Malodorous wounds (wounds that have a bad odour) cause concern to individuals with wounds, their families and friends, and to health care providers. What is the cause and significance of malodour wounds? When do you need to urgently seek medical attention? This blog will explore the affect odour has on persons with wounds and care givers, how to assess odour in a wound, and what can be done.

“Common clinical manifestations associated with wounds include pain, itch, odor, bleeding, and production of exudate; however, malodor is recognized as one of most distressful aspects of some wounds”. Gethin G, Grocott P, Probst S, Clarke E. Current practice in the management of wound odour: an international survey. Int J Nurs Stud. 2014 Jun;51(6):865-74. If you not only have a wound which has been slow to heal, but has begun to smell badly, you are likely concerned about what this means. Feeling that you want to isolate away from others, rush to the health care providers, or mask the smell with something more pleasant are all normal reactions to wound odour. Left unattended persons with malodorous wounds can become withdrawn, depressed, lose their appetite, and sleep poorly.  “Malodor from a wound has been shown to produce psychological discomfort and embarrassment among patients and clinicians caring for these patients.” Lazelle-Ali C Psychological and physical care of malodorous fungating wounds. Br J Nurs. 2007 Aug 9-Sep 12; 16(15):S16-24.  Wound odour can be slightly unpleasant to signaling that something is seriously wrong and the individual must be seen urgently by a health care professional.

What does odour in a wound mean?

Odour can indicate a number of things. To figure out the significance of odour in the wound, first begin with an assessment:

• Change the dressing– first carefully dispose of the dressing in a sealed bag, cleanse the wound, then smell the wound again. If there is little or no odour in the wound it is unlikely there is a serious problem, rather your dressing has trapped the odour and by changing the dressing you have removed the smell. But this early sign may be a warning that bacteria is forming in the wound or the wound is deteriorating. Let your health care provider know that you have noticed a new smell in the wound.
• If the odour remains after you have cleansed the wound, look further:
  • Do you feel unwell e.g.- chilly, fever, new fatigue, pain, unexplained changes in your blood glucose levels?
  • Has there been an increase in drainage?
  • If the wound is on your foot or lower leg, look at both your limbs to asses the difference in colour, temperature, and sensation between both.
  • Is there a change in the colour of the wound bed (e.g. has it become dark red, yellow, brown, black? Does it bleed easily?)
  • Check the skin around the wound- is it red, hot, swollen, painful?
  • Did the wound begin without a known cause?
  • Do you have a black hard and dry spot (like a scab, but called eschar) or moist (like a scab, but is eschar, with drainage under it) and there is an odour?

These may be signs of infection or damage to the tissue possibly caused by circulation problems, or other disease processes. It is important to contact your health care provider as soon as possible. If you have fever (temperature greater than 38.5 °Celsius or 101.3 °Fahrenheit) and feel unwell, seek medical attention immediately.

What can be done?

Your health care provider will assess you, the cause of the wound, the cause of the odour, and determine treatment options. Further test may be required, such as blood work, blood flow studies, biopsy, swabs, X ray or imaging scans etc.

If infection is present you may be prescribed antibiotic(s) and special dressings and treatment. There are dressings that are specifically designed to be antimicrobial/ antibacterial. Ingredients in these dressings may include silver, cadexomer iodine, gentian violet, methylene blue, medical honey, etc.  Dressings that provide continuous diffusion of oxygen to the wound will increased oxygen levels thus aiding the natural capacity to fight infection.  Oxygen stimulates the body’s ability to kill bacteria and to clean the wound of dead tissue and drainage.  Some dressings/ treatments are designed to remove drainage as well as stimulate healing and help fight infection.

If the odour is caused by death of tissue as the result of clogged blood vessels there are procedure that can be done to improve the blood flow and your health care profession can discuss this with you.  Cancerous wounds may also cause odour. Treatment of the cancer, odour reducing dressings and medications, keeping the area as clean as possible, changing and disposing of dressings can be helpful. Talk with your health care provider.

Smoking cessation is very important in reducing the risk of infection and in improving blood flow.  Adequate nutrition and disease management (e.g. diabetes) are essential for wound healing.

For all wounds It is very important to wash your hands, cleanse the wound and the skin around the wound very well, and safely dispose of dressings. Be sure to cleanse the intact skin surround the wound with soap and water.  Taking pictures of your wound may be helpful is assessing the progression.

Please remember odour is a symptom. “The malodor produced by wounds may lower health-related quality of life and produce psychological discomfort and social isolation.”Akhmetova A, Saliev T, Allan IU, Illsley MJ, Nurgozhin T, Mikhalovsky S. A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds. J Wound Ostomy Continence Nurs. 2016;43(6):598-609. There are procedures and treatments that will treat the cause of the odour. Assessment of the cause of the wound and cause of the odour needs to be done by a health care professional.  You are not alone and something can be done.

For detailed clinical information about topical odour-controlling treatment options for chronic wounds:
Akhmetova, A., Saliev, T., Allan, I. U., Illsley, M. J., Nurgozhin, T., & Mikhalovsky, S. (2016). A Comprehensive Review of Topical Odor-Controlling Treatment Options for Chronic Wounds. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 43(6), 598–609.

For an easy to understand discussion on how the sense of smell occurs:
How do we smell? (Rose Eveleth | TED-Ed)