Introduction: Why Chronic Wounds Often Fail to Heal

Moist wound healing is the current cost-effective, evidence-based modality to achieve faster wound healing rates and decreased pain and infection.^1,2 As part of the wound healing process, acute wounds produce reparative exudates consisting of growth factors to support extracellular matrix production; in contrast, chronic wounds contain inflammatory-producing exudates studded with cytokines and proteases that may help maintain the inflammatory phase but can exert destructive effects on the fragile wound bed and may extend to the periwound surface.²

Chronic, hard-to-heal wounds are typically stuck in an exaggerated phase of inflammation with increasingly high exudate levels, thus making these wounds prone to biofilm formation and infection.^2,3 Because these conditions further limit the ability of the wound to heal faster, there is a need for highly absorbent dressings that will effectively manage these heavy levels of exudate.

What Are Superabsorbent Dressings?

Specialty absorptives or superabsorbents are multilayer wound dressings with higher absorption capacity than traditional foam dressings.^1,3 These specialty dressings have a nonadherent and hydrophilic wound contact layer woven with an absorbent core consisting of highly absorptive fibers that may be derived from cellulose.^3,4 These dressings can be applied under compression wraps with a long wear time.^1-3

Which Chronic Wounds Can Be Treated With Superabsorbent Dressings?

Considering their nonadherent, hydrophilic, and highly absorbent capabilities, superabsorbent dressings are beneficial for use in a broad spectrum of wounds. In particular, superabsorbent dressings are beneficial for use in several forms of exudative wounds, as listed here:³

• Venous ulcers
• Pressure injuries
• Incisional and graft sites
• Burn wounds
• Lacerations
• Abrasions

Why Is Wound Exudate Considered Harmful to Chronic Wounds?

Whereas exudates in acute wounds promote healing, chronic wound exudates are considered damaging.^3,5 Chronic wound exudates contain high levels of destructive enzymes, proteases, and cytokines that are harmful to the wound base because they prolong inflammation while stagnating wound healing.⁵ Moreover, chronic wound exudates such as those found in pressure injuries and venous ulcers diminish growth factor response, hinder cell proliferation, and are studded with high levels of matrix metalloproteinases, which break down newly formed granulation tissues.

This breakdown of granulation tissue and impairment of cell proliferation and growth factor response further prolong the inflammatory phase of wound healing. The periwound is also damaged by these factors.⁵ Moreover, chronic wound exudates are abnormally viscous because they contain high protein levels, white blood cells, and bacteria.^3-5

How Superabsorbent Dressings Help Heal Chronic Wounds

Inflammatory cells in chronic wound exudates easily bind to superabsorbent dressings and become locked in the highly absorbent core, thereby wicking harmful bacteria and inflammatory mediators away from the fragile wound base.^1,3 Moreover, superabsorbent dressings can absorb large quantities of exudate while keeping the exudate securely locked within the dressing core, which is typically made up of multiple layers of absorbent powders or gelling agents protected by a water-repellant backing layer.^3,5 This feature enables superabsorbent dressings to absorb high exudate levels without adhering to the fragile wound base and thus prevents wound bed damage and periwound maceration.⁵ Superabsorbent dressings have the benefit of rapid and continuous exudate management, in addition to bacteriostatic properties through microbial inhibition and prevention of maceration.^1,3,4

Are Superabsorbent Dressings Cost-Effective?

Many wound care professionals may find dressings to be costly. Superabsorbent dressings, however, are cost-effective because they can be used for extended periods and under compression wraps for sustained use.³ Superabsorbent dressings come in a thin profile, suitable for use under dressings that require extended wear time, such as venous compression wraps.^3,5 Compared with traditional foam dressings that require frequent changes, the long wear time and higher absorption capacity of superabsorbents make them cost-effective.³ In addition, superabsorbents allow undisturbed wound healing, which facilitates optimal wound healing rates.^3-5 Therefore, superabsorbent dressings not only hasten wound healing but also require less frequent dressing changes while achieving optimal wound healing outcomes.

Conclusion

Excessive exudate can contain harmful substances and microorganisms that damage the wound bed and macerate the periwound. Because of this, exudate must be managed properly to ensure a wound’s progress through the healing cascade. Superabsorbent dressings are an effective way to not only absorb exudate, but wick away harmful drainage. Due to their hydrophilic layer, even the most excessive exudate can be absorbed. Unlike standard dressings, superabsorbent dressings require fewer dressing changes. With fewer dressing changes, superabsorbents are cost-effective and allow for undisturbed wound healing. In contrast to standard dressings, the use of superabsorbent dressings can help chronic wounds get back on track and should be considered in the presence of excessive exudate. ^3,5

References

1. Veličković VM, Szilcz M, Milošević Z, Godfrey T, Siebert U. Cost‐effectiveness analysis of superabsorbent wound dressings in patients with moderate‐to‐highly exuding leg ulcers in Germany. Int Wound J. 2022;19(2):447-459. doi:10.1111/iwj.13645
2. Ermer-Seltun JM, Rolstad BS. General principles of topical therapy. In: McNichol LL, Ratliff CR, Yates SS, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum: Wound Management. 2nd ed. Wolters Kluwer; 2022:136-156.
3. Jones J, Hampton S. Use of a superabsorbent dressing in the management of exudate in hard-to-heal wounds. Br J Community Nurs. 2021;26(suppl 3):S20-S29. doi: 10.12968/bjcn.2021.26.Sup3.S20
4. Singh G, Byrne C, Thomason H, McBain AJ. Investigating the microbial and metalloprotease sequestration properties of superabsorbent wound dressings. Sci Rep. 2022;12(1):4747. doi:10.1038/s41598-022-08361-3
5. Brown A. Managing exudate and maceration in venous leg ulceration within the acute health setting. Br J Nurs. 2017;26(suppl 20):S18-S24. doi:10.12968/bjon.2017.26.Sup20.S18