Analysis of the Benefits and Risks of Superabsorbent Dressings in the Treatment of Moderate to Highly Exuding Leg Ulcers

The Importance and Possibilities of Superabsorbent Dressings

Current systematic reviews and meta-analyses estimate that the prevalence of leg ulcers is 1.51 per 1000 individuals. For patients with moderate to highly exuding leg ulcers, it is essential to use dressings with high absorbent properties.

International guidelines for the treatment of moderate to highly exuding leg ulcers primarily recommend the application of superabsorbent polymer materials, followed by foam and hydropolymer dressings, alginates, and hydrofiber dressings. Superabsorbent polymer dressings demonstrate efficacy in inactivating matrix metalloproteinases (MMPs) in exuding ulcers. Additionally, superabsorbent polymers provide various practical benefits, such as the possibility of use under compression dressings, reduced risk of skin damage, and decreased pain during dressings changes. Moreover, superabsorbent dressings ensure optimal wound moisture.

Although many observational studies demonstrate the efficacy and safety of SAP, there is a lack of adequate professional work for a comprehensive assessment of benefits and risks that consider medium-term wound healing outcomes, adverse effects, and patients' quality of life. Therefore, the aim of the research by an international team of experts, using a decision-analytical model as a prognostic tool, was to evaluate the benefits and risks of superabsorbent polymer dressings and standard dressings (SoC—standard of care), such as antimicrobial dressings, foam dressings, alginates, and others.

Background and Objectives of the Analysis

The input data for this analysis came from studies involving clinical data on the benefits of superabsorbent dressings. This allowed the authors to create a high-quality prediction of the therapy's impact on patients' condition, including the influence on health-related quality of life. The analysis also included a qualitative description of adverse effects of the compared therapies.

The evaluation included adult patients from 2 studies who were treated for hard-to-heal leg ulcers exhibiting moderate to highly exuding activity. The main aim was to compare healing rates and the quality of life of patients with leg ulcers. Differences between the two compared groups of patients were evaluated using relative risk (RR), attributable proportion, and the QALW (quality-adjusted life weeks) indicator.

Results

According to the predictions in the presented model, superabsorbent dressings have more significant health benefits compared to standard dressings regarding healing and the QALW indicator. The difference in absolute risk in healing rates was 2.2%, and the relative risk was 1.07 in favor of SAP. Comparing SAP and SoC also showed that 6.6% of healed leg ulcer cases could be attributed to therapy using superabsorbent dressings instead of standard dressings. The difference in the QALW indicator was 0.13 in favor of SAP, which means 0.9 more days in good condition compared to standard dressings.

Adverse events could not be compared due to the lack of high-quality data. However, the authors noted that the most common adverse effects in leg ulcer therapy are tissue damage at the site and surrounding the ulcer or pain during dressing change.

Discussion and Conclusion

The findings from this work suggest that superabsorbent dressings have a better effect on wound healing compared to standard dressings in patients with moderate to highly exuding leg ulcers. The difference in absolute risk and relative risk favors superabsorbent materials, which also positively impact quality of life measured by the QALW indicator. SAP are the preferred dressing option for leg ulcers, as they absorb more exudate compared to SoC and require fewer dressing changes.

However, the analysis included only 2 observational studies and, like any similar work of this type, was created primarily for predictive purposes—to show potential benefits and risks of therapy rather than causal relationships. Although the findings from this decision-analytical model suggest that SAP provides better conditions for leg ulcer healing and improves quality of life, definitive conclusions regarding the risks of both types of dressings cannot be made due to the existing level of evidence. Systematic reviews, however, indicate that higher absorption of exudate combined with silicone materials reduces wound maceration, allows for less frequent atraumatic dressing changes, and thus improves the healing process. To confirm the findings of this predictive model and establish relevant conclusions, more well-designed studies with a sufficiently large patient sample are needed.

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Source: Velickovic V. M., Lembelembe J. P., Cegri F. et al. Superabsorbent wound dressing for management of patients with moderate-to-highly exuding chronic leg ulcers: an early stage model-based benefit-harm assessment. Int J Low Extrem Wounds 2021 May 3: 15347346211009399, doi: 10.1177/15347346211009399.