ABSTRACT

A review of the literature suggests that the application of self-adhesive hydrocolloid dressings, most commonly associated with the treatment of ulcerative conditions such as pressure ulcers and leg ulcers, may also offer benefits in the management of acute wounds of all types, for example decreasing healing times of donor sites by about 40% compared with traditional treatments. Healing times of superficial traumatic injuries and surgical wounds are similarly enhanced but in the treatment of burns, the principal benefit appears to be a reduction in wound pain, an effect that has also been reported in virtually all other wound types. The impermeable nature of hydrocolloids provides a protective covering to the wound, permitting washing or showering while helping to prevent the spread of pathogenic microorganisms. There also appear to be significant cost–benefits associated with the use of hydrocolloids. In recent years, hydrocolloid dressings have been replaced by other products such as foams for the treatment of more heavily exuding wounds but for more lightly exuding wounds they still offer many practical advantages and as such will undoubtedly continue to meet an important need in wound management practice.

INTRODUCTION

The term ‘hydrocolloid’ was coined in the 1960s during the development of mucoadhesives, based upon carboxymethyl cellulose (CMC) combined with adhesives and tackifiers that were used as a treatment for mouth ulcers. It was subsequently adopted to describe a new type of dressing, based upon this technology, in which a hydrophilic gelable mass was applied in a semisolid form to a flexible semipermeable

carrier.

The first preparation to be described in this way was Granuflex, launched in the UK in 1982 and then subsequently introduced in the USA as Duoderm in 1983 and as Varihesive in some other European markets. The first formulation of Granuflex/Duoderm tended to produce a viscous mobile gel in the presence of exudate and in 1993 a new formulation was introduced that sought to overcome this perceived problem.

Initially called Granuflex E or Duoderm CGF, this eventually replaced the original formulation. Numerous other products followed such as Comfeel (Coloplast, Humlebaek, Denmark),Tegasorb (3M, St. Paul, MN) SureSkin (Euromed, Orangeburg, NY) and Restore (Hollister, Libertyville, IL). All of these products are broadly similar in appearance and are used

for the same range of clinical indications,despite some difference in their structure and composition.

Originally produced in small square pieces, in 1985, a bordered hydrocolloid was introduced followed by a number of shaped dressings

designed for specific anatomical sites. In 1989,a ‘thin’ version was developed that consists.

DISCUSSION

The results of this review strongly support the proposition that compared with more basic dressings such as paraffin gauze (both plain

and medicated), hydrocolloid dressings produce improved healing rates in partial thickness wounds such as burns, donor sites, superficial

traumatic injuries and some types of surgical wounds (Table 1). There is also a body of evidence to suggest that their use is associated with a reduction in wound pain , enhanced quality of life, (including the ability to wash or shower) and also an improvement in the quality of the healed wound .

With the exception of Biobrane, the hydrocolloids tended to be more expensive than products with which they were compared, although a number of authors proposed that the reduction in treatment time resulting from their use more than compensated for this increased initial cost.

The principal advantage offered by this unique group of products is that in their intact state, they are virtually impermeable to water

vapour and therefore provide an effective barrier to transepidermal moisture loss when applied to intact skin or devitalised tissue. In the

presence of exudate, the dressings absorb liquid and form a gel. As they do so, they become permeable to moisture vapour that further

increases their ability to cope with wound exudate.

In most instances, however, they still require frequent replacement if applied to heavily exuding wound such as donor sites in the early stages of treatment as illustrated in this review. In contrast, alginates combined with appropriate secondary absorbent layers are well able to cope with such wounds initially, but as exudate production diminishes after the first

couple of days of treatment, the fibrous dressing has a tendency to dry out leading to adherence and the possibility of secondary trauma.

A logical approach to the management of these wounds would therefore seem to be the initial application of alginate, followed by a change to

a hydrocolloid as exudate production is decreased in order to continue the provision of a moist wound healing environment.