New Dressings for Wound Care and Ulcers
Monday, April 04, 2005
The beneficial effect of a moist wound environment has been well
established for healing rate of acute wounds, pain relief, and
debridement of chronic wounds.1 Modern dressings are
occlusive or semi-occlusive, classified according to their
performances such as absorbent capacity, hydrating ability,
adhesive components, and debridement capacity.
The indications of modern dressings are now consensual, mainly
based on their physical properties and on open studies rather than
on well-designed controlled trials. Dressings are usually
categorized as medical devices. Thus, contrary to medical drugs,
the level of proof of efficacy does not require the implementation
of large-scale, controlled, randomised, clinical studies. In fact,
no significant difference has been demonstrated versus the
reference treatment, which consists in ensuring a moist environment
for the wound through the use of gauze soaked in physiological
Modern dressings optimize the natural healing process without
accelerating it. They mainly improve the comfort and quality of
life of patients and reduce the cost of care by allowing reduced
frequency of dressing changes.2-4
The inner layer of all hydrocolloids is composed of
carboxymethylcellulose enclosed in an elastic adhesive mass.
Hydrocolloids are available in thick or thin versions, in paste to
fill cavity wounds, or in a variety of precut shapes aimed at
different anatomical sites (heels, sacrum, elbows).
The rate of dressing changes is between a few days and a week,
depending on the amount of exudate. As it interacts with the
exudate, the dressing forms a yellow gel with a characteristic foul
smell that can be mistaken for purulent discharge from the wound.
An erythematous eruption around the wound is usually a nonallergic
irritant reaction related to excessively frequent dressing
They can be used at all stages of healing. The film covering the
sheet protects the wound from outside and allows patients to take a
Hydrogels are insoluble cross-linked hydrophilic polymers,
containing more than 80% water. They are available in an amorphous
gel, in packaged tubes, or in sheet form. Gel form appears to be
the most effective in releasing moisture into wounds. A secondary
dressing, such as a hydrocolloid or a polyurethane film, is
The dressing is changed every 3 or 4 days.
Hydrogels are indicated for dry wounds, dermabrasion, chemical
peels, and superficial burns and at the debridement stage. They are
among the most efficient products in softening a plaque of
Transparent film dressings are made up of a polyurethane
membrane coated on one side with an adhesive. They are permeable to
gases and moisture vapor but impermeable to water and bacteria.
They have no absorbent capacity.
The rate of dressing changes ranges from 3 to 7 days.
Films are indicated in superficial, poorly exuding wounds, such
as skin tears6 and low-grade pressure ulcers, and at the
epidermization stage of a wound, but they are mostly used as
secondary dressings to hold another dressing or a catheter in
These polymers are mainly composed of fibers of calcium alginate
derived from seaweed. They are sometimes mixed with
carboxymethylcellulose in varying percentages. They are
commercially available in the form of sheets or ropes for cavities.
They need to be covered with a secondary dressing (such as a
polyurethane film or gauze). They have a high absorbent capacity
and mild bacteriostatic and haemostatic effects.
The dressing is changed daily during the cleansing phase and
every 2 or 3 days during granulation.
They are indicated in heavily exuding wounds and infected or
haemorrhagic wounds, mainly at the debridement
This dressing is made up of carboxymethylcellulose fibers and
presented in the form of sheets or ropes. The absorbent capacity is
almost 2 or 3 times that of alginates. It can be used like an
alginate, in heavily exuding wounds, and has to be covered with a
Under a hydrocolloid sheet, it can usually be changed every 3 or
5 days. On the surface of a wound, it interacts with exudate to
form a cohesive gel, so hydrofiber dressings do not adhere to the
Studies have been performed essentially in the treatment of
pressure sores, leg ulcers, and burns.8
Foam dressings are usually made up of a hydrophilic layer
(microporous polyurethane) combined with a film as the outer layer.
They are available in adhesive and nonadhesive forms as well as in
thick or extra-thin versions. Hydroabsorbent or superabsorbent
dressings are similar to foam dressings, coming from the diaper
industry. Foam dressings are highly absorbent and do not
disintegrate in the wound, preventing the odors that may be
experienced with hydrocolloids. In their nonadhesive form, they can
be used even if the skin around the wound is not irritated or
The rate of dressing changes ranges from 3 to 8 days.
They are indicated particularly from the granulation stage to
complete epidermization for exuding chronic wounds, donor graft
sites, skin tears, and sutures.
These dressings contain a layer of charcoal combined with an
absorbent dressing. Active charcoal absorbs odors from the wound,
which are infected or colonized by anaerobic or gram-negative
bacteria. These dressings can be moistened with physiological
The dressing is changed every 1 to 2 days, and it needs to be
covered with a secondary dressing.
They are indicated as a primary or secondary dressing for
infected wounds and for cancerous wounds.9
Silver acts as a broad-spectrum antibacterial
agent.10 Most of these products contain other
components, such as hydrocolloid, hyaluronic acid, alginate, or
The dressing is changed every 1 to 2 days.
Silver dressings are widely employed for the treatment of burns,
infected wounds, or chronic wounds with a critical colonization and
a high risk of infection.11 On the contrary to acute
wounds and burns, the clinical benefit of a reduction in the
wound's bacterial colonization is not established in chronic
Impregnated Meshes or Coated Nets
More recently designed impregnated meshes or coated nets are
impregnated with hypoallergenic, neutral substances such as
petroleum, paraffin, silicone, or carboxymethylcellulose. These
interface dressings do not adhere to the wound and need to be
covered with a secondary, absorbent dressing.
They are changed between once a day and twice a week.
They are indicated for slightly exuding wounds such as
dermabrasion, epidermolysis bullosa, burns, and laser
wounds,12 or for chronic wounds, whatever the stage
of the wound.
Hyaluronic-Acid-Based Dressings and Collagen Dressings
The rationale for the use of hyaluronic acid or collagen is to
promote healing, because these proteins are present at a very high
level in the dermis. Cream, impregnated tulles, and dressings
containing hyaluronic acid, sometimes in combination with
alginates, are available. Collagen dressings may contain
antiprotease agents to restore the balance of the chronic wound
environment. Their efficacy has been studied in leg ulcers and
They have to be changed daily.
They are mostly indicated in poorly exuding chronic wounds at
the stage of granulation.15
Table 1. Principal trade names of the different
||Comfeel Plus, Duoderm E, Algoplaque HP, Askina Biofilm,
SureSkin STANDARD, Restore, Hydrocoll, Tegasorb, Tetracolloid,
Comfeel Plus Transparent, Duoderm Extramince, Askina Biofilm
Transparent, SureSkin Extramince, Algoplaque Film, Hydrocoll Thin,
Tegasorb Thin,Comfeel Plus Brûlures, Urgomed,Comfeel Plus Contour
(standard, large), Algoplaque Sacrum, Hydrocoll Sacral, Hydrocoll
Concave, SureSkin Border, Duoderm E Border, Algoplaque
Border,Comfeel Pâte, Comfeel Poudre, Duoderm Pâte, Askina Biofilm
Pâte, Algoplaque, Pâte
||ComfeelPurilon, IntraSite Gel, Duoderm Hydrogel, NuGel, Askina
Gel, Hydrosorb Plaque, normlgel, Urgo Hydrogel, SureSkin
||EpiView, Opsite Flexigrid, Opsite Post-Op, Tegaderm, DermaFilm,
Visulin, Lumiderm 6000, Hydrofilm, Mefilm, Askina Derm, Opraflex,
Epitect Film, Tegaderm Pad, Optiskin
||Algosteril, Sorbsan, Urgosorb, Comfeel SeaSorb, Askina Sorb,
AlgiSite, Melgisorb, Sorbalgon
||Allevyn Plaque, Tielle, Biatain, Askina Transorbent,
||CarboFlex, Carbonet, Actisorb Plus
||Acticoat, Aquacel Ag, Urgotül S.Ag
|Impregnated meshes or coated nets
||Vaselitulle, Unitulle, Lomatuell, Jelonet Adaptic,Urgotül,
Cellosorb, Physiotulle, Mepitel
||Hyalgin (AH fim), Hyalofill (AH),Hyalogran (AH + alginate),
Jaloskin (AH film),Ialuset, Effidia
*All trade names are trademarks or registered trademarks of
their respective owners, and are neither owned by nor licensed to
Table 2. Indications of dressings depending on the stage
and the appearance of the wound
|Appearance/stage of the wound
|Presence of black, dry, necrotic tissue
|Presence of fibrin or moist necrotic tissue
Hydrogel if slightly exuding
Alginate or hydrofiber if heavily exuding
||Alginate, hydrofiber, hydrocolloid paste
|Heavily exuding wound
||Alginate or hydrofiber if infected
Foam if no infection
||Hydrocolloid, foam, impregnated meshes, or coated nets
(hydrofiber, alginate, hydrogel)
|Superficial wound, dermabrasion
||Hydrocolloid, foam, hydrogel
|Superficial burn, donor graft site
||Film, impregnated meshes, or coated nets
|Foul-smelling wound, cancerous wound
||Alginate, hydrofiber, charcoal dressings
- Martin P. Wound healing - aiming for perfect skin regeneration.
- Nelson EA, Bradley MD. Dressings and topical agents for
arterial leg ulcers (Cochrane Review). In: The Cochrane
Library, Issue 3. 2004.
- Consensus Development Conference on Diabetic Foot Wound Care:
7-8 April 1999, Boston, Massachusetts. American Diabetes
Association. Diabetes Care. 1999:1354-1360.
- Douglas WS, Simpson NB. Guidelines for the management of
chronic venous leg ulceration. Report of a multidisciplinary
workshop. Br J Dermatol. 1995;132:446-452
- Senet P, Meaume S. Les pansements hydrocolloïdes. Ann
Dermatol Venereol. 1999;126:71-75.
- Thomas DR, Goode PS, LaMaster K, Tennyson T, Parnell LK. A
comparison of an opaque foam dressing versus a transparent film
dressing in the management of skin tears in institutionalized
subjects. Ostomy Wound Manage. 1999;45:22-24,27-28.
- Belmin J, Meaume S, Rabus MT, Bohbot S. Sequential treatment
with calcium alginate dressings and hydrocolloid dressings
accelerates pressure ulcer healing in older subjects: a multicenter
randomized trial of sequential versus nonsequential treatment with
hydrocolloid dressings alone. J Am Geriatr Soc.
- Foster L, Moore P, Clark S. A comparison of hydrofibre and
alginate dressings on open surgical wounds. J Wound Care.
- Holloway S, Bale S, Harding K, Robinson B, Ballard K.
Evaluating the effectiveness of a dressing for use in malodorous,
exuding wounds. Ostomy Wound Manage. 2002;48:22-28.
- Thomas S, McCubbin P. An in vitro analysis of the antimicrobial
properties of 10 silver-containing dressings. J Wound
- Caruso DM, Foster KN, Hermans MH, Rick C. Aquacel Ag in the
management of partial-thickness burns: results of a clinical trial.
J Burn Care Rehabil. 2004;25:89-97.
- Newman JP, Fitzgerald P, Koch J. Review of closed dressings
after laser resurfacing. Dermatol Surg.
- Veves A, Sheehan P, Pham HT. A randomized, controlled trial of
Promogran (a collagen/oxidized regenerated cellulose dressing) vs
standard treatment in the management of diabetic foot ulcers.
Arch Surg. 2002;137:822-827.
- Vin F, Teot L, Meaume S. The healing properties of Promogran in
venous leg ulcers. J Wound Care. 2002;11:335-341.
- Ortonne JP. A controlled study of the activity of hyaluronic
acid in the treatment of venous leg ulcers. J Dermatol