Wounds exudate removal

A topical enzyme aids in the removal of dead soft tissues by hastening the reduction of proteins into simpler substances. This is called proteolysis or a proteolytic action. The components of certain types of wounds, namely necrotic (dead) tissues and purulent exudates (pus-containing fluid), prevent proper wound healing. Removal of this type of debris by application of a topical enzyme aids in healing. Examples of conditions that may respond to application of a topical enzyme include second- and third-degree bums, pressure ulcers, and ulcers caused by peripheral vascular disease An example of a topical enzyme is collagenase (Santyl). 

The red gum tree of the southern United States exudes a yellowish balsamic liquid or gum from wounds, which is known as storax. It is produced by removing a section of bark and incising the wood in much the same manner as that used for the production of naval stores gum described above. Storax is used in medicinal and pharmaceutical preparations, such as adhesives and salves, and as an incense, in perfuming powders and soaps, and for flavoring tobacco. 

The dextranomer is supplied in beads of 100-300 pm diameter containing poloxamer 187, polyethylene glycol 300, and some water. A paste formulation is also available which is the dextranomer in polyethylene glycol 600 (PEG 600). The beads are offered as a discrete particle or enclosed in a low adherence pouch for insertion into a cavity wound. One company (Pfizer) offers a polymeric net which can be placed into a cavity wound before the addition of either granules or paste and facilitates removal and also a vapor permeable film which is superimposed on the dextranomer dressing to control evaporation and retard drying in a low exudating wound. 

The formed colloidal gel also produces a sorption gradient for soluble components within the serous exudate thereby allowing the removal of toxic compounds arising from bacterial or cellular destruction. However, during use, the dressing in contact with the wound liquefies to produce a pus-like liquid with a somewhat strong odor. 

Sheet formulations may be applied to exuding lesions including leg ulcers, pressure areas, donor sites, and most other granulating wounds, but for deeper cavity wounds and sinuses the ribbon packing is generally preferred. The dressing is easy to remove without causing pain or trauma, and leaves minimal residue on the surface of the wound. " ... 

Dressings for human wounds are designed to protect, remove exudates, inhibit exogenous microorganism invasion and improve the appearance of the wound. A normal bioactive wound dressing should fulfil several criteria for its optimal function (a) biocompatibility in the absence of cytotoxicity (b) easily applied to the wound... 

The care and treatment of wounds are matters of clinical judgement. The wounds should first be examined, to determine the amount of exudate and infection that exists. In addition, the surrounding tissue should be assessed to establish the extent of ulceration. The first stage of treatment (debridement) often requires the removal of foreign material and dead tissue from the wound, in order to prevent infection and promote healing. Subsequent... 

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