The Use of a Novel Superabsorbent Dressing to Optimize Healing with Skin Substitute Grafts

Introduction: The BIOMES framework (Blood Flow, Infection Control, Off-Loading, control of Metabolic/co-morbidities, management of Exudate/moisture/bioburden, and understanding of the patient’s Social/economic barriers) helps identify early signs of chronicity in wounds. When evaluating the suitability of skin substitute grafts for chronic non-healing wounds, addressing the BIOMES criteria is essential. Effective management of exudate and bioburden, as well as preventing peri-wound maceration, is crucial when applying grafts. The use of dressings that shift biomarker patterns towards normal wound healing can significantly impact hard-to-heal wounds.Methods:This case series examines the state of chronicity in a hard-to-heal wound using the BIOMES framework. Focusing on a diabetic patient with a trans-metatarsal amputation, this study highlights the importance of managing moisture, wicking away harmful matrix metalloproteinases (MMPs), and protecting the wound while using a skin substitute product. The early implementation of a novel superabsorbent dressing* as part of the wound care protocol is explored, sharing experiences and patient outcomes throughout the various phases of wound healing.Results:The novel superabsorbent dressing proved to be an excellent fit for the treatment plan, optimizing the wound for a skin substitute graft. It protected the graft from excessive exudate, harmful MMPs, and trauma. The dressing’s unique combination of loose cellulose and superabsorbent polymers provided comfort and securely trapped exudate, even under compression. Throughout the treatment timeline, there was no incidence of peri-wound maceration, and the dressing did not adhere to the wound upon removal.Discussion: Skin substitute grafts are highly effective for healing chronic diabetic lower extremity wounds but are costly. Therefore, managing exudate, bioburden, and infection prior to graft placement is essential. Preventing peri-wound maceration, minimizing the harmful effects of MMPs, and protecting against further trauma, particularly in patients with diabetic neuropathy, ensures the best outcomes with skin substitute grafts. The use of a novel superabsorbent dressing can play a pivotal role in achieving these goals.References: Brookshier, T. U. (2024, May). BIOMES A New Tool for Early Recognition of Chronic and Non-Healing Wounds. Orlando, FL: SAWC Spring Conference 2024. Carter M, D. J. (2023). Chronic wound prevalence and the associated cost of treatment in Medicare beneficiaries: changes between 2014 and 2019. JOURNAL OF MEDICAL ECONOMICS, 26(1), 894-901. Garten, A., Smola, H. B., Carr, M., Dumas, F., Schäfer, J., Trouth, S., . . . Willilams, L. G. (2023). Wound Balance: Achieving Wound Healing with Confidence. Wounds International, 1-16. (n.d.). World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound exudate: effective assessment and management Wounds International, 2019 Atkin L, B. Z. (2019). Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care, 28(3 Suppl 3), S1–S49.