Fenestration: An Opening in the Wound Care Market

Disclaimer: The following text includes information pertaining to advanced wound care products. The inclusion of this information within the text below is primarily for educational purposes.

There are many local and systemic factors that affect the body’s natural, complex, wound resolution process. These factors include wound size, location, presence of infection, sustained pressure, excessive moisture, and metabolic disorders.1 Successful wound healing involves eliminating any confounding or contributing factors and providing an optimal environment for granulation formation.2,3 A one size fits all approach doesn’t apply in the realm of wound care. Advanced wound care products exist in a variety of shapes, sizes, and configurations. Each of these variations serves an important purpose in addressing the unique requirements of different wound types. The focus of today’s post is on fenestrated wound care products, which may be advantageous when addressing the needs of wounds that produce high levels of exudate.

What is wound exudate? Why too much of a good thing can be a bad thing.

When an injury occurs, the body’s innate inflammatory response is initiated. This intrinsic response involves the breakdown of tissue and the clean-up of debris. During the inflammatory phase, the capillaries in the surrounding tissue have increased permeability, allowing fluid to leak and enter the wound.4 This fluid, or exudate, often has a negative connotation; however, it has an essential role in the body’s inherent ability to resolve wounds. Exudate consists of substances such as water, electrolytes, nutrients, inflammatory mediators, white cells, protein-digesting enzymes, growth factors, and waste products. Exudate prevents the wound bed from drying out, aids in the migration of cells, and provides essential nutrients and growth factors needed for healing.4 In a typical progressing wound, exudate production decreases over time. If a wound continues to produce high levels of exudate, and that exudate is not able to drain, a slew of problems may arise.

Figure 2

For example, the body’s inflammatory mediators and enzymes that are helpful in the initial stages of inflammation can become detrimental to the healing process when present in the wound in large quantities for too long.4 High volumes of exudate can cause the wound bed to become moisture laden. If exudate is trapped under the dressing, it may cause the skin to soften and break down, an occurrence known as maceration.5 Maceration can have negative effects by prolonging the inflammatory process and causing enlargement of a wound. The presence of macerated tissue can lead to infection which can result in major amputations or life-threatening conditions.5 Exudate can also have a negative effect on a patient’s quality of life. It can lead to malodor, social embarrassment, the soiling of clothing or bedding, and patient discomfort.6 Effective wound management must keep the wound at an optimal moisture level and find the balance between achieving a moist but not macerated wound bed. This can be done by addressing the underlying causes of exudate production (Table 1) and by making appropriate dressing selections.

Table 1: Factors that may increase wound fluid production. Adapted from “Wound Exudate and the Role of Dressings”4

What is fenestration? How a simple solution can address a complex problem.

The word fenestrate is derived from the Latin term “fenestratus” which means “provided with openings.”7 In medicine, it refers to the surgical creation of a new opening.8 In the context of advanced wound care, fenestrated products provide an opening, through which exudate can drain. It should be noted that in addition to fenestrations, there are various other product formats, such as perforations and expandable matrices; these are manufactured using different production techniques and create an outlet for wound fluid (Table 2). Fenestrations in advanced wound care products are created by making a cut through the full thickness of the sheet. These cuts allow exudate to drain from the wound. By draining excess exudate from the wound through channels of a fenestrated product, complications associated with high levels of exudate may then be avoided, thus increasing the likelihood of improved patient outcomes. Fenestrated products provide a simple solution to healthcare providers who consistently face challenges associated with highly exudating wounds.

Table 2: Types of Openings in Advanced Wound Care Products

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1. Labib, A. M., & Winters, R. (2022). Complex Wound Management. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK576385/ 2. Wound Assessment—StatPearls—NCBI Bookshelf. (n.d.). Retrieved September 2, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK482198/ 3. Zhao, R., Liang, H., Clarke, E., Jackson, C., & Xue, M. (2016). Inflammation in Chronic Wounds. International Journal of Molecular Sciences, 17(12), 2085. https://doi.org/10.3390/ijms17122085 4. Would Exudate and the Role of Dressings. (2008). International Wound Journal, 5(Suppl 1), iii-NaN12. https://doi.org/10.1111/j.1742-481X.2008.00439.x 5. Haryanto, H., Arisandi, D., Suriadi, S., Imran, I., Ogai, K., Sanada, H., Okuwa, M., & Sugama, J. (2016). Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: A prospective study. International Wound Journal, 14(3), 516–522. https://doi.org/10.1111/iwj.12638 6. Adderley, U. (2008). Wound Exudate: What it is and how to manage it. Wound Essentials. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiBxYyiq_b5AhXVk2oFHXiEBTMQFnoECAgQAQ&url=https%3A%2F%2Fwww.wounds-uk.com%2Fdownload%2Fresource%2F1093&usg=AOvVaw0dPLJkpgbntJA6hppHDOxk 7. Oxford University Press. (n.d.). fenestrate etymology. Oxford English Dictionary. Retrieved September 1, 2022, from https://www.google.com/search?client=safari&rls=en&q=fenestrate+etymology&ie=UTF-8&oe=UTF-8 8. Publishers, H. (n.d.). The American Heritage Dictionary entry: Fenestration. Retrieved September 1, 2022, from https://ahdictionary.com/word/search.html?q=fenestration&submit.x=0&submit.y=0

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