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Moisture Imbalance

 

Why exudate is a problem in chronic wounds
Chronic inflammatory wounds frequently produce a substantial amount of exudate. Because exudate has been shown to interfere with the healing process of chronic wounds, controlling it is an important part of wound bed preparation. Chronic and acute wounds are intrinsically different in terms of aetiology and biochemistry. Acute wounds are caused by trauma or as a result of surgery, whereas chronic wounds are forms of tissue destruction that originate from underlying pathogenic abnormalities. In chronic wounds, the ordered cellular and molecular processes that occur in acute wounds are disrupted.

 

Several studies have demonstrated biochemical differences between the exudative component of chronic and acute wounds. These differences are likely part of the reason that chronic wounds fail to heal in the same way as acute wounds. Chronic wound exudate slows down or blocks the proliferation of cells such as keratinocytes, fibroblasts and endothelial cells, all of which are important in the wound repair process. It also contains a number of matrix metalloproteinases and serine proteases that can break down or damage essential extracellular matrix materials that are vital for cell movement and re-epithelialisation. Growth factors, which are essential for optimal wound closure, are also inhibited by macromolecules that are found in chronic wound exudate. By managing the amount of fluid produced, the detrimental effects of wound exudate can be minimised.

 

Excessive exudate can be associated with other clinical issues in chronic wounds. It may result from increased bacterial burden related to local wound infection. With regard to venous leg ulcers, excessive exudates can also be associated with oedema in the lower extremities, which is often related to chronic venous insufficiency. Lower extremity oedema can be controlled with compression therapy—the deliberate application of pressure using bandages to force fluid back into the venous and lymphatic systems. Compression therapy facilitates venous return by enhancing the calf pump mechanism and valve functioning within the veins. Venous leg ulcers are symptoms of underlying venous hypertension and capillary damage. Valve and muscle pump function are significantly compromised. Continuous compression re-establishes valve function and helps reduce hypertension, even while patients are standing. Using compression therapy for venous leg ulcers lowers costs by reducing patient visits, nursing time, and use of material.