(CS-034) Managing Maceration, Exudate, and Infection Risk: A Case Study on Super Absorbent (SAP) Dressing Strategies in a Lower Extremity Wound

The patient presented to the wound center clinic three days later with complaints of increased pain at the wound site. Upon initial assessment, the wound had moderate, copious serosanguinous drainage and 100% necrotic tissue. The decision was made to use an antimicrobial gel, a foam dressing, sharp debridement, and compression sleeve, and to order home health. The antimicrobial gel was discontinued after week one, but debridement methods and compression continued until the wound was granular. However, the patient developed a sensitivity to the foam dressing, which delayed progress in the wound healing. The foam dressing was changed to a novel, silicone super absorbent (SAP) dressing containing 1% silver. The wound was reassessed one week after the implementation of the new silver SAP use. The peri-wound maceration had resolved, skin fragility had improved, and the wound healing had recommenced. With granulation of the tissue and the risk of infection lowered, the silver SAP dressing was changed to a non-silver version of the super absorbent dressing. 100% Bovine Type I Collagen powder was also added to the wound bed to assist in wound closure progression. The patient was reassessed weekly until wound closure.


Results:

The change from a foam to a 1% silver silicone-based SAP improved the patient’s peri-wound irritation by assisting with exudate management, and resulted in wound progression. Then, the continued use of the non-silver version of the SAP-bordered dressing assisted in continued wound closure once non-viable/necrotic tissue around the wound had resolved.


Discussion:

When assessing a wound, providers need to ensure the wound bed and peri-wound tissue are addressed to prevent further wound breakdown. Although it is a standard of care, providers should consider discontinuing the use of a foam dressing when peri-wound irritation is present. This can potentially eliminate further breakdown and lead to wound improvement. Silicone-based super absorbent (SAP) dressings offer an alternative to foam and are superior regarding skin integrity protection and exudate management, with the addition of silver providing an extra level of support with infection prevention and management.