Delivery of wound care in the current climate is challenging so effective solutions are more important than ever. It is vital to be aware of the latest products and innovations that have the potential to improve outcomes.  

Here, we present Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag, absorbent gelling fibre dressing primary wound dressings used to manage wound exudate. 

Wound exudate is produced as a natural and essential part of the healing process. Exudate provides a moist wound environment, enables the diffusion of cells and growth factors and acts as a medium for the migration of tissue-repairing cells across the wound bed. It also helps to supply essential nutrients for cell metabolism and promotes separation of dead or damaged tissue by a process called autolysis (World Union of Wound Healing Societies [WUWHS], 2019).  

The aims of exudate management are to:  

• Optimise wound bed moisture level as appropriate for the patient and their wound  
• Protect the periwound skin  
• Manage symptoms and improve patient quality of life (WUWHS, 2019). 

What is Suprasorb^® Liquacel Pro? 

Suprasorb^® Liquacel Pro (figure 1) is a soft, absorbent primary wound dressing used to manage exudate. When in contact with wound exudate it forms a gel, which retains its shape and maintains a moist wound environment, supporting wound healing and autolytic debridement. The gel-forming fibres closely conform to the wound bed, leaving no space or gap for bacteria to grow. Exudate is absorbed vertically, protecting the wound edge and the surrounding skin from maceration. Bacteria and cell debris are locked-in to the dressing and removed during dressing changes (reducing the microbial burden). Exudate, cell debris and bacteria are absorbed into the dressing even under compression. 

The product is made up of 80% gel forming sodium carboxymethylcellulose fibres (CMC fibres) and 20% strengthening fibres. Suprasorb^® Liquacel Ag is made up of 60% CMC fibres, 40% blend of Lyocell^® and silver fibres (with 1.1% silver nanoparticles). 

The cellulose used in production of the Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag CMC fibres and Lyocell^® fibres is derived from wood pulp from sustainable forests , usually eucalyptus trees. During the production process, more than 99% of the solvents used are recovered and reused within a closed chemical loop, with a focus on environmental responsibility. 

Figure 1. Suprasorb® Liquacel Pro and Suprasorb® Liquacel Ag

Mode of action: Suprasorb^® Liquacel Pro 

When Suprasorb^® Liquacel Pro comes into contact with wound exudate a gel is formed, which maintains a moist wound environment and supports autolytic debridement. The gel conforms to the wound bed, protects delicate wound tissue, making removal atraumatic. The dressing fibres trap wound exudate, cell debris and bacteria and the dressing is removed in one piece during dressing changes (Data on 2024) (figure 2). 

Figure 2. Suprasorb® Liquacel Pro 1. fibres in dry condition 2. fibres in gelled state and 3. bacteria trapped in the gel

Mode of action: Suprasorb^® Liquacel Ag

Suprasorb^® Liquacel Ag performs in the same way as Suprasorb^® Liquacel Pro when it comes into contact with wound exudate. The silver nanoparticles release low cytotoxity silver ions into the dressing which activates their antimicrobial action, killing bacteria (Data on file, 2020), destroying biofilm (Data on file, 2021). Suprasorb^® Liquacel Ag is effective against a broad spectrum of pathogens including MRSA (Data on file, 2020). As before, the silver dressing traps wound exudate, cell debris and bacteria and is removed in one piece during the dressing change.
 

 

What are the key benefits of using Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag?

Lock-in technology  

When Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag come into contact with wound exudate, a gel is formed, which maintains a moist wound environment that supports autolytic debridement. Bacteria and cell debris are also securely trapped in the dressings. This is then removed during dressing changes, thus reducing the microbial burden.. This also happens under compression systems. The dressings conform to the wound bed, leaving no space or gaps for bacteria to grow (Data on file, 2024). 

Stable structure  

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag have reinforced Lyocell^® fibres and tight needling which together enhance tensile strength, even in wet conditions. When the dressing has absorbed exudate, it can be removed from the wound bed in one piece (Data on file, 2024) and does not leave dressing debris behind on the wound bed. Because the gelled fibre’s structure remains intact, little shrinkage of the dressing occurs during wear time, meaning that the wound bed remains covered, thus protecting wound edges (Data on file, 2024). 

High vertical absorption  

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag absorb exudate vertically, confining it to the exudate-soaked area and moving it away from the wound bed. This aids absorbency (160 grams per square meter), retention of exudate within the dressing and protects the wound edges thus preventing maceration. 

Silver nanotechnology  

The addition of silver to Suprasorb^® Liquacel Ag provides a reservoir of silver ions inside the dressing which respond to changes in the components of the wound fluid. Suprasorb^® Liquacel Ag contains 1.1% silver nanoparticles incorporated into the cellulose fibres across the whole dressing giving a sustained and consistent antimicrobial effect (Data on file, 2022a). Silver nanoparticles release silver ions which activates their antimicrobial action, including against MRSA (Data on file, 2020). Continuous release of silver particles results in low cytotoxicity (Data on file, 2022a; 2022b). When the dressing is in contact with wound exudate a gel is formed, which maintains a moist wound environment and supports autolytic debridement.  

When to use Suprasorb^® Liquacel Pro and Liquacel Ag 

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag can be used as part of biofilm-based wound care. This may include mechanical wound debridement using monofilament fibre technology to remove debris, slough, bacteria and biofilm from the wound where appropriate, (e.g. Debrisoft® pad or Debrisoft ^® Lolly), followed by Suprasorb^® Liquacel Ag to destroy biofilm, kill bacteria and prevent biofilm reformation (Mayer et al, 2024). 

Suprasorb® Liquacel Pro and Suprasorb^® Liquacel Ag can be used for the management of shallow and cavity wounds in the presence of a moderate-to-heavy volume of wound exudate.  

Suprasorb^® Liquacel Pro is indicated for:  

• Leg ulcers 
• Diabetic ulcers  
• Pressure ulcers  
• Postoperative wounds 
• Second-degree burns 
• Abrasions/lacerations  
• Oncological wounds. 

Where wounds are infected, or at risk of infection, Suprasorb^® Liquacel Ag may be used as a silver gelling fibre dressing in line with local policies and clinical assessment. Suprasorb^® Liquacel Pro is not intended for use on heavily bleeding wounds, inside internal body cavities or on closed wounds. 

How to use Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag 

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag:  

• Can be cut to size when dry 
• The wound dressing should overlap the wound edges by approximately 1 cm 
• The packing rope should extend out of the wound cavity by approximately 2.5cm to enable easy removal  
• Secure the product with an appropriate secondary dressing that will maintain a moist wound environment (e.g. foam or superabsorbent dressing) 
• Can also be used under compression systems  
• The interval between changes should be no more than seven days. 

Clinical evidence for Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag 

Edwards-Jones (2022) conducted a review of the current health and safety data associated with the introduction of new products containing silver nanoparticles using Suprasorb^® Liquacel Ag dressings as an example. Edwards-Jones (2022) reports that the silver nanotechnology is effective against biofilm and a broad spectrum of pathogens such as MRSA (figure 3). In vitro testing also confirms Suprasorb^® Liquacel Ag’s low cytotoxicity profile compared to other commercially available silver dressings (Data on file, 2020). Safety studies on Suprasorb® Liquacel Ag have been undertaken receiving CE (conformité européenne) marking from Europe approving its use in humans. In safety testing, Suprasorb^® Liquacel Ag has been shown to be non-toxic, and to have no detrimental effect on wound healing when evaluated in a rat and porcine model (Data on file, 2020). 

Figure 3. Antimicrobial efficacy   

King et al (2023) undertook in vitro biofilm prevention testing using a standard and reproducible method. Staphylococcus aureus and Pseudomonas aeruginosa were the first bacteria to be evaluated because of their prevalence in chronic wounds and because they are the bacteria most widely used in biofilm models. They concluded that the silver nanoparticle dressing was very effective in preventing biofilms for both gram-positive and gram- negative bacteria.  

In an observational study in six centres in Germany and Austria (Mete et al, 2024), eight wound managers treated 81 patients with Suprasorb^® Liquacel Ag, performing at least four dressing changes over seven to 28 days. The authors made several observations: 

• Over the study period, signs of infection such as redness, overheating, tissue dysfunction, swelling, pain, and wound odour were significantly reduced by an average of 2.64 on the visual analogue scale (VAS) 
• On average, practitioners successfully achieved their treatment goals, including maintaining wound moisture, facilitating autolytic debridement, protecting the wound edge from maceration, supporting wound healing, managing exudate, controlling existing infections, and preventing new infections 
• The dressing conformed to the wound in 98.8% of cases 
• Signs of biofilm were no longer visible in 60% of the treated wounds that initially showed visible signs of biofilm at the beginning of the treatment 
• In all cases, wound exudate was successfully directed into the secondary dressing, dressings could be removed intact and dressing changes were atraumatic 
• Dressings did not adhere in 95% of cases. 

The study concluded that the new wound dressing is effective for managing infected or infection-prone wounds. 

A study was performed to compare the fluid handling properties of Suprasorb^® Liquacel Pro and Suprasorb Liquacel Ag with market leading products (Data on file, 2024). 

The data demonstrated that Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag were leading dressings with respect to fluid handling characteristics. They had the highest free swell absorbency of the products evaluated using a common testing method. Both products maintain high wet strength and integrity while avoiding the use of a stitch-bonded exoskeleton to impart strength on the dressing. The use of stitch-bonding can constrict the swelling of the fibres when they absorb wound exudate leading to the potential for spaces between the dressing and the wound. This may cause exudate to pool in these locations potentially leading to a site for possible infection. 

Conclusion 

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag offer key benefits of gelling fibre dressings. These are lock-in technology ensuring bacteria, cell debris and exudate are trapped and removed, a stable structure resulting in one piece removal, no shrinkage and atraumatic removal, and vertical absorption protecting the wound edges from maceration and promoting a moist environment. 

Suprasorb^® Liquacel Pro and Suprasorb^® Liquacel Ag are high quality dressings which provide significant cost savings when compared to market leading brands.  

For further information contact the Customer Services Team on 08450 606707/01283 576800 or email at customerservices@uk.lrmed.com .  

References  

Data on file (2020) VENGATR-25  

Data on file (2021) VENAGTR-63  

Data on file (2022a) VENAGTR-69  

Data on file (2022b) VENAGTR-6  

Data on file (2024) Comparison of the fluid handling properties of Suprasorb Liquacel Pro and Suprasorb Liquacel Ag with marketed products 

Edwards-Jones V (2022) Silver nanoparticles: an overview of scientific toxicity and safety data and introduction of a new dressing, Venus Ag. Wounds UK 18(4): 22-29  

King E, Wynn-Jones G, Kettlewell G (2023) Antibiofilm performance of silver nanoparticles and new silver nanoparticle wound dressing. Poster presentation, Symposium on Advanced Wound Care (SAWC), 2023, Las Vegas  

Mayer et al (2024) International Consensus Document. Best practice for wound debridement. Available online: www.magonlinelibrary.com/pb-assets/JOWC/Debridement_Consensus_24-05-01-1716559025990.pdf 

Mete E, Westermann G, Rainer C, Roes C (2024) Observational, international, multicentre, single-arm study to assess the performance, safety and handling of new antimicrobial hydro-active fibre dressing. Poster presentation, EWMA, 2024 May 1–3, London, UK 

World Union of Wound Healing Societies (2019) Consensus document. Wound exudate: effective assessment and management. Wounds International, London