cox-Hayley D. Palliative Care Network of Wisconsin. Fast facts and concepts #218. Managing wound odor. Internet. Accessed on January 25, 2016. Available at http://www.mypcnow.org/#!blank/jigxu

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Wound Drainage

Wound drainage can be described according to the following four characteristics/descriptors:

• Type- Drainage can be described as serous, sanguinous, both serous and sanguinous (serosanguinous), purulent or seropurulent. Serous or sanguinous drainage (or a combination of the two) is normal, while seropurulent or purulent drainage is often a sign of infection.
• Color- Normal wound drainage is clear or pale yellow in color; red or dark brown drainage signifies old or new bleeding. Wounds that have a distinctive blue-green drainage present often have Pseudomonas
• Consistency- wound drainage consistency may be thin and watery or thick. Thick drainage hints at the possibility of infection.
• Amount- Most wounds will have some drainage present. Wounds that have no drainage at all are often desiccated or necrotic. Minimal to moderate drainage should be considered normal, providing the amount of drainage is not disproportionate to the amount of necrotic tissue present, which could signify that infection is present. A copious amount of drainage should raise a concern about the presence of infection.

When assessing drainage, it is important to consider the type of dressing that is being used, as the dressing may have absorbed a large amount of fluid; in addition, it is important to ask when the dressing was last changed.

Wound Odor

Because wound odor can be subjective, it is important not to attach too much importance to its presence; on the other hand, a strong or foul odor may signify infection and should be taken into consideration along with other factors, such as amount and type of drainage.

Wounds should be assessed for odor after debridement (if necessary) and wound irrigation. Keep in mind that odor might not be from the wound itself, but may instead be from an old dressing. Unpleasant odors may also be due to body odor or incontinence.

Certain microorganisms have distinct odors. Proteus is reminiscent of ammonia, while Pseudomonas is often described as “sickly sweet”. Once you have smelled these odors, they are easy to recognize the next time you encounter them.

Wound Care Certification Online

If you enjoy learning about wound care management, or your job requires you to manage clients with wounds, you might consider becoming a certified wound care professional. The online wound care certification education offered by Wound Educators allows you to study in the comfort of your own home, at your own pace. Our wound care certification for nurses and healthcare professionals will allow you to advance your career on your own time! 

Sources

Fleck, C. (2006). Palliative Dilemmas: Wound Odor. Wound Care Canada, 4(3). http://cawc.net/images/uploads/wcc/4-3-fleck.pdf

Meyers, B (2008). Wound Management: Principles and Practice. 2nd edition. Pearson Prentice Hall. Upper Saddle River, New Jersey. pg. 48-50.