HydroClean® plus: a new perspective to wound cleansing and debridement

T he process of debridement is an important step in the preparation of the wound bed in chronic wounds. Ways in which wound debridement can be achieved include surgical, sharp, mechanical, enzymatic and autolytic debridement. Expert opinion and clinical experience suggest that removal of the material such as necrotic tissue and fibrinous slough from the surface of a wound is necessary for the preparation of the surface for healing progression to take place (Schultz et al, 2003; Wolcott et al 2012; Strohal et al, 2013). A number of clinical papers have focused on the importance of debridement in the preparation of the wound bed for subsequent healing (Kirshen et al, 2006; Marazzi et al, 2006; Ousey and McIntosh, 2010; Milne, 2015). Tissue necrosis and fibrinous slough present on the wound act as a physical barrier for wound epithelialisation. The devitalised tissue can also act as a reservoir for bacterial contamination. As well as the potential for the development of wound infection, the uncontrolled release of bacterial toxins and other irritant molecules can cause an intensification of wound inflammatory reactions, further inhibiting healing. Moist wound healing is a concept which lies at the heart of many of today’s modern wound dressings (Bishop et al, 2003; Sibbald et al, 2015). Optimising the moisture levels of the wound provides the ideal environment for wound healing to progress. One of the important advantages of an ideally hydrated wound bed is wound cleansing through the promotion of autolytic debridement. The requirements of the modern wound dressing are manifold: effective control of exudate balanced against promotion of an appropriate level of wound hydration to optimise a moist wound healing environment, promote autolytic debridement of devitalised tissue and aid its removal, as well as reduce the bacterial burden of the wound bed. HARTMANN have developed a range of dressings that can deliver or absorb moisture depending on the environmental fluid balance (i.e. hydroresponsive dressings) based upon a chemically inert superabsorbent polyacrylate (SAP) material which is ‘activated’ with Ringer’s solution (Table 1). The Ringer’s solution is made available to the wound bed and fibrinous slough coatings and necrotic tissue are softened and detached. At the same time, the SAP within the wound dressing pad absorbs bacteriaand proteinase-laden wound exudate into its absorbent core and binds it away from the wound surface (Bruggisser, 2005; Eming et al, 2008). This article describes the benefits of these hydro-responsive wound dressings.