Case StudiesCase series evaluation: the use of Durafiber on exuding wounds

Case series evaluation: the use of Durafiber on exuding wounds

Exudate Management, Leg Ulcers, Pressure Ulcers, Research, Skin integrity

Case series evaluation: the use of Durafiber on exuding woundsThis article presents a series of case studies into the efficacy of a new dressing that seeks to control wound exudate, as well as reducing pain on removal and increasing conformability.

Click here to download a PDF version of these studies. 

Healthcare professionals continue to encounter patients whose lives are adversely affected by wounds, both in the acute sector and increasingly in the community, where treatment is being driven by government initiatives seeking to offer patients more choice about where they receive care (Department of Health [DoH], 2006; 2009).

Wound care as a specialty is high on the UK government agenda at the moment, with pressure ulcers in particular being targeted as a marker of poor care by the NHS's High Impact Actions campaign (NHS Institute for Innovation and Improvement, 2012). Similarly, the government's Any Qualified Provider (AQP) programme specifically targets leg ulcer and wound healing services as areas where care can be improved (DoH, 2012).

As well as the impact of wounds on patients' quality of life, they are also a drain on resources - wound care is estimated to cost the NHS £1.4-£2.1bn each year, representing up to 4% of total NHS expenditure (Dowsett and Shorney, 2010).


One element of wounds that clinicians can find particularly difficult to manage is exudate, partly because of the challenge of absorbing the copious amounts of fluid produced by some wounds, plus the harmful bacteria and enzymes contained within wound fluid (World Union of Wound Healing Societies [WUWHS], 2007).


Pain is also a problem at dressing change, with patients often complaining about trauma when dressings are removed, having adhered to the wound bed and edges (Finnie, 2004).
This article presents a series of case studies into the efficacy of a new dressing that seeks to control wound exudate, as well as reducing pain on removal and increasing conformability.


EXUDATE
Exudate is fluid that has leaked from the circulatory system and is comprised of a range of substances including electrolytes, water, nutrients, inflammatory mediators, white cells, enzymes (e.g. matrix metalloproteinases [MMPs]), growth factors and waste products (WUWHS, 2007).


When the skin integrity is breached through trauma, the body initiates an inflammatory response. Mediators involved in inflammation, such as histamines, increase the permeability of blood vessels and the excess fluid produced enters the wound where it forms the basis of exudate.

Although a certain amount of exudate and a moist wound environment are necessary to a healing wound, stimulating cell proliferation for example, an excess of fluid in chronic wounds due to ongoing inflammatory or other processes can have an adverse affect on healing. This is because the exudate may contain high levels of inflammatory mediators and activated MMPs, which can actually begin to break down the cell-supporting extracellular matrix before it has a chance to heal the wound.

Excess exudate production can also present a management problem for clinicians and carers, necessitating frequent changes due to dressings becoming saturated with fluid.


PAIN

Certain dressings that have been used in the past, such as gauzes and paraffin tulles, and dressings that contain adhesives, accentuate pain at dressing change as they can become attached to the wound bed, causing trauma on removal (Finnie, 2004). It is important that clinicians work with patients and carers to minimise pain on dressing change, a process that can be aided by the selection of specifically designed dressings, such as those that form a gel on contact with the wound bed, thus making removal less traumatic.

Wounds that produce an excess of exudate are also at risk of maceration at the periwound area (Cooper et al, 2006). This is where the skin begins to break down through exposure to continual moisture.

 

WHAT IS DURAFIBER®?

Durafiber® (Smith & Nephew) is a highly absorbent, non-woven, gelling fibre dressing composed of a blend of cellulose-based fibres. When the dressing fibres come into contact with exudate, they swell and form a soft cohesive gel sheet. Exudate is locked within the gel dressing structure. It is designed for use in the management of medium to heavily exuding chronic and acute full thickness, partial thickness or shallow granulating wounds.

Durafiber has the following properties:

  • Provides long-lasting dressing integrity and gelled strength (Smith & Nephew, 2010a). Also provides easy one-piece dressing removal and minimises the risk of leaving dressing residue, which may lead to quicker, more comfortable dressing changes for the clinician and patient (Foster and Moore, 1997; Smith & Nephew 2010a)
  • High absorbency: provides excellent fluid management and is able to remain in place for up to seven days (Smith & Nephew, 2010a)
  • Minimal dressing shrinkage - for sustained wound bed coverage (Smith & Nephew, 2010a)
  • The absorbent properties of the dressing mean that it locks in fluid, helping to remove excess exudate and bacteria from the wound bed and potentially reducing the risk of cross contamination on dressing removal (Smith & Nephew, 2010a; Smith & Nephew, 2010b; Smith & Nephew, 2010c)
  • Controls the lateral wicking of fluid - this minimises the risk of periwound maceration (Smith & Nephew, 2010d)
  • Forms a soft cohesive gel sheet on contact with wound fluid, conforming closely to the wound bed and helping to promote a moist wound environment (Smith & Nephew, 2010e; WUWHS, 2007).

 

Durafiber is indicated for use in exuding acute and chronic wounds.
Whilst Durafiber assists the management of wounds prone to bleeding, it is not intended for use as a surgical sponge in heavily bleeding wounds and should be discontinued if reddening or sensitisation occurs.


Durafiber is available in a range of sizes:

  • 5 x 5cm
  • 10 x 10cm
  • 15 x 15cm
  • 4 x 10cm
  • 4 x 20cm
  • 4 x 30cm
  • 2 x 45cm.


CASE SERIES
The primary objective of this case series was to evaluate the overall acceptability of Durafiber to a number of patients with a variety of different wound types by clinical staff.
In each case, the clinician used Durafiber on an exuding wound, including leg ulcers (under multi-layer compression), pressure ulcers, diabetic foot ulcers or cavity wounds.
All clinicians taking part in the evaluation were offered specific guidance on the recommendations for use of the dressing, in accordance with the indications in the product insert leaflet and patients were treated in accordance with the instructions for use.
The objective in each of these case studies was to assess the ease of use, exudate handling and conformability properties of Durafiber.


Exclusion criteria
Patients were excluded from this evaluation if they demonstrated the following:

  • Subjects under 18 years of age
  • Any pregnant woman
  • Patients who were unable to understand/unwilling to take part in the evaluation
  • Subjects with a history of skin sensitivity to any of the components of the series product.
  • Subjects whose wounds were clinically infected or erysipelas, exhibited malignant changes, or who have had recent deep venous thrombosis or venous surgery within the last three months
  • Subjects who have progressive neoplastic lesion treated by radiotherapy or chemotherapy, or ongoing treatment with immunosuppressive agents or high dose corticosteroids
  • Patients with a necrotic wound

Throughout the series, 10 cases were completed in total from three different centres. The four cases considered the most representative are presented in detail below, with results from these and the remaining six cases collated in Table 1.