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.
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