Hence, exudate management is a key issue in chronic wound therapy, particularly given that exudate from chronic wounds has a composition different from that of acute wound fluid.
Several studies have shown that exudates from non-healing wounds contain significantly elevated levels of protease activity, increased formation of free radicals, and abundant amounts of proinflammatory cytokines, while concentrations of growth factors and protease inhibitors are markedly decreased.
The acronym stands for Tissue management (wound cleansing), Infection or inflammation (reduction of infection/inflammation), Moisture imbalance (humidification), and Edge of the wound (epithelialization support).
According to this concept, non-viable or deficient tissue needs to be debrided (by autolytic, surgical, enzymatic, mechanical, or biological means) to remove the defective matrix and cell debris that is impairing healing.
This is especially true in Germany, where more than 4 million chronic wounds are treated each year.
Therapeutic decisions must be patient-centered and reflect wound etiology, localization, and healing status.
such as achieving a clean wound for skin grafting, containing odor or exudates, and reducing pain to improve the patient’s social life, or maintaining a clean wound bed to place the patient in another setting to continue care.
Several types of dressings, such as hydrogels, hydrocolloids, alginates, hydrofibers, foams, and superabsorbent dressings, are reviewed here and evaluated with regard to their efficacy for highly exuding wounds.Thick, soft construction that is extremely conformable and comfortable. Made of nonadherent, highly absorbent, lint-free, polyurethane foam. Thick, soft construction that is extremely conformable and comfortable. Clinically, the wound edge may be non-advancing or “undermined” as a result of non-responsive wound cells or abnormal protease activity.Debridement, skin grafting, biological agents, and other adjunctive treatment options have been suggested as corrective therapies to increase cellular migration and restoration of an appropriate protease profile.This restores the wound base as well as functional extracellular matrix proteins and clinically leads to a viable wound base.Chronic wounds are characterized by prolonged inflammation and often high bacterial counts.Consequently, the treatment of chronic ulcers is complex.After thorough wound diagnostics, therapy of the underlying disease (eg, metabolic control of diabetes, prevention of chronic venous insufficiency, slowing the progression of atherosclerosis) and general systemic treatment (eg, anticoagulant treatment, systemic antibiotic therapy, anti-inflammatory therapy, treatment inhibiting immunologic reactions, vasodilator treatment, rheology-improving drugs, and protein, vitamin, and microelement supplements) have to be initiated before local therapy can be effective.It is imperative that clinicians reassess wound status during dressing changes so that appropriate interventions can be implemented.Moist wound healing and exudate management Wound exudate, which is essentially blood depleted of most of its red cells and platelets, is a key component in all stages of wound healing, irrigating the wound and keeping it moist, supplying nutrients, and providing favorable conditions for cell migration and proliferation.