Evaluation of a chitosan dressing in the management of hard-to-heal wounds
It is vital that as tissue viability teams, we are constantly striving to improve service delivery, healing rates and positive patient outcomes. In 2021 the author's team were introduced to a unique bioactive microfibre gelling (BMG) dressing, MaxioCel®, which uses chitosan to maintain a cohesive structure to increase fluid handling, antimicrobial and wound-healing properties. Method: Following Isle of Wight NHS Foundation Trust guidelines and with patient consent, 11 patients with chronic wounds of various aetiologies and wound durations were enrolled in a multicentre, clinical 4-week evaluation. Results: Over a 4-week evaluation period, all patients showed a significant improvement in wound healing parameters including average tissue type, condition of periwound skin, patient comfort, exudate levels. The assessments demonstrated a significant decrease in necrotic and sloughy tissue (from >75% at the start of treatment), replaced with healthy granulation and epithelial tissue (>80% by week 4). Significant reduction in pain score was also reported in all patients, with average pain score at the start of the evaluation reducing from 5.8 ± 2.7 to a score of 2.5 ± 1.9 within 3 weeks. Conclusion: The complicated wounds seen in this study were previously non-healing and MaxioCel, with BMG technology, demonstrated both significant clinical improvement and a positive impact on patient quality of life within just 4 weeks, resulting in its addition to the team's woundcare formulary.
The management of chronic or hard-to-heal wounds such as pressure ulcers, lower limb diabetic or venous ulcers, or wounds stalled in their healing trajectory such as open trauma or some surgical wounds, is an ever-increasing challenge. Although there is the financial burden to the NHS, hard-to-heal wounds taking a protracted period to heal often result in long-term morbidity for patients, negatively impacting on their quality of life (Guest et al, 2015; Guest, 2021; Sen, 2021). The cost of wound care to the NHS across the UK, originally suggested as comparable to the management of obesity in 2012/13 (£8.3 billion) (Guest et al, 2020), has now overtaken obesity costs and is approaching the combined cost of managing osteoarthritis and rheumatoid arthritis (£10.2 billion in 2017) (Guest, 2021). Dressings remain the mainstay and most accessible option for the management of hard-to-heal wounds. It is therefore important that clinicians have access to dressings that can be effective in wound progression while ensuring that patient comfort and quality of life remain acceptable.
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