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The right dressing for moderate to highly exudating wounds

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While exudate is a natural and essential part of healing, excessive production in the wrong location or of inappropriate composition can hinder healing. In naturally progressing wound healing, exudate plays a vital role by maintaining a moist environment, aiding immune mediators and growth factors' diffusion, facilitating tissue-repairing cell migration, providing nutrients for metabolism, and aiding in dead tissue separation. Moist wounds heal two to three times faster than dry ones, underscoring exudate's significance.1

Addressing the root cause alongside suitable dressing selection is imperative. Managing exudate involves treating the cause and optimising the wound bed. Dressings contribute by balancing moisture, fostering healing while averting maceration. For highly exuding wounds, greater nursing involvement, more dressings, and time are required.2

When selecting a suitable dressing, WUWHS recommends that the dressing selection should be individualised, considering the management approach that is required. Factors that can guide decision-making include dressings' ability to absorb and evaporate fluid.1

Certain dressings, like cotton, viscose, polyester, and basic foam variants, absorb and retain fluids within their structure. Under pressure, fluid can escape. Other materials like hydrocolloids, alginates, and superabsorbents form gels when fluid is absorbed, keeping the liquid even when compressed. Cohesive gel-forming materials minimise fluid spread and can capture exudate components and microorganisms.1

Some dressings allow moisture evaporation and are measured by their moisture vapour transmission rate (MVTR). High MVTR dressings can manage exudate with less bulk, but potential drawbacks should be considered such as matrix metalloproteinases (MMPs), which contribute to all phases of the healing process and may be trapped under dressings with a very high MVTR.1

Superabsorbent polymer (SAP) dressings contain highly permeable dressing materials, which inhibit MMP activity in chronic wounds through multiple mechanisms (eg direct binding, competition for divalent ions), thus, reducing wound inhibitor factors. SAP dressings are recommended by the WUWHS for the management of exuding wounds.  These dressings maintain their fluid-retention capacity under compression and provide high MVTR and cushioning. Some SAP dressings are available with a silicone contact layer.1,2

Cost-effectiveness of superabsorbent dressings

Panca et al conducted a study to estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose (CMC) dressing in the treatment of highly exuding chronic venous leg ulcers.3

The study included 439 patients with highly exuding chronic (≥3months) venous leg ulcers. Patients were treated with one of the five dressings including Cutimed® Sorbion®  and the team estimated the costs and outcomes of patient management over a period of six months and the relative cost-effectiveness of using each dressing.3

Between 39% and 56% of venous leg ulcers were healed by month six. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis.3

The six-monthly cost of managing a venous leg ulcer with Cutimed® Sorbion®  was £3700 per patient, which was 15%–28% lower than the cost of managing patients with the other three superabsorbent dressings.3

Additonally, the use of Cutimed® Sorbion®  improved patients' health status to a greater extent than the other three superabsorbent dressings since patients treated with Cutimed® Sorbion®  accrued 0.3%-3% more quality-adjusted life year. Panca et al recommend starting treatment with Cutimed® Sorbion®  was the preferred strategy followed by DryMax, Kerramax and Flivasorb in that order.3

More about Cutimed® Sorbion®

The new self-adhesive superabsorbent dressing for atraumatic and easy to change dressing. The original Cutimed® Sorbion® core for outstanding absorption and retention performance – now combined with silicon adhesive for easy and atraumatic yet secure adhesion.4,5

 The Cutimed® Sorbion® dressing is a hydration response technology dressing with ultrasonically sealed polypropylene fleece. It can be used as a primary dressing suitable for all moderate to highly exuding wounds and offers soft debridement, easily removing slough from wounds. It is hypoallergenic and contains gel-forming polymers to absorb and bind exudate and detrimental agents (eg matrix metalloproteinases, bacteria).4

Cutimed® Sorbion®  dressings can be used under compression bandages and offers protection for peri-wound skin by helping to prevent maceration and excoriation.4

Furthermore, Cutimed® Sorbion® dressings reduce the bacterial load on the wound bed by drawing and binding free-floating bacteria (eg Methicillin-resistant Staphylococcus aureus), helping to manage odour due to the reduction of bacterial burden.4

Cutimed® Sorbion® dressings can be used for up to four days and are indicated for the treatment of patients with venous/mixed aetiology leg ulcers, pressure ulcers, diabetic foot ulcers, dehisced wounds, drainage wounds, discharging laparotomy wounds healing by secondary intention, secreting wounds, and purulent fistulas to the skin.4

Further information is available on request from Essity. Email medical.za@essity.com.

References

  1.  Schultz G, Tariq G, Harding K, et al. WUWHS Consensus Document – Wound Exudate, effective assessment and management. 2019. [Internet]. Available at: https://woundsinternational.com/world-union-resources/wuwhs-consensus-document-wound-exudate-effective-assessment-and-management/#:~:text=Exudate%20plays%20a%20key%20role,timely%20wound%20healing%20without%20complications
  2. NHS Clinical Evaluation Team. Clinical Review Superabsorbent Dressings. [Internet]. 2018. Available at: https://wwwmedia.supplychain.nhs.uk/media/Clinical-Review-for-Superabsorbent-Dressings-October-2018.pdf
  3. Panca M, Cutting K, Gues JF. Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs. J Wound Care, 2013.
  4. Product information. Cutimed® Sorbion® Sachet S. [Internet]. Available at: https://medical.essity.co.uk/brands/wound-care-vascular/category-product-search/cutimed/exudate-management/cutimedr-sorbionr-sachet-s.html
  5. Product information. Cutimed® Sorbion® [Internet]. Available at: https://medical.essityusa.com/en/brands/wound-care-vascular/category-product-search/cutimed/exudate-management/cutimedr-sorbionr-border/

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