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Wound Bed Preparation

A Clinical Concept led by Smith & Nephew

Exudate Management

Why Exudate is a Problem in Chronic Wounds

Substantial volumes of exudate are a common clinical finding of chronic inflammatory wounds. The control of exudate is an important part of wound bed preparation, since chronic wound exudate has been shown to interfere with the repair process(7). Chronic and acute wounds are intrinsically different in terms of etiology and biochemistry. Acute wounds are caused by trauma or as a result of surgery, whereas chronic wounds are forms of tissue destruction originating from underlying pathogenic abnormalities. In chronic wounds the ordered cellular and molecular processes that occur in an acute wound are disrupted. Since chronic wounds are highly inflammatory, they are often associated with excessive production of exudate. Several studies have demonstrated biochemical differences between the exudative component of chronic and acute wounds(43-46). This difference is likely to be of great importance in explaining why chronic wounds fall to repair 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 repair process. Wound exudate contains a number of matrix metalloproteinases and serine proteases that can break down or damage essential extracellular matrix materials. These are vital for cell movement and re-epithelialization. Growth factors, which are essential for optimal wound closure, are also inhibited by macromolecules found in chronic wound exudate. By managing the amount of fluid produced, the detrimental effects of wound exudate can be minimized(47). Increased volumes of exudate can be associated with other issues in chronic wounds such as:

  • excessive exudate could be the result of increased bacterial burden related to local wound infection
  • edema in the lower extremities most often related to chronic venous insufficiency.

This edema can be controlled, and the swelling reduced, by employing compression therapy; the deliberate application of pressure using bandages to force fluid back into both the venous an lymphatic systems. Compression therapy facilitates venous return by enhancing both 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 is significantly compromised. Continuous compression re-establishes valve function and helps reduce hypertension, even when patients are standing. Using compression therapy for venous leg ulcers lowers costs because of fewer patient visits, less nursing time and reduced material usage. The PROFORE Multi-Layer Compression Bandaging System has been specifically designed for the management of venous leg ulcers and associated conditions. This system is designed to provide effective levels of sustained graduated compression for up to seven days. The use of full compression therapy to control edema should not be used on patients where diagnosis has revealed arterial insufficiency (ABI is of less than 0.6 for patients with small vessel diseases). In clinical practice, there needs to be a comprehensive approach to exudate management which addresses the underlying factors while maintaining a moist wound environment. To achieve this it is essential to use dressings that match the requirements of the wound. With regard to exudate control, some chronic wounds may need a highly absorbent dressing because there is too much exudate at the surface, while others may require a product that adds moisture.

How and Why ALLEVYN Can Help Manage Excess Exudate in Chronic Wounds

The ALLEVYN dressing range provides effective management of exudate levels in chronic wounds(48,49). ALLEVYN is a hydrophilic polyurethane dressing with a trilaminate structure comprised of a wound contact layer, a highly absorbent central layer and an outer layer which is waterproof and aids in the prevention of bacterial contamination. ALLEVYN is a highly useful dressing that can be used for low to heavy exuding wounds. For example, in heavily exuding wounds, such as pressure and leg ulcers, ALLEVYN is the dressing of choice since it absorbs more exudate for longer periods of time than the leading hydrocolloid, alginate or impregnated gauze (data on file, Smith & Nephew, Inc). Wound model studies show that, based on an exudation rate of a typical highly exuding wound, ALLEVYN can be left in place for approximately four days without exudate leakage(50). While being highly absorbent, ALLEVYN also maintains a moist wound environment at the wound surface which may assist in the prevention of eschar or non-viable tissue. In addition, the ALLEVYN dressings are easy to use, require less frequent dressing changes and are soft and conformable for patient comfort. Since chronic wounds vary in size, severity and location, several different types of ALLEVYN dressing are now available to accommodate these differences. ALLEVYN and ALLEVYN Adhesive differ in the wound contact layer The standard ALLEVYN dressing is non-adherent while ALLEVYN Adhesive, as its name suggests, has an effective adhesive which does not require a secondary dressing. Other ALLEVYN dressings such as ALLEVYN Heel, and the newest addition to the group, ALLEVYN Sacrum, are specifically designed to provide enhanced pressure ulcer management for specific anatomical areas. Furthermore, the specialized ALLEVYN dressings provide a solution for wounds which are particularly difficult to treat. ALLEVYN Cavity, has been developed for the treatment of deep wounds. This pliable and easy to use dressing is able to fit inside cavities and absorb exudate, thereby helping to maintain an optimal wound environment. It is clear that exudate levels are an important issue in chronic wounds and their effects should not be underestimated. In controlling the quantity of exudate, and thereby minimizing the imbalance of cellular and biological components, this provides a significant step forward in helping to correct the microenvironment within the wound.

Exudate Management Chart

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Exudate Management _About Wound Bed Preperation