Hydrogel Wound Dressings: Where Do We Stand in 2003?
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A new era in wound care is under way in which the old one-size-fits-all approach to dressing selection has given way to individualized treatment based upon the needs of the particular patient and wound assessment findings. Advanced wound care, as practiced in specialized wound management centers and by sophisticated providers, is based upon physiologic considerations and a comprehensive observation of the wound. With recent advances in the understanding of detailed mechanisms of wound repair, and in response to heightened interest in wound care, the wound dressing market has been flooded with new products. Hydrogels, hydrocolloids, films, gauzes, alginates, biologics, and foams are among the many classes of dressings available to the practitioner.1
The hydrogel, originally developed in the 1950s, comprises a wide variety of hydrated polymer dressings that regulate fluid exchange from the wound surface.2 Because of their excellent biocompatibility, hydrogels are used in a wide variety of products including medical coatings, biosensors, skin-friendly adhesives, contact lenses, and wound dressings.3 The US Food and Drug Administration (FDA) has designated hydrogels as Class I devices, requiring minimal regulation.4 Nearly every major dressing manufacturer has one or more hydrogels in its product line.
Hydrogel products are marketed in various physical forms: gels, sheets, and gels pre-applied (or impregnated) to ordinary cotton gauze pads.5 Hydrogel sheets are used as primary dressings for shallow, flat wounds; examples include NU-GEL™ (Johnson + Johnson Wound Management Worldwide, A Division of Ethicon, Somerville, NJ), Vigilon® (CR Bard, Inc., Covington, Ga.), Flexigel® (Smith + Nephew, Largo, Fla.) and Aquamatrix (Hydrogel Design Systems, Langhorne, Pa.). Some are provided with adhesive borders. Depending upon the degree to which a wound is draining, hydrogel sheets may remain in place up to 4 days. Most hydrogel sheets come packaged with a protective layer of plastic that is removed before application to the wound surface; an additional layer of backing plastic may be left in place or can be removed to facilitate diffusion of water through the hydrogel into the atmosphere. Manufacturers have created a wide variety of sizes and shapes to accommodate uses on awkward surfaces such as the perineum.
Amorphous hydrogel can be used to fill a deep wound with irregular contours and is held in place with a secondary dressing that is generally changed at least once daily. Examples include Curasol™ Gel Wound Dressing (HEALTHPOINT, Fort Worth, Tex.), Iamin® Hydrating Gel (ProCyte, Redmond, Wash.), DuoDerm® Hydroactive Gel (ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ) and Restore™ Hydrogel Dressing (Hollister, Libertyville, Ill.).6 Amorphous hydrogels are available in tubes, spray bottles, and foil packets.
Hydrogel-impregnated gauze is sold as Aquagauze™ (DeRoyal, Powell, Tenn.), MPM Gel Pad™ Hydrogel Impregnated Gauze Pad (MPM Medical, Inc,, Irving, Tex.), Curafil® Hydrogel Impregnated Gauze (Kendall, Mansfield, Mass.) and Derma Cool (Afassco, Carson City, Nev.) These products better satisfy the reimbursement rules set forth by certain insurers, who in some cases limit access to hydrogel. In addition, each hydrogel product has an individual reimbursement code; in the hospital setting, such products are covered under the surgical dressing benefit. Hydrogel-impregnated gauze is particularly useful in tunneled and undermined wounds because the dressing is able to fill in the dead space.
1. Moore J, Smith AP, Steinberg JS. A comprehensive review of topical agents. Podiatry Today. 2002;15:40-47.
2. Mandy SH. A new primary wound dressing made of polyethylene oxide gel. < i>J Derm Surg Oncol. 1983;9:153-155.
3. Wheeler JC, Woods JA, Cox MJ, et al. Evolution of hydrogel polymers as contact lenses, surface coatings, dressings and drug delivery systems. J Long Term Eff Med Implants. 1996;6:207-217.
4. Fed Regist. 1999;64:53927-9.
5. Kestrel Wound Product Sourcebook. Williston, Vt.: Kestrel Health Information, Inc.; 2002:133-144.
6. Ostomy/Wound Management 2002 Buyers Guide. Malvern, Pa.: HMP Communications; 2002:98-102.
8. Thomas S, Hay P. Fluid handling properties of hydrogel dressings. Ostomy/Wound Management. 1995;41:54-59.
9. Winter GD, Scales JT. Effect of air drying and dressings on the surface of a wound. Nature. 1963;197:91-92.
10. Alvarez O, Rozint J, Wiseman D. Moist environment for healing: matching the dressing to the wound. WOUNDS. 1989;1:35-51.
11. Ovington LG. The well-dressed wound: an overview of dressing types. WOUNDS. 1998;10 Suppl A:1A-11A.
12. Gates JL, Holloway GA. A comparison of wound environments. Ostomy/Wound Management. 1992;38:34-37.
13. Mulder GD. Cost-effective managed care: gel versus wet-to-dry for debridement. Ostomy/Wound Management. 1995;41:68-74.
14. Trudgian J. Investigating the use of Aquaform Hydrogel in wound management. Br J Nurs. 2000;9:943-948.
15. Coats TJ, Edwards C, Newton R, et al. The effect of gel burns dressings on skin temperature. Emerg Med. 2002;19:224-225.
16. Cable B, Stewart M, Davis J. Nipple wound care: a new approach to an old problem. J Hum Lact. 1997;13:313-318.
17. Briggs M, Torra I Bou JE. Understanding the origin of wound pain during dressing change. Ostomy/Wound Management. 2003;49:10-11.
18. Eisenbud D. Modern Wound Management. Columbus, Ohio: Anadem Publishing, Inc.;1997:109-111.
19. Whittle H, Fletcher C, Hoskin A, et al. Nursing management of pressure ulcers using a hydrogel dressing protocol: four case studies. Rehabil Nurs. 1996;21:239-242.
20. Darkovich SL, Brown-Etris M, Spencer M.. Biofilm hydrogel dressing: a clinical evaluation in the treatment of pressure sores. Ostomy/Wound Management. 1990;29:47-60.
21. Thomas DR, Goode PS, LaMaster K, et al. Acemannan hydrogel dressing versus saline dressing for pressure ulcers. A randomized, controlled trial. Advances in Wound Care. 1998;11:273-276.
22. Motta G, Dunham L, Dye T, et al. Clinical efficacy and cost-effectiveness of a new synthetic polymer sheet wound dressing. Ostomy/Wound Management. 1999;45:41-49.
23. Thomas S, Banks V, Bale S, et al. A comparison of two dressings in the management of chronic wounds. Journal of Wound Care. 1997;6:383-386.
24. Seeley J, Jensen JL, Hutcherson J. A randomized clinical study comparing a hydrocellular dressing to a hydrocolloid dressing in the management of pressure ulcers. Ostomy/Wound Management. 1999;45:39-47.
25. Dinh T, Pham H, Veves A. Emerging treatments in diabetic wound care. WOUNDS. 2002;14:2-10.
26. Jandera V, Hudson DA, de Wet PM, et al. Cooling the burn wound: evaluation of different modalities. Burns. 2000;26:265-270.
27. Brent N, Rudy SJ, Redd B, Rudy TE, Roth LA. Sore nipples in breast-feeding women: a clinical trial of wound dressings vs conventional care. Arch Pediatr Adolesc Med. 1998;15:1077-1082.
28. Goldman MP, Roberts TL III, Skover G, et al. Optimizing wound healing in the face after laser abrasion. J Am Acad Dermatol. 2002;46:399-407.
29. Newman JP, Fitzgerald P, Koch RJ. Review of closed dressings after laser resurfacing. Dermatol Surg. 2000;26:562-571.
30. Thomas S, Humphries J, Fear-Price M. The role of moist wound healing in the management of meningococcal skin lesions: a case study. Journal of Wound Care. 1998;7:503-507.
31. Vogt PM, Hauser J, Rossbach O, et al. Polyvinyl pyrrolidone-iodine liposome hydrogel improves epithelialization by combining moisture and antisepsis. A new concept in wound therapy. Wound Repair Regen. 2001;9:116-122.
32. Masters KS, Leibovich SJ, Belem P, et al. Effects of nitric oxide releasing poly(vinyl alcohol) hydrogel dressings on dermal wound healing in diabetic mice. Wound Repair Regen. 2002;10:286-294.
34. Sprung P, Hou Z, Ladin DA. Hydrogels and hydrocolloids: an objective product comparison. Ostomy/Wound Management. 1998;44:36-46.
36. Sparholt SH, Wilhelmsen F. Outcome evaluation of two hydrogels. Abstract. Presented at the 15th Annual Symposium on Advanced Wound Care + 12th Medical Research Forum on Wound Repair. Baltimore, Md; April 26, 2002.
37. Klucinec B, Scheidler M, Denegar C, et al. Effectiveness of wound care products in the transmission of acoustic energy. Phys Ther. 2000;80:469-476.
38. Agren MS. An amorphous hydrogel enhances epithelialisation of wounds. Acta Derm Venereol. 1998;78:119-22.
39. Thomas S, Hay NP. In vitro investigations of a new hydrogel dressing. Journal of Wound Care. 1996;5:130-131.
40. Bale S, Banks V. Haglestein S, et al. A comparison of two amorphous hydrogels in the debridement of pressure sores. Journal of Wound Care. 1998;7:65-68.