Managing the chronic wound environment with Hydration Response Technology; Excerpt from a case study

Mr S. an elderly, obese, gentleman was admitted for assessment and management of bilateral lateral malleolar leg ulcers. The patient’s legs were grossly oedematous with virtually circumferential, severe, bilateral, sloughy, malodorous, maceration of the peri-wound skin. (Figures 1-3)

Fig. 1 Left leg Day 0		Fig. 2 Close-up of Left lateral malleolus

The production of exudates was unrelenting so that dressings and bed linen required at least daily changes and sometimes night changes as well. Dressing change took more than an hour each time to complete, often requiring the assistance of a second nurse.

If a (chronic) wound is to make progress then the barriers to healing need to be identified and addressed. The persistent inflammation that is found in chronic wounds is a consequence of elevated levels of pro-inflammatory cytokines, proteases and neutrophils². This is often accompanied by elevated production of exudate. The high levels of exudate combined with the pro-inflammatory mediators result in a detrimental effect on healing, including wound enlargement and damage to the peri-wound skin such as maceration and excoriation³. It has been suggested that the wound bed preparation (WBP) model may assist in overcoming these barriers to healing when targeted therapeutic measures are initiated¹.

Hydration Response Technology

A recent publication by Evans4 shows how sorbion sachet S utilises the concept of Hydration Response Technology (HRT) and specifically its value in managing infection in a recalcitrant pressure ulcer. Hydration Response Technology was created specifically to meet the challenge of wounds which produce moderate to high levels of exudates.

Clinical performance and related evidence

Hydration Response Technology using sorbion sachet S enables effective wound bed preparation and can lead to a significant reduction of overall treatment costs^4,5,6,7. Efficient management of exudates extends beyond mere absorption and includes,:^{4, 5, 8, 9}

* extended dressing wear time5,6,7 * excellent fluid retention properties5,6,7 * dressing form stability ensuring wound edge protection, * Matrix metalloproteinases (MMP) modulation avoiding extracellular matrix (ECM) degradation, * bacterial sequestration (immobilisation), lowering the bacterial burden, * maintenance of hydro-balance avoiding too wet or too dry interface even under compression * debridement of moist devitalised tissue on the wound surface and improvement in quality of life5,6

Table 1

Read the full article and see more photographs of the progress of this gentleman’s leg ulceration in Sharp C.A. Managing the wound environment with Hydration Response Technology. Wounds UK 2010 Vol 6, No 2 and on the website http://www.sorbion.com/en/clinical-data/

References

1. Schultz GS, Barillo DJ, Mozingo DW, et al. Wound bed preparation and a brief history of TIME. Wound Repair and Regeneration 2004; 1(1):19-32.

2. Wolcott RD, Rhoads DD, Dowd SE. Biofilms and chronic wound inflammation. Journal of Wound Care 2008; 17(8):333-341.

3. Nelson A. Is Exudate a Clinical Problem. In: (Eds.) Cherry, G., Harding, K. Proceedings, Joint Meeting, European Wound Management Association and European Tissue Repair Society. Management of Wound Exudate. London:. Churchill Communications Europe 1997.

4. Evans J. Hydration response technology and managing infection. Journal of Community Nursing 2010; 24(1):15-16.

5. Romanelli M, Dini V, Bertone M. A pilot study evaluating the wound and skin care performances of the Hydration Response Technology dressing: a new concept of debridement. Journal of Wound Technology 2009; 5:1-3.

6. Chadwick P. The use of sorbion sachet S in the treatment of a highly exuding diabetic foot wound. The Diabetic Foot Journal 2008; 11(4):183-186.

7. Cutting KF, Acton C, Beldon P, et al. Clinical evaluation of a new high absorbency dressing. EWMA conference, Lisbon 2008; 14-16 May.

8. Cutting KF. Managing wound exudate using a super-absorbent polymer dressing: a 53-patient clinical evaluation. Journal of Wound Care 2009; 18(5):200-205.

9. Armitage M, Macaskill C. Simplifying the management of complex chronic leg ulcers. Poster presentation – Wounds-UK 2009; Harrogate.