Sorbion sachet S: clinicalapplication and resultsSorbion sachet S was designed to bestow a range of clinical advantages across anumber of indications, particularly in moderately to highly exuding wounds. Thispaper explores the evidenceMartyn Butcher, Independent Tissue Viability Consultant, Plymouth, UKThe large volume of exudate generated by manychronic wounds, and the ensuing fluid-handlingchallenges, are discussed in the two precedingpapers. Management can be problematic,with fluid harbouring bacteria 1 and containingharmful compounds such as matrix metalloproteases(MMPs), 2 which contribute to wound chronicity. 3-5Exudate can also damage periwound skin, causingmaceration 6,7 and subsequent wound extension.To effectively manage exudate, a <strong>dressing</strong> shouldtherefore protect the wound edges, remove harmfulcompounds and microbes from the wound surface(via MMP modulation and bacterial sequestration)and promote autolytic debridement, all the whileproviding a moist, healing environment. This will, inturn, improve the patient’s quality of life.Sorbion sachet S is specifically designed to achieveall of these goals as a primary <strong>dressing</strong>, as Whiteexplains in the previous paper. The theoretical argumentsfor its use in managing both acute and chronicwounds are compelling. However, practitioners musthave the opportunity to appraise the clinical evidenceif its use is to be integrated into clinical practice. It isworth considering the key <strong>performance</strong> indicators ofthe product: exudate management, wound edge protection,MMP modulation, bacterial sequestration,debridement and impact on the patient’s quality oflife. In many cases, the multiplicity of product actionsis clearly demonstrated through the results obtained.Managing exudate and protectingthe wound edgeOne valuable function of Sorbion sachet S is its effectivemanagement of wound exudation. Throughoutnumerous case studies and clinical evaluations, frequentreference has been made to its ability to rapidlydraw excess fluid away from the wound surface, lockingit into the <strong>dressing</strong> matrix. This prevents soilingof outer <strong>dressing</strong>s and bandages, reduces the need forfrequent <strong>dressing</strong> changes and prevents macerationof the periwound tissues.A case study by Sharp demonstrates the benefits ofthe product in the management of wound exudate. 8She describes an elderly, obese gentleman withgrossly oedematous legs and virtually circumferential,bilateral ulcerations, who had been admitted forwound assessment and management.These ulcers had been present for three years andwere highly exuding. <strong>Wound</strong> management had beena major problem: <strong>dressing</strong> changes took at least onehour to complete, often requiring the assistance of asecond nurse. The highly absorbent <strong>dressing</strong>s previouslyused, including gauze, foams, non-adherentpads and a non-specific ‘super-soaker’, had beenineffective, and extensive excoriation of the periwoundskin had been observed.Sorbion sachet S <strong>dressing</strong>s were applied frombelow the knees to toes and kept in place with crepebandages as compression bandaging could not beused. The first <strong>dressing</strong> applied needed changingafter 48 hours and, on removal, the periwound skinmaceration was noticeably reduced and appearedless red and inflamed. The exudate had been efficientlyabsorbed and retained within the <strong>dressing</strong>s.By day 4, the dorsum of each foot was free ofexcess moisture and within 14 days the wounds hadmade such good progress that the <strong>dressing</strong> was nolonger clinically indicated. The reduction in <strong>dressing</strong>change frequency meant that nursing time wasalso reduced.Cutting , in a product review of Sorbion sachet S,cited the case of an 80-year-old female with longstandingvenous leg ulcers (VLUs) that had failed torespond to foam <strong>dressing</strong>s under graduated compressionbandages. 9 Despite twice weekly <strong>dressing</strong>changes, she had extensive excoriation and macerationof the medial ankle and foot.Four weeks of treatment with Sorbion sachet Sresulted in a vast improvement of the periwoundskin, which was no longer macerated, and improvementsin the condition and size of the ulcer (reducedfrom 3.5 x 2cm to 3.0 x 1.5cm).1 4J O U R N A L O F W O U N D C A R E S O R B I O N S U P P L E M E N T 2 0 1 0
Fig 1: Poor exudate control has resulted in an increase inthe wound size and periwound macerationA 10-patient study of the use of Sorbion sachet Sto achieve wound bed preparation was undertakenin the US. 10 The average age was 66.3 years (range:33–92). A total of 16 lesions were treated with theproduct: nine pressure ulcers, four VLUs, two casesof wound dehiscence and one case of pyodermagangrenosum. The average wound duration was24.5 months (range: 1–96). On enrolment, the averagesurface area was 131.1cm 2 (range: 2.86–624).Patients were treated with the Sorbion <strong>dressing</strong>for a mean of 23.1 days, during which 164 <strong>dressing</strong>procedures were performed. Dressing <strong>performance</strong>criteria investigated included pain, debridement,wound reduction and healing. During the study,exudate handling was scored as excellent or goodin 91% of all cases, adequate in 8% and poor in0.5%. There was a regular and sustained reductionin maceration and in 100% of all <strong>dressing</strong> changesSorbion sachet S was considered easy to remove.A case study taken from this evaluation demonstratedthe success of this product. A 94-year-oldfemale enrolled into the trial had a non-specificulcer on the left medial ankle of three years’ duration.The ulcer had been triggered by a traumaticinjury and was complicated by rheumatoid arthritis.Treatment with absorbent <strong>dressing</strong>s (alginates,Hydrofiber, foams), external compression and thedaily use of an external pneumatic compressiondevice failed to promote healing. In fact, the ulcerhad increased in size, with a surface area of 25cm 2 ,Table I. <strong>Wound</strong> aetiology and durationFig 2: Resolution of maceration and complete ulcerhealing 12 weeks after initiation of Sorbion sachet Sand the periwound skin was compromised (Fig I).Management with Sorbion sachet S was initiatedto control exudation and minimise periwoundmaceration. The <strong>dressing</strong> was combined with supportstockings and vasopneumatic compression,both of which had been used beforehand. The ulcerand periwound skin improved rapidly and, at 12weeks, the wound had completely re-epithelialised(Fig 2).Chadwick reported on the treatment of a 64-year-old patient with a highly exuding diabeticulcer following a forefoot amputation. 11 The woundhad been present for nearly one year. Here, thechallenge was not only to manage exudate levelsand prevent periwound maceration and excoriation,but also to find a product capable of retainingthe fluid taken up, even during weight-bearing.Although the patient was fitted with total contactcasts and total contact insoles, it was impossible tocompletely eliminate load from the wound area.This, combined with limb dependency and excessiveexudation, made management difficult andcaused rapid soiling of his orthotic devices.Changing the <strong>dressing</strong> regimen to Sorbion sachetS brought about major changes to the patient’swound status. Soiling ceased to be a problem, exudatelevels were well managed and it was possibleto reduce the frequency of <strong>dressing</strong> reapplicationfrom daily to twice weekly. By week 12 the woundhad healed completely and it remains healed.<strong>Wound</strong>duration(weeks)<strong>Wound</strong>s with high level of exudate on enrolmentAbdominaldehiscenceDiabetic footulcerVenous legulcerPressure ulcerVein graftdonor site0–6 1 - 2 2 - 56–12 - - - 1 - 1>12 - 2 28 5 1 36Total 1 2 30 8 1 42J O U R N A L O F W O U N D C A R E S O R B I O N S U P P L E M E N T 2 0 1 01 5
Change language