Use of a superabsorbent dressing in the management of exudate in hard-to-heal wounds

Hydration response technology dressings for low to excessively exuding wounds: a systematic review

OBJECTIVE

The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate.

METHOD

A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included.

RESULTS

The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy).

CONCLUSION

The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.

A robotic venous leg ulcer system reveals the benefits of negative pressure wound therapy in effective fluid handling

We applied a market-leading, single-use negative pressure wound therapy device to a robotic venous leg ulcer system and compared its fluid handling performance with that of standard of care, superabsorbent and foam dressings and compression therapy. For each tested product, we determined a metrics of retained, residual, evaporated and (potential) leaked fluid shares, for three exudate flow regimes representing different possible clinically relevant scenarios. The single-use negative pressure wound therapy system under investigation emerged as the leading treatment option in the aspects of adequate fluid handling and consistent delivery of therapeutic-level wound-bed pressures. The superabsorbent dressing performed reasonably in fluid handling (resulting in some pooling but no leakage), however, it quickly caused excessive wound-bed pressures due to swelling, after less than a day of simulated use. The foam dressing exhibited the poorest fluid handling performance, that is, pooling in the wound-bed as well as occasional leakage, indicating potential inflammation and peri-wound skin maceration risks under real-world clinical use conditions. These laboratory findings highlight the importance of advanced robotic technology as contemporary means to simulate patient and wound behaviours and inform selection of wound care technologies and products, in ways that are impossible to achieve if relying solely on clinical trials and experience.

Evaluation of a chitosan dressing in the management of hard-to-heal wounds

It is vital that as tissue viability teams, we are constantly striving to improve service delivery, healing rates and positive patient outcomes. In 2021 the author's team were introduced to a unique bioactive microfibre gelling (BMG) dressing, MaxioCel®, which uses chitosan to maintain a cohesive structure to increase fluid handling, antimicrobial and wound-healing properties.

METHOD

Following Isle of Wight NHS Foundation Trust guidelines and with patient consent, 11 patients with chronic wounds of various aetiologies and wound durations were enrolled in a multicentre, clinical 4-week evaluation.

RESULTS

Over a 4-week evaluation period, all patients showed a significant improvement in wound healing parameters including average tissue type, condition of periwound skin, patient comfort, exudate levels. The assessments demonstrated a significant decrease in necrotic and sloughy tissue (from >75% at the start of treatment), replaced with healthy granulation and epithelial tissue (>80% by week 4). Significant reduction in pain score was also reported in all patients, with average pain score at the start of the evaluation reducing from 5.8 ± 2.7 to a score of 2.5 ± 1.9 within 3 weeks.

CONCLUSION

The complicated wounds seen in this study were previously non-healing and MaxioCel, with BMG technology, demonstrated both significant clinical improvement and a positive impact on patient quality of life within just 4 weeks, resulting in its addition to the team's woundcare formulary.

Fluid handling performance of wound dressings tested in a robotic venous leg ulcer system under compression therapy

We designed, developed, built, and utilised a robotic system of a leg with two venous leg ulcers for testing the fluid handling performance of three wound dressing types. The results showed that a foam-based dressing technology is inferior in fluid handling performance when applied to an exuding venous leg ulcer, such that the dressing needs to manage the exudate in a vertical configuration with respect to the ground, that is, so that gravity pulls the exudate to concentrate in a small region at the bottom of the dressing. Moreover, wound dressings containing superabsorbent polymers do not necessarily function equally in fluid handling for venous leg ulcer scenarios, as the extreme requirements from the dressing (to manage the viscous fluid of a vertical and typically highly-exuding wound) appear to distinguish between optimal and suboptimal product performances despite that the tested products contain a superabsorbent, theoretically lumping them together to belong to a so-called 'superabsorbent dressing category'. In other words, it is a false premise to categorise products from different manufacturers into families based on material contents, and then assume that their laboratory or clinical performance is equal, so that from this point they can be judged solely on the basis of price.