Evaluation of UrgoClean® for the treatment of sloughy, exuding wounds

Slough covering the surface of a wound is formed of dead tissue, fibrin, fibrinogen and proteins that may have contributed to the healing process (Gray et al, 2010). It can adhere to the wound surface and be difficult to remove. Slough can act as a growth medium for bacteria, inhibit angiogenesis, extra cellular matrix formation and the progression of keratinocytes across the surface of a wound (Wounds UK, 2013). Therefore clinicians should aim to remove slough as quickly as possible with the least amount of trauma to the patient. Approaches to the removal of slough include sharp or surgical debridement, bio-surgery and use of dressings that create a moist environment and promote autolysis. These can take time and the process needs to be carefully monitored as excess fluid can result in maceration and excoriation of the skin surrounding a wound. Exudate, containing water, nutrients and inflammatory mediators is greatest during the inflammatory stage of healing. This plasmalike fluid normally reduces as the inflammation subsides and the wound begins to granulate (World Union of Wound Healing Societies, 2007; Tickle, 2013). However, excess exudate production can occur in systemic illness, where haemostasis is disrupted, in the presence of bacteria and when poor venous return causes vessels to distend (Hampton, 2004). Its composition alters with MMPs and other degradatory, proteolytic enzymes increasing in numbers (White and Cutting, 2006). Maceration and erosion of the skin surrounding the wound can occur, this is painful and distressing to patients and causes the wound to increase in size. The best approach to reducing exudate is to identify and address the underlying cause. Topical management of the wound requires a dressing that will absorb exudate and hold it away from the skin’s surface. These include topical negative pressure, super absorbent dressings, alginates, hydrofibres and foams. While exudate is generally thought to promote removal of non-viable tissue persistent slough can exist on an exuding wound, and, as prolonged presence of slough stimulates bacterial infiltration and an inflammatory response, exudate production can increase (Figure 1). This poses a challenge for nurses aiming to soften and remove slough without increasing the risk of damage to the wound and surrounding skin. Practitioners need to assess what is required for healing and balance the desired outcomes with unwanted consequences of any intervention (Hampton, 2004). Using the right product is important, inappropriate use of a dressing will not achieve the right results for the patient, practitioner and manufacturer (Anderson, 2002), as healing will not be achieved and the product will wrongly be viewed as ineffective.