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The wound process is a set of stages that successively replace each other and as a result lead to epithelization of the skin and closure of the wound defect. The development of the wound process is influenced by the pH value of the wound contents, which determines the rate of all biochemical reactions occurring in the wound. In the course of the study, patients were measured for wound exudate in the postoperative period. It was noted that in patients with the initial values of the hydrogen index, which was 7, a more effective healing process of the postoperative wound was observed, while in patients with the initial pH value of 8, the wound process took a protracted character.

Amniotic tissues have been long utilised to treat chronic wounds; however, there are few studies evaluating how the wound microenvironment responds to these therapies. The goal of this study was to evaluate the changes in wounds treated with a hypothermically stored amniotic membrane (HSAM). In this prospective single‐arm study, 15 female patients with venous leg ulcers were treated with HSAM from male donors and standard of care for 12 weeks. Over the course of the study, wound exudate was collected and evaluated using proteomic microarrays. Biopsies were collected during the course of treatment to detect the presence of HSAM tissue. By 4 weeks, 60% of subjects achieved 50% or greater reduction in wound size, and by 12 weeks, 53% of subjects achieved 100% re‐epithelialization. HSAM DNA was detected in 20% of biopsies as determined by the detection TSPY4, indicating HSAM was no longer present within the wound bed approximately 7 days from the last treatment for the majority of wounds. Proteomic analysis of wound exudate found that wounds on a healing trajectory had significantly higher levels of MMP‐10, MMP‐7, and TIMP‐4 and significantly lower levels of CX3CL1, FLT‐3 L, IL‐1ra, IL‐1a, IL‐9, IL‐2, IL‐3, MCP‐1, and TNF‐b compared with other wounds.

Controlling wound pain, absorption of wound exudate, and minimizing the frequency of changing the dressing are necessary parameters to facilitate wound-healing process. Hence, stable hydrophilic hy...

It has been demonstrated that wound dressings provide a protective effect against pressure injuries. However, no method exists to measure either the life or performance of dressings used in prevention; testing dressings in a clinical setting or a research environment has typically been based on measuring its moisture absorption capacity. This article examines the changes that occur in the structural and mechanical properties of a prophylactic dressing based on conditions of use when wound exudate is not present.A clinically relevant method was developed to simulate the loading, friction-inducing shear, and moisture transpiration present in a typical hospitalization where a dressing is applied for prevention. Single-use dressings were tested using this method to evaluate their ability to protect patients from pressure injuries throughout the typical 5 to 7 days of use. Following this aging process, researchers measured the physical, structural, and mechanical changes in prophylactic dressings over time.This innovative method provides guidance for clinicians on dressing use and replacement intervals. For bioengineers, the method generates important empirical data for computer modeling of dressing performance, which can then reveal the consequences of changes in dressing structure and function on sustained tissue loads. It is the authors' hope to generate discussion about the creation of industry-wide standards for testing dressings to improve patient care.

Wound healing is an intrinsic and dynamic process. Wound exudate is a normal feature of wound healing; however, when there is insufficient or excessive production, or the composition of the exudate is harmful, wound healing may be compromised with resulting psychosocial and financial implications. Therefore, the management of exudate is essential for improved patient outcomes and in the prevention of future complications. The purpose of these studies, carried out in Germany and Poland, was to observe and to evaluate the clinical performance of Cutimed® Siltec® and Cutimed Siltec B on patients' wounds. Three visits (initial visit, dressing change visit and final visit) were scheduled and documented. In all, 129 patients took part in these studies and 150 wounds were treated. The results were pooled. Positive attributes of using these dressings included a decrease in exudate, intact wound margins and a decrease in pain during dressing changes. Clinicians and patients were satisfied with the product and rated the following parameters as ‘good’ to ‘very good’: wearing comfort, ease of application and removal, absorption and retention capacity, adaptability to the affected body part, absorption and retention capacity under compression. The results from this study suggest that Cutimed Siltec and Cutimed Siltec B absorbent dressings are beneficial in wound management due to the positive attributes, and clinicians and patients showed satisfaction with these dressings.

An integrated smart microfluidic dressing with a multibiomarker immunosensor can provide in situ wound status profiling on site., Chronic wounds arise from interruption of normal healing due to many potential pathophysiological factors. Monitoring these multivariate factors can provide personalized diagnostic information for wound management, but current sensing technologies use complex laboratory tests or track a limited number of wound parameters. We report a flexible biosensing platform for multiplexed profiling of the wound microenvironment, inflammation, and infection state at the point of care. This platform integrates a sensor array for measuring inflammatory mediators [tumor necrosis factor–α, interleukin-6 (IL-6), IL-8, and transforming growth factor–β1], microbial burden (Staphylococcus aureus), and physicochemical parameters (temperature and pH) with a microfluidic wound exudate collector and flexible electronics for wireless, smartphone-based data readout. We demonstrate in situ multiplexed monitoring in a mouse wound model and also profile wound exudates from patients with venous leg ulcers. This technology may facilitate more timely and personalized wound management to improve chronic wound healing outcomes.

Alginate is a naturally occurring biopolymer which has been widely used to design materials for wound dressing. The attractive features of alginate include biocompatibility, biodegradability, antibacterial activity, hydrophilicity, and nontoxicity. Alginate accelerates wound healing by providing a moist environment around the wound, removing wound exudate, and restricting the colonization of microorganism. The properties such as mechanical, water adsorption, biodegradability, and cell affinity of the alginate are generally improved by incorporating it with polymers and nanoparticles. The alginate has often been encapsulated with several drugs to enhance its wound healing properties. In this review, we discussed about the recent literature about several types of alginate-based nanocomposite for wound healing application. This chapter gives an overview of the recent developments of alginate-based materials in wound dressing, which outlines the characteristic properties of different alginate-based wound dressing materials.

At present, there are various wound dressings that can protect the wound from further injury or isolate the external environment in wound treatment. Whereas, infection and slow self-healing still exist in wound healing process. Therefore, it is urgent to develop an ideal wound dressing with good biocompatibility and strong antibacterial activity to promote wound healing. Bacterial cellulose is a kind of promising biopolymer because it can control wound exudate and provide a moist environment for wound healing. However, the lack of antibacterial activity limits its application. In this paper, the advantages of bacterial cellulose as wound dressings were introduced, and the preparation and research progress of bacterial cellulose-based antibacterial composites in recent years were reviewed, including adding antibiotics, combining with inorganic antibacterial agents or organic antibacterial agents. Finally, the existing problems and future development direction of bacterial cellulose-based antibacterial wound dressings were discussed.

The absorption capacity of cotton dressings is a critical factor in their widespread use where they help absorb wound exudate. Cotton wax dressings, in contrast, are used for wounds where care is taken to avoid adhesion of dressings to sensitive wounds such as burn injuries. Accordingly, we explored the loading of 2‐deoxy‐D‐ribose (2dDR), a small sugar, which stimulates angiogenesis and wound healing in normal and diabetic rats, into both types of dressings and measured the release of it over several days. The results showed that approximately 90% of 2dDR was released between 3 and 5 days when loaded into cotton dressings. For wax‐coated cotton dressings, several methods of loading of 2dDR were explored. A strategy similar to the commercial wax coating methodology was found the best protocol which provided a sustained release over 5 days.\ud \ud Cytotoxicity analysis of 2dDR loaded cotton dressing showed that the dressing stimulated metabolic activity of fibroblasts over 7 days confirming the non‐toxic nature of this sugar‐loaded dressings. The results of the chick chorioallantoic membrane (CAM) assay demonstrated a strong angiogenic response to both 2dDR loaded cotton dressing and to 2dDR loaded cotton wax dressings. Both dressings were found to increase the number of newly formed blood vessels significantly when observed macroscopically and histologically.\ud \ud We conclude this study offers a simple approach to developing affordable wound dressings as both have the potential to be evaluated as pro‐active dressings to stimulate wound healing in wounds where management of exudate or prevention of adherence to the wounds are clinical requirements.

Aim: The aim of this study was to investigate the relationship between CXCL-6 levels in wound exudates and healing of diabetic foot ulcers (DFU). Materials & methods: One hundred patients with neuropathic DFU were recruited. Wound exudate CXCL-6 levels were measured by enzyme-linked immunosorbent assay. Patients were followed for 24 weeks and divided into rapidly healing and nonhealing groups. Results: Compared with the NH group, the mean CXCL-6 levels in the wound exudates of the rapidly healing group were significantly higher. After adjusting for traditional risk factors, wound exudate CXCL-6 levels were still significantly associated with wound healing. Conclusion: CXCL6 is an independent predictor of wound healing in DFU patients and may be a potentially novel therapeutic target for the treatment of DFU.

Glucose is a common component of body fluids. We describe a hydrogel wound dressing that can be obtained by pouring an aqueous solution of a polyvinyl alcohol derivative possessing phenolic hydroxyl moieties (PVA-Ph), containing glucose oxidase (GOx) and horseradish peroxidase (HRP), onto a wound. The in situ hydrogelation progresses through GOx-catalysed hydrogen peroxide (H2O2) generation from glucose in the wound exudate and HRP-catalysed cross-linking between phenolic hydroxyl moieties in PVA-Ph by consuming the H2O2. The potency as a wound dressing is demonstrated by experiments which reveal that the existence of the conditions inducing hydrogelation within 20 s at normal blood glucose concentration, the durability of the resultant hydrogels to compression and stretching, and the faster closure of full-thickness wounds created on rats treated with the in situ formed hydrogel than those treated by a commercially available hydrogel dressing.

This article reports on a product evaluation of KytoCel, an absorbent wound dressing used in the treatment of 30 wounds treated in community care and 10 split-thickness skin-graft donor sites treated in acute care. Within the community-treated cohort, unspecified leg wounds were the most common wound type (n=6) with the mean wound area of the 30 wounds being 17.6 cm2 (standard deviation (SD) 31.7) and mean volume being 8.4 cm3 (SD 21.4). Most community treated wounds (27/30; 90%) were reported to have moderate to high levels of wound exudate with the majority (n=19) either healed or improved during treatment. All ten split-thickness skin graft donor sites healed during the evaluation. A semi-structured focus group consisting of 17 nurses provided their opinions on KytoCel, with positive comments offered on the dressing during the focus group and of the 17 participants, 10 commented that the KytoCel dressing was available on their local wound care formulary.

Wound exudate adsorption and blood clotting are of critical importance for promoting wound healing in diabetic patients. In this study, cellulose-chitosan hybrid sponges were prepared by a facile pathway with controllable structure and morphology. Aimed at wound dressing, the physical properties, cytocompatibility, and hemocompatibility of the cellulose-chitosan hybrid sponges were evaluated. The results indicated that the hybrid sponges were non-toxic and outperformed silicon in promoting blood coagulation. The sponges could also effectively adsorb abundant wound exudate due to their highly porous structure. Moreover, the maximal shape recovery of these chemically crosslinked sponges from a 50% compression strain was up to 95% of their original thickness, without obviously compromising their macro/microstructure and mechanical properties after 10 cycles. The superior blood coagulation, adsorption performance, and shape recovery properties of the sponges make them ideal for use in making wound dressings for diabetic patients.

Wound healing is a multipart and dynamic process of replacing devitalized and damaged cellular structures and tissue layers. Numerous conventional wound dressings are employed for the management of wounds but there is a lack of absolute and versatile choice. An ideal wound healing modality should provide a moist environment, offer protection from secondary infections, eliminate wound exudate, and stimulate tissue regeneration. Hyaluronic acid (HA) has been known to promote angiogenesis, granulation tissue formation, remodeling of extracellular matrix (ECM), and wound healing. Accumulation and turnover of ECM is a hallmark of tissue injury, repair, and remodeling in wound healing. HA is a major component of ECM and plays an important role in regulating tissue injury, accelerating tissue repair, and controlling disease outcomes. A wide range of in vitro, in vivo, and clinical studies have demonstrated the wound healing efficacy of HA-based biomaterials not only in the treatment of wound in the tympa...

Purpose Effective management of wound pain is essential for optimal wound healing. Nevertheless, the outcomes of wound pain interventions are based on subjective measures, which can prove problematic in patients with cognitive impairment. Identification of biomarkers associated with wound pain and wound healing can be used to more objectively estimate wound pain and contribute to the development of precise management options to reduce wound pain and promote wound healing. This scoping review aimed to identify wound pain and wound healing biomarkers from wound exudates and to describe different wound collection methods to identify these biomarkers. Methods We searched the literature (PROSPERO database registration number: CRD42018103843) via a scoping review. Search strategy The PubMed database was searched for articles that explored relationships between cutaneous wound pain, wound healing, and biomolecules. Inclusion criteria were articles that reported original data, used adult human samples, and were published in English. Findings Twenty-one articles were retrieved: 17 investigated molecules from wound exudate associated with wound healing status, and 4 reported molecules associated with wound pain. The most frequently observed wound pain biomarkers were proinflammatory cytokines; the most frequently observed wound healing biomarkers were proteases including those in the matrix metalloproteinase family. Six wound exudate collection methods were identified to extract potential wound pain and wound healing biomarkers from wound exudate. Implications The results can guide future wound exudate research to validate these wound pain and wound healing biomarkers and to develop therapies targeting these biomarkers to reduce wound pain and promote wound healing.

Alginate biopolymer has been used in the design and development of several wound dressing materials in order to improve the efficiency of wound healing. Mainly, alginate improves the hydrophilic nature of wound dressing materials in order to create the required moist wound environment, remove wound exudate and increase the speed of skin recovery of the wound. In addition, alginate can easily cross-link with other organic and inorganic materials and they can promote wound healing in clinical applications. This review article addresses the importance of alginates and the roles of derivative polymeric materials in wound dressing biomaterials. Additionally, studies on recent alginate-based wound dressing materials are discussed.

This common feature of wound care presents a challenge to clinicians, writes Edwin Chamanga

A D-optimal design was used to identify and model variables that affect the transit time of wound exudate through an illustrative dressing used for negative pressure wound therapy. Many authors have addressed the clinical benefits of negative pressure wound therapy, but limited information is available on how to assess performances of dressings. In this paper, the transit time of wound exudate through a dressing was chosen as a model parameter to show how experimental design (DOE) can be used for this purpose. Results demonstrated that rate of exudate production, temperature and dressing thickness were the variables with the largest impact on transit time. The DOE approach could be used to model other dressing properties, like for example capability of absorbing excess exudate or breathability.

Objective:To evaluate the safety and performance of a gelling fibre dressing, with respect to wound exudate management, maceration and periwound skin conditions.Method:Complex (non-healing) surgical or chronic wounds healing by secondary intention were treated with a gelling fibre dressing (Biosorb, Acelity) as part of a prospective, two-centre case series product evaluation study. Dressing performance was evaluated at each change, and weekly for up to four weeks or until the wound healed, if this was in less than four weeks. The main outcome measure was dressing performance, wound bed and periwound skin condition.Results:A total of 15 patients, aged 26–87 years, were enrolled; 10 patients (66.7%) presented with chronic wounds including venous leg ulcers (VLUs), arterial leg ulcer, one mixed leg ulcer, pressure ulcer (PU), and diabetic foot ulcers (DFUs). The remaining wounds (33.3%) were postsurgical complex wounds healing by secondary intention, located in the upper leg, foot, abdomen, and sacrum. Mean wound area was 22.6±36.6cm2(range: 1.3–144.0cm2). Treated wounds showed complete granulation in eight (53.0%) wounds, 75% granulation coverage in two (13.3%) wounds, 50% coverage in three (20.3%), and 25% coverage in two (13.3%) wounds. Patients evaluated the dressing effectiveness as ‘excellent’ or ‘very good’ in 45% of cases, ‘moderate’ in 45%, and ‘poor’ in 10% of cases. Results of Visual Analogue Scale (VAS) showed 70% of patients rated their pain as ‘low’ and 30% as ‘moderate’ at dressing removal. Clinicians' evaluation of dressing ability to absorb and retain wound exudate was rated ‘excellent’ or ‘very good’ in 80% of cases, and moderate in 20% and poor in 10% of cases. Overall, clinicians' impression of the dressing performance was reported as ‘excellent’ or ‘very good’ in 80% of cases and ‘moderate’ in 20% of cases. No patient had to be removed from the study due to adverse events directly related to the dressing or its performance.Conclusion:These clinical findings suggest the new gelling fibre dressing to be safe and effective in wound treatment of complex (non-healing) surgical or chronic wounds, to manage exudate effectively, and to optimise the conditions of wounds healing by secondary intention

In this study, absorption capacity of the most commonly used types of wound dressings was measured with an objective, quantifiable, and easily reproducible method. The use of objective measurements allowed us to perform an objective comparison of the capacity of the different types of dressings. An experimental study was performed, in which the absorptive capacity of polyurethane foams, alginate, hidrofiber, and hydrocolloid dressings was measured by using a methodology designed by the researchers. Polyurethane foams showed a higher absorption capacity than hidrofibers, alginates, and hydrocolloids when using a similar surface of dressing. A modification of dressing size after saturation was also observed, increasing its size in the case of foams and decreasing or maintaining it in the case of hidrofibers, alginates, and hydrocolloids. The results of this study show a better wound exudate management for polyurethane foams. However, when deciding which dressing to use for a specific wound, absorption capacity is not the only quality that should be taken into account, as other properties should also be considered.

A survey was undertaken with the aim of identifying health professionals' understanding of wound exudate and their ability to assess and manage it. The survey was carried out at Wound Expo, which is a large annual event that provides generalist nurses with interactive education on the core aspects of wound care, including wound exudate. The sample comprised 223 delegates. Almost all delegates (89%) included exudate in every wound assessment, but only 20% based assessment of excess exudate on colour, viscosity and malodour, with the majority (67%) basing it on leakage and increased frequency of dressing changes. While almost all (94%) delegates said they always assess exudate colour and most (80%) that they always assess its viscosity, 18% did not understand the clinical significance of exudate colour and 29% were unable to correctly identify the characteristics of low-viscosity exudate. Furthermore, one quarter of the sample did not always take absorbency into account when selecting a wound dressing. The results indicate that exudate assessment is often subjective, and there is scope for greater use of wound exudate assessment tools and exudate descriptors.

The wound contact layer of UrgoTul Absorb Border (Urgo Medical) foam dressing contains a Technology Lipido Colloid (TLC) Healing Matrix, which includes hydrocolloid and lipophilic substances designed to stimulate fibroblast proliferation and thus promote granulation tissue formation. A multicentre, noncomparative, clinical evaluation of UrgoTul Absorb Border investigated whether use of the dressing promoted granulation tissue formation and the management of wound exudate. Other parameters evaluated included: pain-free dressing changes, protection and improvement of surrounding tissue, ease of application, conformability, ability to remain in place, wear time, effect on peri-wound skin, durability, ease of removal, and patient comfort. There were 43 patients recruited into the evaluation. Results show that 8 wounds (19%) achieved full epithelialisation and 34 (81%) improved. All participating clinicians rated the dressing's overall performance, including its ability to manage exudate, as excellent, very good, or good.

Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

Good quality wound dressings should have exceptional properties for usage, such as being able to remove excess wound exudates, having rapid dehydration, and providing optimal water vapour permeability. This study evaluated and compared the morphological and physical properties of six different commercially absorbent wound dressings in Thailand: two hydrocolloids, two alginates, and two foams. These wound dressings are available in a variety of components and structures, some of which have a multilayer structure. The results showed that the calcium sodium alginate dressings had better absorption properties than the calcium alginate dressings, hydrocolloid dressings, hydrocolloid with foam layer dressings, foam with polyurethane film layer dressings, and foam with hydrogel and polyurethane film layer dressings. Furthermore, the calcium sodium alginate dressings had the highest rate of dehydration and provided an optimal water vapour transmission rate. However, the calcium sodium alginate dressings could not retain the original structure after being submerged with a wound exudate.

Objective: The wound bed score is a validated tool to monitor wound healing in chronic wounds, and depends on visual examination by trained personnel. This study describes the feasibility of adding some biochemical and immunohistochemical parameters to increase the objectivity and specificity of the wound bed score Method: Patients with chronic wounds on the lower leg with different durations were enrolled to assess the correlation between the wound bed score and specific wound-related biomarkers, namely MMP-9, MMP-2, NGAL, albumin, integrin α2/β1, and other histochemical (CD68, PK1, CD32, fractalkine, periostin) and immunocytochemical markers from biopsies and smears taken from wound edges and bed. Results: The study examined samples from 10 patients. Patients with an unfavourable wound bed score had a low expression of periostin and fractalkine in the wound bed tissue. CD68 PK1 showed a low or negative expression in the majority of the samples. Patients negative for CD68 PK1 were also negative for CD32. Principal component analysis revealed that the albumin level and the amount of proteins were associated with a high wound bed score. Two different subsets of patients could be discriminated either by integrin α2/β1 and albumin percentages or the MMP-9 and MMP-2 activities Conclusion: These preliminary results pave the way towards an improved wound status diagnosis and an advanced quality of wound care and management. These findings need confirming with a large number of patients and at different time points.

There are a number of physiological changes that occur with aging that make the older adult more susceptible to traumatic wounds, as well as pressure ulcers following a traumatic injury. Nursing care of wounds in the older adult trauma patient should include control of comorbidities, particularly those that may inhibit wound healing. Additional risk factors for the older adult that can impair the wound-healing process include dehydration, malnutrition, unresolved pressure/shear and friction, excessive skin moisture, pruritus and dry skin, increased levels of wound exudate, and inappropriate management of wound exudate [1].

Objective: To identify the clinical empirical evidence for identifying, managing and preventing skin maceration in human subjects. Method: A rapid review of the current literature was undertaken between 5 September and 19 September 2016 using the electronic databases CINAHL, MEDLINE, PUBMED and Cochrane, with the key words: skin macerat*, wound macerat*, moisture associated skin damage, wound exudate and hyper-hydration of skin, Results: Of 526 papers found using an electronic database search, four were identified as fitting the search parameters, and a further two were retrieved from a manual search of reference lists. There were three themes that emerged: how to identify and measure maceration, how to manage and reduce maceration once it has already occurred, and how to prevent skin maceration. Hyper-hydration can reach greater skin depths than previously thought, thus engendering more extensive damage potential, which in turn can impact on treatments and healing time. Realistically, the deeper the hyper-hydration issue, the more extensive the damage and it will take longer to recover—a problem compounded if the hyper-hydration is due to incontinence and skin is also exposed to urine and/or faeces. In relation to wound management, the authors advocate the removal of moisture away from the wound or skin, either through superabsorbent dressings, or by allowing the excess moisture to evaporate through semi-permeable dressings to reduce maceration, enhance patient comfort and encourage healing. However, we found no evidence regarding the limits of hydration of the dermis and epidermis and thereby the optimal conditions for managing exuding wounds and promoting skin health. Each of the six papers in this review calls for further research to help identify, treat and prevent maceration. Conclusion: Maceration causes patients' discomfort and pain as well as prolonging healing time and deserves more focused research. This rapid review highlights how limited the clinical empirical research is on identifying and managing skin maceration from an early stage so that health professionals may be better equipped to prevent it. Further clinical research is also needed to determine when levels of hydration in the skin become damaging. The small number of studies within this review show that skin maceration can be avoided, but clearer guidance is needed.

The physical and biological assessments of the innovative bilayered wound dressing made of silk and gelatin that we have developed previously were performed to evaluate its efficacy for clinical applications. The absorption ability and dehydration rate of the dressing were assessed using the split-thickness skin graft and leg ulcer wound bed models. The bioactivities of the bilayered wound dressing were evaluated. The bilayered dressing showed continuous absorption rate of wound exudate, providing the suitability for the wound with extended inflammation phase. The dehydration rate of the bilayered dressing was comparable to the commercially available dressing of which the moisture maintenance capability is claimed. The bilayered dressing showed good conformability, as can be seen by the homogeneous distribution pattern of bromophenol blue absorbed. In terms of biological activities, the bilayered dressing was less toxic to skin cells than the commercially available dressing. The bilayered dressing was also shown to promote cell migration and collagen production due to the bioactive protein components. We here concluded that the superior properties of the bilayered dressing over the commercially available dressing were the conformability and biological activities to accelerate the wound healing, while the other properties were comparable to those of commercially available dressing. The data obtained in this study would be very useful for the further evaluation of the bilayered dressing in clinical trial.

The management of wound exudate remains a clinical challenge despite technological advances in products with better exudate-handling capacities. This clinical challenge is occasionally encountered when thick exudate (viscous exudate) is present, and when most modern dressings do not possess the capabilities to manage the viscosity while enabling exudate absorption. Maceration to the peri-wound area poses another challenge, irrespective of the number of topical barrier application products on the market and the innovation of dressing products that lock exudate away or those that encourage vertical wicking. In addition to all the above, in clinical practice, the assessment and documentation of wound exudate remains sporadic, leading to the challenges of effective wound exudate dressing selection and cost-effective dressings.

A polypeptide nanofilm made by layer-by-layer (LbL) self-assembly was built on a surface that mimics nonwoven, a material commonly used in wound dressings. Poly-L-lysine (PLL) and poly-L-glutamic acid (PLGA) are the building blocks of the nanofilm, which is intended as an enzymatically degradable lid for release of bactericides to chronic wounds. Chronic wounds often carry infection originating from bacteria such asStaphylococcus aureusand a release system triggered by the degree of infection is of interest. The dry nanofilm was studied with ellipsometry. The thickness of the nanofilm was 60% less in its dry state than in its wet state. The measurements showed that a primer was not necessary to build a stable nanofilm, which is practically important in our case because a nondegradable primer is highly unwanted in a wound care dressing. Added V8 (glutamyl endopeptidase) enzymes only showed adsorption on the nanofilm at room temperature, indicating that the PLL/PLGA “lid” may remain intact until the dressing has been filled with wound exudate at the elevated temperature typical of that of the wound.

Controlling wound exudate is a common problem that has traditionally been managed by changing dressings frequently—and using dressings that were not designed for highly exuding wounds. Wound exudate can have a significant impact on a patient's quality of life and can delay wound healing ( World Union of Wound Healing Societies (WUWHS), 2007 ). It is also challenging for clinicians and can be costly in terms of clinical time and dressing cost ( Dowsett, 2011 ). Use of appropriate absorbent dressings for effective exudate management can reduce time to healing, reduce exudate-related problems such as periwound skin damage and infection, improve patients' quality of life, reduce dressing change frequency and clinician input, and so, overall, improve healthcare efficiency ( Romanelli, et al, 2009 ).

Exudate and infection are two of the key challenges facing clinicians in the management of wounds, especially chronic wounds. The associated increased use of healthcare resources and nursing time are also important consequences. What we cannot underestimate, however, is the challenge for patients and their carers of living with wounds that impact on the quality of their daily lives, causing misery and distress. This article focuses on the importance of exudate as a marker of infection and the link between the two. It looks at infection and the difficulties confronting clinicians in managing wound bioburden when sometimes the wound appears not to give any clues, or at the least, very subtle ones that could easily be missed. The pivotal role of ongoing patient assessment and wound assessment is discussed; timely intervention is seen as the key to management.

Objective: The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. Method: Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. Results: We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (pConclusion: Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.

Moisture-associated skin damage (MASD) occurs when excessive moisture in urine, stool, and wound exudate leads to inflammation of the skin, with or without erosion or secondary cutaneous infection. This article, produced by a panel of clinical experts who met to discuss moisture as an etiologic factor in skin damage, focuses on peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis. The principles outlined here address assessment, prevention, and treatment of MASD affecting the peristomal or periwound skin.

Wound exudate can have a significant impact on patient's quality of life and delay wound healing. It is also challenging for clinicians and can be costly in terms of clinical time and dressing cost. Understanding the difference between acute and chronic wound fluid is essential in order for clinicians to select the most appropriate treatment for their patients. Good patient assessment is the starting point for successful management and should include assessment of the patient, their wound and the type and amount of exudate. The management pathway should aim to address contributory factors, improve the patient's quality of life, optimise the wound bed and ensure the correct level of moisture at the wound bed. Dressings and topical negative pressure therapy are the main option for managing exudates and selection should be based on their clinical and cost effectiveness. A structured approach to exudate assessment and management as outlined in this article will help to reduce complications such delayed wound healing, prolonged treatment and patient suffering.

Chronic wounds are associated with an altered wound milieu that results from an imbalance in extracellular matrix (ECM) homeostasis. This alteration is characterized by an increased destruction and degradation of components of the ECM with a concomitant lack of synthesis of these elements. Traditionally wound fluid has been considered a reflection of the internal wound milieu. It has been used to monitor and reflect on the chronic status of a wound or to measure the efficacy of wound treatment. However, on closer inspection of chronic wound fluid, certain components of the fluid, particularly matrix metalloproteinases (MMPs) and their subcomponents (MMP-9) have been found to exist at higher levels in wound fluid than in the corresponding wound. There is mounting evidence that much of the destructive effects observed in chronic wounds may be compounded by components of the wound exudate which are corrosive in nature resulting in a continuum of ECM breakdown. Isolation of these components has identified MMPs, in particular MMP-9 as dominant in this destructive process. Additionally an association has been made between high bacterial levels and elevated MMP9 in chronic wounds. Agents that have efficacy against MMP-9 and significant antibacterial potency thus provide a dual defense against chronic wounds. It is likely that these agents cause a change in the chronic wound fluid components that more closely resemble the balance of proteases and growth factors seen acute wounds, thus triggering a positive wound healing process. Nanocrystalline silver appears to fulfill these criteria. A strategy is suggested whereby wound fluid is directly targeted to diminish the corrosive wound fluid elements in an attempt to break the ongoing destructive inflammatory cycle. This presents a relatively new treatment paradigm attempting to influence wound healing by working from without to initiate changes within.

Hyaluronate-iodine complex is a wound healing adjuvant approved for use in the European Union. The objective of this study is to validate hyaluronate-iodine as a potential wound healing agent. Patients were recruited from the hospital, the outpatient clinic, and the wound healing center. Hyaluronate-iodine soaked gauze was applied to wounds either daily or every other day depending on the amount of wound exudate. Wounds were measured weekly, and progression was documented with digital photography. All wounds were debrided as needed using standard surgical techniques. Fourteen patients (19 wounds) were entered into this prospective study, and 10 patients completed treatment. Fourteen wounds progressed to complete healing with a mean healing time of 18.1 ± 15.1 weeks. Treatment was interrupted in four patients. One patient discontinued treatment due to pain related to application of hyaluronate-iodine, another patient for transportation issues, and the other two patients were lost to follow-up due to relocation out of state and noncompliance with scheduled appointments. Hyaluronate-iodine was helpful in the healing of all types of wounds treated in this pilot study. The antiadhesive and antimicrobial properties of hyaluronate-iodine create a desirable environment conducive to wound healing without apparent detrimental effects.

Earlier in the year Wound Care published an article on dressing choice and considered the benefits of using Cutimed® Sorbact® in conjunction with the exudate management properties of Cutimed Siltec® and Cutisorb® Ultra ( Derbyshire, 2010 ). This article provides an update on the three case studies which used these products. The results of the case studies suggest that the dressings improve quality of life, enhance wound beds and help to reduce costs through factors such as reduced nursing time and fewer dressings used.

Efficient and cost-effective management of excessive wound exudate continues to present unique challenges to nurses. Accurate patient and wound assessment is essential to inform the treatment and selection of suitable dressings. The wide range of modern wound management products should be sufficient to meet the needs of every wound type at all phases of healing, and as circumstances change. However, there are still situations in which nurses are having to change dressings a number of times in 24 hours to prevent maceration (i.e. the softening and whitening of skin that is kept constantly wet), soiling, and the potential for cross-infection. There is no easy solution to the problem, but as nurses become more knowledgeable about identifying and managing the causes of excessive exudate, the available management options, and, as dressing materials become more sophisticated, practice should improve in this area.

The role of endogenous porphyrins in the effect of laser irradiation on the superoxide dismutase (SOD) activity of wound exudate and rat leukocyte activity has been studied on models of aseptic incised skin wounds. Wounds were irradiated with a He-Ne laser (632.8 nm, 1.5 J/cm2) on the 2nd, 3rd, and 4th days after the beginning of the experiment. Irradiation effects were evaluated by the SOD activity (NBT test) and the activity of leukocytes of the wound exudate (as a chemiluminescent response to opsonized zymosan). It was found that in animals subjected to laser irradiation, the SOD activity sharply increased. This effect depended on endogenous porphyrin concentration and was retained throughout the experiment. The SOD activity in unirradiated animals decreased from the 2nd to the 5th day of experiment. The evaluation of the activity of wound exudate leukocytes did not reveal any distinct dependence of the effect on the concentration of endogenous porphyrins.

The management of wound exudate can be challenging for patients and their carers. Una Adderley explains how good wound care can prevent health deterioration

The engraftment of a free skin graft introduced into an unhealing wound as a source of epithelization in combination with a transplantation of a dermal equivalent was studied in rats. The course of wound healing was estimated by changes in the activity levels of metalloproteinases (MMPs) in wound exudates. It was shown that the results of skin-graft transplantation could be predicted by monitoring changes in wound exudates MMP-2 and MMP-9 activities. It was found that engraftment of the skin graft occurred at intermediate activity values of MMP-2 and MMP-9 in the wound exudates, whereas their low and high activities correspond to lysis of the transplanted skin graft.

Skin grafting is one of the most common operations performed in plastic surgery. This is now spreading rapidly to other disciplines, but can pose a variety of wound care problems for nurses. Shearing or displacement of the graft prevents revascularization of the graft, therefore immobilization is important. An ideal dressing for a skin graft should prevent mechanical displacement, allow drainage of serous wound exudate and haematoma, and be easy and painless to change. Application of topical negative pressure (TNP) ensures stabilization of the skin graft as well as prevention of shear and seroma formation underneath the skin graft, thus preventing loss of skin graft and promoting `take`. Use of TNP ensures graft take and means that the patients do not need to go back to the operating theatre for further grafting and can be discharged earlier. This paper sets out to demonstrate the use of Wound Assist® (Huntleigh Healthcare), on newly applied skin grafts.

Effective management of wound exduate is a considerable challenge for clinicians. Treatment of the patients underlying condition, accurate assessment of the wound and exudate, as well as selection of an appropriate dressing are all important factors for success. A variety of dressings are available to the clinician for the management of exudate, but not all handle fluid in the same way. A gelling foam dressing combining foam with Hydrofiber® technology is described and the supporting evidence for its use reviewed. Versiva® XC™ dressing has some good evidence to support its use in the management of wound exudate and performs well in clinical practice.

This study investigated select vitamin and trace element loss from wound exudates in burn and trauma patients treated with negative-pressure wound therapy (NPWT).A prospective observational study was performed using wound exudate samples.A level I trauma center acute care hospital.The study was composed of 8 patients with open abdomens and 9 patients with 12 soft-tissue wounds.The goal was to collect wound exudate samples daily for 3 days, then every other day to day 9 or until NPWT was discontinued, and to analyze for vitamins A (retinol), C, and E and zinc (Zn), iron (Fe), and copper (Cu). Daily loss of each micronutrient was calculated from their concentration and 24-hour volumes of the exudates.Exudate loss in the open-abdomen group was significantly higher than in the patients with soft-tissue wounds (900 ± 547 vs 359 ± 246 mL/d). The mean 24-hour loss of vitamins A, C, and E were 0.3, 2.8, and 11 mg, respectively, in the open-abdomen group. Over the same period, the losses of Zn, Fe, and Cu were 0.5, 0.4, and 0.25 mg, respectively, in these patients. Micronutrient 24-hour loss was significantly lower in the soft-tissue wound patients than in the open-abdomen group.The data support the concept that significant amounts of micronutrients can be lost from NPWT wound exudates, particularly in open abdomens. These losses should be considered in the nutritional support of these patients who typically are in a hypermetabolic and catabolic state.

Wound healing is a normal response to injury and is initiated after the integrity of the skin has been interrupted. The management of exudate in practice can be challenging, as there are clinical situations where the patient's wound may produce copious amounts of exudate. It is therefore important that excess wound exudate is accurately assessed and diagnosed and subsequently managed effectively to relieve the significant burden it places on those who suffer with the problem. This article will look at the effect of Exufiber® in the management of three wounds with different aetiologies.

Objective: A collaborative project between Hull CHCP and Smith and Nephew wound management, which sought to enhance practice efficiency, specifically in relation to the optimisation of dressing change frequency. The project involved the use of a new foam dressing (Allevyn Life, Smith & Nephew, Hull) designed to manage wound exudate more effectively, be more acceptable to patients by masking staining of the dressing surface, and to provide both the patient and clinical staff with an indicator for dressing change. Method: The project comprised a targeted programme of training and education to promote appropriate use of the new product and encourage practice change in dressing change frequency. The frequency of nursing visits, dressing changes and, where applicable, the reasons for a dressing change were documented pre- and post-implementation to determine the effect of this approach. Results: Switching to the new dressing was accompanied by a reduction in dressing change visit frequency in 97.3% (36/37) of patients. The mean reduction in dressing change frequency was 1.8 visits per week, representing a 50.0% reduction. Post-implementation the mean number of dressings used per patient per dressing change had fallen from 2.1 at baseline to 1.1 (a 47.6% reduction). Furthermore, at baseline an average of 9.8 dressings were used per week per patient. This fell to an average of 2.0 dressings per week per patient following implementation, a reduction in dressings per patient of 79.6%. Conclusion: The results illustrate that a much less complex approach to the use of dressing products can be achieved. Furthermore, they demonstrate that with the adoption of advanced practice-enhancing products, coupled with appropriate training, education and effective promotion of practice change, valuable nursing time can be released.

This non-comparative study explored the benefits of a natural gelling fibre dressing in 10 children with epidermolysis bullosa (EB). The clinical challenge in managing these children is that they often present with recalcitrant wounds that are perpetuated by critical colonisation, presence of biofilms and infection. KytoCel® (Aspen Medical) is a highly absorbent dressing composed of natural, biodegradable acylated chitosan. These fibres bond with wound exudate to form a clear gel that locks in fluid absorbs pathogens and is conformable to the wound bed. It also has haemostatic properties. ( Dutta PK et al, 2004 ; Lee et al, 2009 ; Stephen Haynes et al, 2014 ). Factors considered were whether the dressing could aid healing, reduce bleeding, reduce bioburden, be atraumatic and comfortable during wear time and removal.

Wound healing progresses most rapidly in an environment that is clean, moist (but not wet), insulated, and protected from trauma and bacterial invasion. Selection of a dressing is based on specific wound characteristics: (1) the presence or absence of necrotic tissue, (2) bacterial load, (3) exudate volume, and (4) need for a bacterial barrier. Therefore, the optimal dressing should be able to control exudate without desiccating the wound surface; act as a bacterial barrier; allow atraumatic removal with no dressing left in the wound; and provide moisture vapor permeability sufficient to prevent overhydration of the wound and surrounding skin. There are a multitude of dressings on the market, and clinicians are frequently confused as to which type of dressing is the best for a particular wound. Effective dressing selection requires both accurate wound assessment and current knowledge of available dressings. The articles in the current supplement to the Journal of Wound, Ostomy and Continence Nursing review research about wound exudate management and the use of foam dressings.

Objective: The objective assessment of chronic wound therapies for exudate management (WRAP study) tested a variety of methods that could be used to improve understanding of dressing performance in the presence of wound exudate, including measurement of the levels of exudate production. The aim of this study was to identify a valid and reliable method of measuring wound exudate production per unit area of wound surface. Method: Two methods were tested. Method A measured the weight of exudate collected in dressings by ‘before and after’ weighing of all dressing materials that came into contact with wound exudate. Method B measured wound exudate collected as part of topical negative pressure (TNP) therapy. Results: Method A: Complete data were collected on three patients (at which point the study was halted), but it was only possible to obtain accurate measurements for two of these. Exudate production was 0.10g/cm2/24 hours and 0.21g/cm2/24 hours. It was time-consuming and required special equipment. Method B: Fifteen measurements from five patients were analysed and showed a mean exudate production of 1.3g/cm2/24 hours. Conclusion: There are problems with both methods of exudate measurement, but measuring wound fluid collected in TNP canisters seems simpler than weighing dressings and deserves further investigation. Declaration of interest: This study was part of the Wrap project and was funded by the Engineering and Physical Science Research Council.