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Exudate Management in Acute and Chronic Wounds

While the level of expertise and judgment of wound care professionals plays a significant role in the selection of wound dressings for managing drainage, decisions should, nonetheless, be evidence-based. This article discusses the most crucial considerations for choosing wound dressings. It also outlines the best products for managing various kinds of wounds. 

What is Wound Exudate?

Wound exudate refers to the transparent, semi-opaque, or colored liquid produced from a wound bed as part of the natural healing process which provides essential nutrients, leucocytes, growth factors, and moisture to prevent the wound from drying out. In a previous article, we defined the various kinds of exudate produced from acute or chronic wounds. It was also noted that sustained or excessive or malodorous drainage indicates problems that may slow the rate of healing. Wounds prone to high levels of drainage include diabetic foot ulcers, venous insufficiency ulcers, post-operative dehisced wounds, and donor sites. 

Factors that contribute to a higher volume of drainage in chronic wounds include:

  • Edema
  • Increased bioburden
  • Size and depth of the wound
  • Additional trauma to the wound bed
  • Underlying medical conditions (e.g., diabetes, renal failure, hepatic failure, etc.)
  • Use of certain medications (e.g., NSAIDs)

Why Exudate Management is Essential

Wound drainage that is not managed adequately may result in a host of problems that affect the rate of healing as well as a patient's satisfaction and confidence in the treatment. Heavy drainage may cause maceration, excoriation, malodor, and provide a viable environment for the growth of bacteria if not regularly absorbed from the wound bed. 

Choosing The Proper Wound Dressing

A holistic assessment is required to choose the most suitable and cost-effective dressing to manage wound exudate as it can have a significant impact on the healing process. Some considerations include:

  • Wound etiology (was it caused by trauma, a surgical procedure, or chronic disease? A comprehensive investigation should be carried out to confirm the diagnosis)
  • The location of the wound (is ulceration present on the toes, sides, or bottom of the foot, etc? Note the anatomy of the wounded body part to choose a dressing that provides optimal comfort, especially if the patient is ambulatory) 
  • The amount of exudate produced (does the patient have a low, moderate, or heavy-draining wound?)
  • Is there bacterial colonization or infection in the wound? (the presence of infection may require the use of topical antiseptics or 
  • Is compression necessary? (chronic wounds, such as venous ulcers will require compression to reduce constriction in the vein walls)
  • The shape and size of the wound
  • Condition of the wound bed and periwound skin
  • Any known sensitivity to certain materials used to design the dressings 

How Much Absorption is Needed?

Wound care professionals must always consider the absorptive properties of the available dressing types for adequate management of exudate. It is important to verify any claims made by manufacturers about the efficacy of their products. 

Wound Dressing Types for Exudate Management

There are a wide variety of dressings available for exudate management, including foam dressings, alginate dressings, interactive dressings, and hydrocolloids. Below is a closer look at each of these dressing types and their benefits and disadvantages. 

Foam

Foam dressings are ideal for moderate to heavily draining wounds. These types of wound dressings are highly absorbent and can be removed from ulcers with minimal trauma. They can also be conformed to any body part and include borders that adhere to periwound skin. Foam dressings help provide a moist environment for wound healing. The main disadvantage of using foam dressings is moisture-associated skin damage (MASD) when the dressing is saturated. Thus they must be monitored and changed often. 

Alginates

Alginate dressings are biodegradable materials derived from seaweed that are ideal for heavy drainage wounds. Alginates are highly absorbent materials (up to 20 times of weight in exudate) available in a variety of shapes and sizes. In heavy drainage wounds, calcium ions in the alginate combine with sodium ions of exudate to form a gel. Note that the use of alginate dressings must be avoided in low drainage wounds as they tend to harden into a plug and stick to the wound causing trauma on removal. Sometimes, it may be necessary to cut alginates to fit the size of the wound to prevent maceration of periwound skin. 

Hydrocolloids

Hydrocolloid wound dressings are ideal for low to moderate drainage wounds owing to their moisture-donating properties. Like alginates, hydrocolloids have gel-forming properties. A key advantage of this dressing type is its waterproof backing, which aids visual inspection of the wound and also prevents strikethrough (exudate escaping through the dressing that creates a path for bacteria to reach the wound bed). However, great care should be taken using hydrocolloid dressings on diabetic foot wounds. In this case, they should be applied where the ulcer shows no signs of infection or ischemia with only low to moderate exudate and should be changed frequently.