Made EasyHydrocolloids in practice

Hydrocolloids in practice

Pressure Ulcers, Skin integrity | Ousey K, Cook L, Young T, Fowler A

 

 

Hydrocolloids and wound healing
There is a plethora of research and evidence discussing the use of hydrocolloids in the treatment of acute and chronic wounds (Queen 2009; Thomas 2010). Hydrocolloids can be used in a wide range of partial thickness wounds and have a particular role in the management of Category/Stage II pressure ulcers. They are also increasingly used in the management of Category/Stage I pressure ulcers and to protect newly formed skin (Fletcher et al 2011).
This made easy supplement focuses on the use of hydrocolloid dressings to manage three types of wounds:

  • Leg ulcers
  • Minor injuries
  • Burns, including split thickness graft donor site wounds.

The following review presents the rationale for selection and particular challenges.

Hydrocolloids for leg ulcer management
Venous leg ulcers can present with a variety of tissue types within the wound bed, including eschar, sloughy tissue, granulating tissue or a combination of tissue types (Figure 2). In addition, these wounds often have light to moderate exudate levels. Hydrocolloid dressings are an ideal choice for the management of venous leg ulcers as the dressings are designed to cope with up to moderate levels of exudate, while promoting autolytic debridement of sloughy tissue and protecting existing granulation tissue (Figure 3).

Compression is the cornerstone of therapy in the management of venous leg ulcers. This needs to be in combination with adequate wound bed preparation (debridement and cleansing of the wound) to optimise the environment for wound healing to take place. Compression bandaging is designed to be renewed on a weekly basis, unless high exudate levels demand more frequent dressing changes. Hydrocolloid dressings have the ability to be left in place for up to seven days making them an ideal primary dressing under compression systems.

When applying hydrocolloids to a venous leg ulcer, the practitioner needs to ensure that the exudate level is not too high for the hydrocolloid dressing to manage effectively. If the exudate level is excessive this may require an alternate dressing, e.g. super-absorbent foam dressing. Poor or inadequate exudate management can lead to maceration and an increase in the ulcer size (Figure 4). When using hydrocolloid dressings, it is essential that the correct dressing size is selected. This should cover the whole of the ulcer and allow for a margin of approximately 2-3cm to ensure adherence to the surrounding skin. This then forms a seal around the ulcer to help prevent maceration (Figure 5).

Tip: Overgranulation may occur under hydrocolloids. A more permeable dressing (e.g. non-adhesive foam or film dressing) should be substituted

Evidence for use
A systematic review and meta-analysis performed by Palfreyman et al (2007) examined healing rates of dressings in venous leg ulcer management. The author concluded that there was insufficient evidence of effectiveness to recommend one type of dressing over another and stated that, wherever possible, simple non-adherent dressings should be applied under compression.

An earlier cost-effectiveness study by Harding et al (2000) measured the cost per healed wound using published clinical trial data. They concluded that hydrocolloid dressings were more cost-effective than gauze in the treatment of venous leg ulceration.

 

 

related links