wound care - met passie voor bijzondere medische ... care drymax extra puts you in control of wet...

WOUND CARE

DryMax ExtraPuts you in control of wet wounds!

§Superabsorbs and retains large amounts of exudate

§Minimizes the risk of maceration and skin damage

§Convenient and safe single-use wound dressing

§Works well under compression

§Reduced dressing changes = patient comfort and cost efficiency

cost efficiency

material. SAPs usually consist of polyacrylates which are a sort of plastic made from petroleum. When it comes to modern as well as tra-ditional dressing materials, there are also other environmental aspects, e.g. waste disposal during produc-tion of raw materials, farming and finishing of cotton /textiles and use of various chemicals and metals. However, compared to traditional dressings made of cotton and cel-lulose, most modern dressings have considerable clinical advantages relative to the very small amount of non-biodegradable waste. All these aspects should be conside-red in procurement and contracting of wound dressings.23-24 There is ongoing research to produce biode-gradable superabsorbents that can be recycled and composted25.

ConclusionWhen the wound exudate produced is too much or of the wrong com-position, a multitude of problems can follow, causing delayed healing, anguished patients and carers and considerable costs for society. Ac-curate use of modern, advanced dressings may save time and money and reduce suffering.

Although superabsorbents have existed for almost half a century, their applications in wound dressings has only just begun. More research and evaluation of the clinical implications of their special properties is needed. In view of the last decades’ intense research and development in wound healing, research on superabsor-bents in wound dressings may well lead to further progress in the care of patients with exuding wounds.

Anne HindhedeRN, B.Sc., Specialist in wound heal-ing and dermatologyÖrebro University Hospital, Örebro, Sweden

References 1. Romanelli M, Vowden K & Weir D.

Exudate management made easy. Wounds International 2009-02-10. Available from www.woundsinter-national.com.

2. Folestad A, Gilchrist B, Harding K et. al. Wound exudate and the role of dressings. A consensus docu-ment. International Wound Jour-nal 2008;5 (suppl 1: iii-12).

3. Tachi M, Hirabayashi S, Yonehara Y, Suzuki Y and Bowler P. Compa-rison of bacteria-retaining ability of absorbent wound dressings. International Wound Journal 2004;1(3):177-81.

4. Buchholz F and Graham AT (Eds.). Modern Superabsorbent Polymer Technology. 1997, Wiley- VCH, New York.

5. Bruggisser R. Bacterial and fungal absorption properties of a hydro-gel dressing with a superabsor-bent polymer core. Journal of Wound Care 2005;14(9):438-42.

6. Tadej M. The use of Flivasorb® in highly exuding wounds. British Journal of Nursing 2009;18(15):S38-42.

7. Pollard T (Ed.).Wound Care Hand-book 2009-2010, p.160. Journal of Wound Care.

8. Godar S and Guy H. Managing highly exuding wounds with Eclyp-se dressings. British Journal of Nursing 2010;19(6):S24, S26-9.

9. Cutting KF. Managing wound exu-date using a super-absorbent po-lymer dressing: a 53-patient clini-cal evoluation. Journal of Wound Care 2009;18(5):200-5.


11. Bain G. Case report on a non-hea-ling venous ulcer utilizing a cellu-lose/super polymer dressing for exudates control. Wound Practice and Research 2008;16(4):186-91.

12. Hampel-Kalthoff C., Krankenpfle-ger, Fachkrankenpfleger für Anäs-thesie- u. Intensivpflege, Pflegeri-scher Fachexperte für Menschen

mit chronischen Wunden. Orga-Med Dortmund GmbH, Dortmund. Letter 2009-07-31.

13. Meuleneire F. Absorbest. Clinical Cases DryMax®Dressing Extra. 2009-08-17. Wound center AZ St. Elisabeth, Zoettegem, Belgium.

14. Meuleneire F. Absorbest. Clinical Cases DryMax®Dressing Extra Part 2. 2009-10-31. Wound cen-ter AZ St. Elisabeth, Zoettegem, Belgium.


16. Lindholm C and Grauers M. Sår-behandling 2009/2010, p. 129-31. Katalog över sårprodukter. Stock-holm 2009. Gothia Förlag AB.

17. KBS Development, Spånga: ISO 11948-1 was used.

18. Bishop SM, Walker M, Rogers AA and Chen WYJ. Importance of moisture balance at the wound-dressing interface. Journal of Wound Care 2003;12(4):125-8

19. Cutting KF and White RJ. Mace-ration of the skin and wound bed 1: its nature and causes. Journal of Wound Care 2002;11(7):275-8.

20. Pollard T (Ed.) Wound Care Hand-book 2010-2011, p.182. Journal of Wound Care.



23. The Swedish Environmental Ma-nagement Council. Background information for Environmental Ma-nagement Council’s procurement criteria for dressings 2007-01-11.

24. The Swedish Environmental Ma-nagement Council. Environmental Management Council’s procure-ment criteria for dressings 2007-11-16.

25. Weerawarna SA, Method for Ma-king Biodegradable Superabsor-bent Particles. Patent application. Available from www.faqs.org/pa-tents/app/20090324731.

Manufacturer: Absorbest AB Kisa, [email protected]

Wound exudate – also called wound fluid - can promote cell proliferation, supply

nutrients for cell metabolism, and aid autolysis of necrotic or damaged tissue. Generally, exudate is odour-less, although some dressings give a characteristic odour that may be mistaken as coming from exudate. In a healing wound the amount of exudate decreases with time.

An increase in the amount of exudate may indicate inflamma-tion, bacterial contamination, limb dependency or other factors. If the wound does not heal, the composi-tion of the exudate changes and the exudate may impede healing.1

Problems caused by exudateExudate can be a problem when any of the following occurs:- leakage and soiling- periwound skin changes, e.g. ma-

ceration, skin stripping or erosion- delayed healing- odour- discomfort, pain- infection- protein loss, fluid and electrolyte

imbalance- need for frequent dressing chan-

ges- psychosocial problems associa-

ted with exudate.1

Handling of wound exudateWhen too much exudate is produ-

Author: Anne Hindhede

ced, it is important that the health-care professional accurately deter-mines which factors contribute to the problem. Only then can effective treatment begin. Successful exu-date management can reduce time to healing, prevent exudaterelated problems, increase patients’ quality of live and improve healthcare ef-ficiency. Dressings are the key op-tion for managing exudate at wound level. When excessive exudate is a problem, or when exudate compo-sition is suspected of obstructing healing, removal of exudate from the wound bed is a priority.1

Wound dressingsDressing materials are often avai-lable in a number of different forms. Combinations of layers or pockets of different types of dressing mate-rials are increasingly common. For example, dressings may consist of a wound contact layer, an absorbent layer and a non-permeable or semi-permeable backing. Consequently, the fluid handling characteristics and usages of individual dressings of the same type may vary considerably.

Simple absorptive dressings, e.g. cotton, foams, viscose or polyester textiles, hold fluid within spaces in their structure like a sponge. When these materials are placed under pressure, fluid is released from the spaces and may leak from the dres-sing.

Many absorbent dressings also allow moisture to evaporate from the surface of the dressing. This charac-teristic is quantified as the moisture vapour transmission rate (MVTR).

Interactive dressings, e.g. hy-drocolloids, alginates and hydro-fibers, take up liquid to form a gel. When placed under pressure, the gel changes shape but retains the fluid. This characteristic can reduce lateral tracking of fluid and the risk of periwound maceration, which is particularly useful when the patient is sitting or lying on the dressing or in connection with compression tre-atment.2

In vitro studies have shown that some dressings, e.g. hydrofibers and some alginates, trap bacteria and exudate components such as enzymes in a process called se-questration. Materials that produce a uniform coherent gel seem to have enhanced sequestrations.3

Absorption capacityIn recent years, several companies have introduced wound dressings that contain so called superabsor-bents4. Superabsorbent dressings have considerably higher absorption capacities than that of other absor-bent dressings5-6, 8-9, 11-16.

A dressing’s efficiency in mana-ging wound exudate should not just be viewed in terms of the volume absorbed, but also in terms of its

Superabsorbents in wound healing

ability to retain the exudate within the dressing, even when external pressure is applied. Wound dres-sings that only absorb low volumes and have little or no capacity to re-tain wound exudate are more likely to cause maceration and/or excoria-tion of the periwound skin.18

Consequently, dressings that absorb relatively large quantities of exudate, but lack the capacity to sequester the exudate and remain wet on the surface, may be less effi-cient in the management of exuding wounds than dressings that absorb less but retain the exudate inside the dressing18-19.

SuperabsorbentsSuperabsorbent polymers, SAPs, is a collective name for synthetic absor-bing materials based on polymers. Their distinguishing feature is their ability to absorb and retain extre-mely large volumes of liquid relative to their own mass. The secret con-sists of long polymer chains based on a carboxyl group, usually sodium polyacrylate. The carboxyl group has a negative charge. When exposed to water, the polymer chains attract the water molecules which have a posi-tive charge. The polymer chains con-stitute a kind of three-dimensional network that retains the water and transforms it into a gel.

The special properties of supe-rabsorbents can be used in many applications and their performance can be adapted to suit specific re-quirements.

Until the 1980’s, water absorbing materials were cellulose or fiber-based products from cotton or fluff pulp. The water retention capacity of these materials is only 20 times their weight at most. In the early 1960’s, a product was developed, based on polymers and starch, that gave water absorption greater than 400 times it weight. In addition, the gel did not release water the way that fiber-based absorbents do. In the early 1970’s, superabsorbent po-lymers were used commercially for the first time for disposable hygienic products, namely feminine sanitary napkins and adult incontinence pro-ducts. In Europe, SAP was first used in baby diapers in 1982.

The development of superabsor-bent technology has been largely led by demands from users of dispo-sable hygiene products. Advances in absorption performance have al-lowed the development of ultra-thin diapers and other hygiene products which use a fraction of the materials which earlier disposable products consumed. Superabsorbents are available in the form of powder, gra-nules or fibrous fleece.4 All of these

can be used in medical devices, such as wound dressings5-6, 8-9, 11-

16.

Superabsorbents in wound healingSeveral companies produce wound dressings that contain superabsor-bents. These dressings come in va-rious forms with varying fluid hand-ling capacities 5-6, 8-9, 11-16.

One example is a hydrogel dres-sing (Tenderwet by Hartmann) com-prising a polypropylene fabric cover and an absorbent core containing a superabsorbent polymer, polyacry-late. Before use, the dressing is ac-tivated with a premeasured volume of Ringer’s solution. An in vitro study shows that the hydrogel dressing attracts and retains microorganisms and reduces the number of viable germs, while gauze which was used as comparison in the study, did not. The dressing creates a moist healing environment while absorbing and retaining microorganisms inside the dressing.5

Another dressing (Flivasorb by Lohmann & Rauscher) has a wound contact layer of polyethylene, which reduces the possibility of wound adherence. Above this is a polypro-pylene layer, which facilitates the even distribution of absorbed exu-dates into the absorbent core. The next layer is the absorbent cellulose core, containing superabsorbent polymer particles with the capacity to absorb very large amounts of ex-udate. The top layer is a non-woven polypropylene layer, which prevents leakage of the absorbed fluid onto clothing. The dressing absorbs exu-date and holds it within the centre of the dressing without the risk of the fluid leaking back onto the skin. At the same time it reduces the number of bacteria and harmful enzymes in the wound by ensuring that they are absorbed into the inner core of the

dressing.6 The dressing is categori-sed as a protease modulator.7

One dressing (Eclypse by Advan-cis Medical) uses highly absorbent crystal technology to increase its fluid handling capacity. The dressing combines a rapid wicking polyester and viscose woven face with a sheet of highly absorbent crystals and a mechanically bonded cellulose pad. The polyethylene backing is highly breathable and provides a viral and bacterial proof barrier in addition to preventing strike through.8

Another superabsorbent dressing (Sorbion Sachet by Sorbion) has a hypoallergenic outer covering of po-lypropylene, thus permitting appli-cation of either side of the dressing to the wound. The covering also prevents leakage of the absorbed exudate. The dressing has been tested in an observation study of 53 patients with various types of mo-derately (11 patients) or highly (42 patients) exuding, chronic wounds. Before entry into the evaluation, the patients had received a variety of wound dressings including foams, alginates and hydrofiber. At week 4 the percentage of patients with maceration of the peri-wound skin had dropped from 57% to 28%, of which all but one patient had mini-mal maceration. The results indi-cate that the dressing’s absorptive function, together with its gelling and retention capability, appears to protect the wound margins. None of the wounds required systemic anti-biotics during the evaluation period. An observation made was that the dressing appears to function most efficiently when the exudate is not highly viscous in nature.9 The dres-sing is categorised as a protease modulator.10

One of the latest superabsorbent wound dressings (DryMax Extra by Absorbest) has been developed and manufactured by a Swedish compa-

ny. This dressing also has a core of cellulose and superabsorbent poly-mers contained within a polypropy-lene cover. Wound exudate is drawn vertically into the dressing where it alters the core to a gel consistency. Fluid is bound within the gel, which both prevents peri-wound macera-tion and retains a humid surface en-vironment to facilitate tissue repair. The dressing also absorbs during pressure and the fluid is retained in-side the dressing. The dressing has been evaluated in a few carefully do-cumented observation studies11-14, one of which has been published11. One of the studies compares the Swedish dressing to two other su-perabsorbent dressings in the treat-ment of 10 patients with various ty-pes of highly exuding wounds. The results indicate that the Swedish

dressing had equal or better capa-city to absorb exudate and prevent peri-wound maceration and that it provided the same patient satisfac-tion compared to the other two dres-sings12. The dressing is categorised as a protease modulator20.

Superabsorbent dressings should not be applied to bleeding wounds (especially arterial bleeds). Use of creams or ointments in the wound area may interfere with absorbency and sequestering function of pro-ducts.21 Dressings that bind pro-teases are likewise not suitable for dry wounds or wounds with a lea-thery eschar22.

Environmental aspectsMost modern wound dressings, in-cluding superabsorbent dressings, contain some non- biodegradable

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Absorption capacity

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Superabsorbent dressing for exu-ding wounds. Photographs by Mediq Danmark

Wound exudate plays a central role in wound healing. Its main functions are to facilitate the diffusion of vital healing factors and the migration of cells across the wound bed.

But wound exudate can also be a problem. New wound dressings – which contain superabsorbents – can assist wound healing because of their capacity to absorb and retain large amounts of fluid.

Figure of absorption capacities in traditional ab-sorbent cellu-lose dressings, hydrocolloids, foams, algina-tes, hydrofibers and super-absorbents. Reference 17

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