Exudate management has been proven to be a vital part of the wound healing process. However, patients with a wound that needs exudate management can be challenging, even under the best of circumstances. If not managed properly it can be the difference in a wound progressing to healing or developing a chronic wound. This can be the difference in a patient returning to work and being financially unstable, and the difference between a grandparent getting to play catch with their grandchild or not.
By controlling the drainage, we minimize periwound maceration and fragility of the skin. The other advantages is that it prevents the wound increasing in size as well as decreases the bioburden capacity. Thus, preventing tissue injury caused by elevated components involved with tissue damage (ie, MMPs), and therefore, reduces the risk of infection. It is also important to understand that by managing exudate it reduces the malodor. This can also reduce the psychological stress of these patients.
I recently started using a Superabsorbent Polymer (SAP) called Zetuvit® Plus from the wound care company, HARTMANN USA. It was designed with the goal of providing extra fluid handling capacity as compared with standard dressings. It can be used on almost any wound type that has moderate to high drainage including diabetic, venous and pressure wounds.
Figure 1: Zetuvit® Plus Superabsorber Dressing
60-year-old male presents to the wound care center status post right partial 5th ray amputation. Patient had osteomyelitis that was treated with IV antibiotics with subsequent recurrence. Wound is right plantar lateral foot with partial closure of surgical site. He presented wearing a pneumatic walking boot.
PMH: DM with neuropathy, CAD, HTN, MI, HTN, osteomyelitis
Right foot plantar lateral wound, +drainage, +periwound maceration, +no odor, + edema, no erythema, surgical wound not coapted, sutures still present.
Amount of drainage, aggressive offloading, exudate management, control blood sugars
Zetuvit® Plus, 3-layer compression and continue with pneumatic walking boot
Day 26: Wound Progression
3.1cm x 1.0cm x 0.1cm
Day 33: Wound Progression
2.9cm x 0.9cm x 0.1cm
Day 40: Wound Progression
1.0cm x 0.3cm x 0.1cm
Day 47: Wound Healed
Concern with using different wound dressing options for this patient was based on the amount of wound drainage. The patient was at high risk of limb loss if the wound did not heal. Zetuvit® Plus controlled the drainage and allowed for fewer dressing changes which decreased the chances of the wound becoming reinfected and decreased the bioburden. This in turn decreased appointments by home health or for the patient to return to the wound center. The wound progressed quickly without causing periwound maceration and allowed for closure in a timely fashion.
Exudate management delays wound healing and often cause chronic wound infection, pain, and chronicity. We must as clinicians do a better job of dressing selection for our patients. Zetuvit® Plus has the versatility to be left on for up to 7 days due to its high absorptive capabilities and at the same time be covered for a daily dressing change for those patients who are using an enzymatic debriding agent. This product has been a game changer for me and has taken the guess work out of the dressing selection process.
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