Cath Lab Digest

P ressure ulcers are a common and painful problem among the elderly. Despite progress in prevention, many patients still develop pressure ulcers, and managing these wounds remains a challenge to healthcare professionals.

Most wound management products are designed to achieve a number of goals. Many provide a moist environment in order to promote healing.^1,2 An effective dressing should absorb large amounts of exudate and stay in place a reasonable length of time. Another important aspect of dressing performance is minimizing pain and trauma to the wound and surrounding skin on removal. Dressing removal is a major challenge for the clinician when the patient's skin is fragile and easily broken, especially around sacral pressure ulcers in elderly patients where body fluids (often due to incontinence) and/or microbial proliferation can damage the surrounding skin. In addition, removing a dressing with a strong adhesive can damage the surrounding skin, be painful, and cause new wounds. A variety of techniques has been used to protect and treat periwound skin, including skin barriers, powders, pastes, and skin sealant. Analgesia is sometimes given to reduce the procedural pain of dressing changes.

One traditional approach to producing adhesive dressings involves use of an adhesive plaster that makes contact only with the peaks of the skin. However, when dressings coated with these adhesives are removed from the skin, the adhesion threshold is reached and a layer of epidermal cells is peeled off. The hydropolymer dressing, like many adhesive dressings, consists of an adhesive that may remove epithelial cells when the dressing is changed.³

A new dressing, with an adhesive technology consisting of a soft silicone layer that adheres to the surrounding skin but does not stick to the moist wound (silicone is hydrophobic), has been developed. The soft silicone layer is more flexible than other wound dressing adhesives and moves into the uneven skin surface to create a larger effective contact area with the skin. As a result, less adhesion force per square millimeter is needed with a level of adhesion that is comparable to traditional adhesive dressings. When the same peeling force is applied, the soft silicone will distribute the forces over a larger area of skin under the dressing. This means that dressings with what has been termed atraumatic soft silicone technology cause significantly less epidermal stripping on removal than dressings with other adhesive technologies.³ To compare the new self-adherent soft silicone dressing to a commonly used hydropolymer dressing in the treatment of Stage II pressure ulcers, an open, randomized, controlled clinical study was conducted.