The Family Of Wound Care Products

Meet The Family ..............

Hydrogels
Hydrogel Sheets
Hydrogel Impregnated Gauze
Alginates
Moisture Vapor Permiable Films
Wound Cleansers
Hydrofibers
Foams
Hydrocolloids


Staging Of Pressure Ulcers


Hydrogels

Curasol Gel is a commonly used hydrogel that keeps the wound bed moist

Product Information - Hydrogels generally are clear, viscous gels that protect the wound from dessicating. Application of hydrogels is contraindicated when the wound is producing moderate to heavy exudate because if the wound is very wet, the presence of the hydrogel would contribute to wound maceration. If a wound is infected, application of most hydrogels serves no real purpose since plain hydrogel products do not contain an antimicrobial agent.

Curasol Gel is a clear hydrogel

Curasol Gel is placed on sterile gauze and is ready to be instilled into a wound

Product Application - Curasol Gel should be used as a primary wound dressing choice in wounds that are substantially or fully granulated. If there is a great deal of black eschar or yellow or white slough, the wound should be enzymatically debrided or sharps debrided to remove the necrotic tissue. Often when a wound is in transition from the inflammatory (reaction) phase to the proliferative (regenerative) phase, it will have some eschar and a good deal of granulation tissue present concomitantly. In this case, the use of a hydrogel is justified to keep the granulation tissue moist while helping to autolytically debride the eschar in the wound bed. It also acts as a barrier against wound contamination from external sources.

Suggestions For Re-Dressing A Wound : A wound that is granulating well and largely free of eschar, needs to have the wound bed protected while it heals. Dressing a clean wound could be done as follows :

Some Hydrogel products, manufacturers, and toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
Curasol GelHealthpoint1-800-441-8227HydrogelMPM Medical1-800-232-5512
AguasorbDeroyal1-800-251-9864BiolexBard1-800-526-4455
Woun'DresSween1-800-533-0464GelipermFougera1-800-645-9833
Saf-GelConvatec1-800-325-8005HypergelScott Health Care1-800-992-9939
SolositeSmith & Nephew1-800-876-1261HydrogelGentell1-800-840-9041
IntrasiteSmith & Nephew1-800-876-1261Nu-GelJohnson & Johnson1-800-255-2500
CarrasynCarrington1-800-358-5205SkintegrityMedline1-800-323-6204
ElastogelSW Technologies1-800-247-9951ClearsiteConmed1-800-783-1767

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Hydrogel products come in other forms besides the gel form. Hydrogel products come as 1) hydrogel sheets and 2) as hydrogel impregnated gauze.

Hydrogel Sheets

Flexderm Hydrogel Sheet Dressing is a sterile hydrogel sheet that is non-adhesive and will not stick to the wound bed. It keeps the wound moist, protects the wound against contamination, is capable of absorbing some exudate and promotes healing. It is secured to the wound using a secondary dressing such as a biocclusive type of covering, Kerlex roller gauze, or a tubular net type of dressing such as Spandage.

Some Hydrogel Sheet products, manufacturers, and toll free numbers are listed below:

Product Name
Manufacturer
Toll Free #
Flexderm
Dow Hickam
1-800-848-9234
Vigilon
Bard
1-800526-4455
Flexigel
Smith & Nephew
1-800-876-1261

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Hydrogel Impregnated Gauze

These products are simply a combination wound care product incorporating gauze and hydrogel in the same package. There is no difference in the reasons to use either a hydrogel impregnated gauze, hydrogel sheet or a hydrogel product - all three variant forms are used to keep the wound moist. Again, all three products should be used in wounds that are mostly free of necrotic tissue and should not be used in wounds that are infected or in wounds that are creating moderate to heavy exudate. The only disadvantage to any of these products is that after they are applied, a secondary dressing needs to secure the hydrogel products in place.

Some pictures of hydrogel impregnated gauze below :

This is an example of Curasol hydrogel impregnated gauze manufactured by Health Point

This is what Curasol hydrogel impregnated gauze looks like. Notice how wet it appears.

Some Hydrogel Impregnated Gauze products, manufacturers and the toll free number for ordering are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
NutraGauzeDerma Sciences1-800-825-4325BiolexBard1-800-526-4455
CarraGauzeCarrington1-800-358-5205SkinTegrityMedline Industries1-800-323-6204
CurafilKendall1-800-962-9888PanoGauzeSage Labs1-800-960-0599
RestoreHollister1-800-323-4060CurasolHealth Point1-800-441-8227
ClearsiteConmed Corporation1-800-783-1767TransiGelSmith & Nephew1-800-876-1261

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Medicare/DMERC Utilization Guidelines

The hydrogel wound gel is used once/day. In a 30 day period, about 3 ounces of wound gel per wound is typically needed for care. This is dependent on how large the wounds are and how many wounds are being treated. The hydrogel impregnated sheets or gauze are changed once per day.


Alginates

Characteristics & Uses :

Alginates are made from seaweed. The seaweed is formed into flat squares or sheets of unwoven fibers, into twisted robes or pads. These fibers are soft in texture and are easily pulled apart without any difficulty. The alginate dressings are considered to be primary dressings for wounds that have moderate to heavy exudate and transudate. Generally they are placed in wound beds for the purpose of absorbing exudate or transudate and keeping the wound moist. The alginate, once wet with exudate, forms a gel-like plug in the wound. The alginate can absorb up to 20 times its weight in exudate. It facilitates autolytic debridement of the wound and generally has to be held in place by a secondary dressing such as a biocclusive thin film, a hydrogel sheet, or gauze.

Alginates are most often lifted out from the wound or irrigated and washed free from the wound bed when a dressing is being changed. They do not adhere to the wound bed surface and therefore do not debride the wound when removed. One very nice feature of the alginates is the ability to leave them in the wound - they do not have to be removed from the wound during dressing changes because they do not cause increased inflammation or irritation to the wound. When a wound has a deep and extensive undermined region or has a number of tunnels, the alginate can remain behind without any fear of causing infection. The body will dissolve and absorb the alginate if it remains in deep cavitations, tunnels or undermined areas. See the picture below.

Contraindicated Uses Of Alginates : Alginates should not be wet with normal saline or sterile water before being placed in the wound bed. Wetting the alginates defeats the purpose in using them in a wound. Also, alginates should not be used in dry or dessicated wounds.

Some Pictures Of Alginates :

A calcium alginate named Sorbsan made by Dow Hickam

Sorbsan is made from seaweed into delicate fibers and cut into unwoven sheets

Sorbsan can be easily separated and fluffed up before placing it into a wound bed

Some Calcium Alginate products, manufacturers, and toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
AlgiDERMBard1-800-526-4455AlgiSITESmith & Nephew1-800-876-1261
AlgosterilJohnson & Johnson1-800-255-2500CarraSorb HCarrington1-800-358-5205
CurasorbKendall1-800-962-9888GentellGentell1-800-840-9041
KALTOSTATConvatec1-800-325-8005KALGINATEDeRoyal1-800-251-9864
MaxorbMedline1-800-323-6204RestoreHollister1-800-323-4060
SorbsanDow Hickam1-800-848-9234SeaSorbColoplast-Sween1-800-533-0464

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Medicare/DMERC Utilization Guideline :

Alginate dressings are usually changed once a day (QD).


Moisture Vapor Permeable Films

Characteristics and Advantages

Moisture vapor permeable film dressings are adhesive film dressings that are waterproof but which are also semi-permiable to the passage of oxygen and water vapor to and from the wound site. These dressings prevent the wound from dessication as well as from contamination by bacteria. They help maintain a moist wound healing environment and retain growth factors next to the wound bed that are in the exudate and transudate. These dressings also promote autolysis of necrotic tissue in the wound bed.

These film dressings are translucent or clear and help the wound care clinician to visualize the wound. They can be placed over areas that are somewhat difficult to bandage because they are very thin, flexible and have an adhesive backing.

Uses

These dressings are good secondary dressings over wounds in areas where there may be a good deal of shear such as the elbows, heels, iliac crest, knees, and wrists. MVPF dressings adhere better to the skin over wounds that are producing light to medium exudate. MVPF dressings may be left in place for several days in wounds that are not infected and which are not continually producing lots of exudate. In wounds that are producing heavy exudate, they will need to be changed more often and may become so wet as to lessen the effectiveness of the adhesive causing them to easily be rolled off the area of application with very little shear or frictional force.

These dressings are especially good when they are applied over wounds in which a primary dressing must be held in place. The application of alginates into a wound bed can be retained in the wound bed very efficiently with the application of a thin film dressing.

Some pictures of moisture vapor permiable film dressings are pictured below :

Biocclusive, a MVPF product by Johnson & Johnson.

This MVPF is transparent to enable the wound care clinician to see the wound clearly

Tegaderm is a MVPF product made by the 3M Corporation

This MVPF product is translucent but still offers a view of the wound bed

Some Moisture Vapor Permiable Film dressings, their manufacturers and the toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
Tegaderm3M1-800-327-5380DermAssistAssisTec Medical1-800-274-7835
CarraFilmCarrington1-800-358-5205PRO-CLUDEConvaTec1-800-325-8005
TransealDeRoyal1-800-251-9864BiocclusiveJohnson & Johnson1-800-255-2500
PolyskinKendall1-800-962-9888SureSiteMedline1-800-323-6204
OpSiteSmith & Nephew1-800-876-1261BlisterFilmKendall1-800-962-9888

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Medicare/DMERC Utilization Guidelines

Transparent film dressings can be changed three times/week (TIW).


Wound Cleansers

Wound cleansers are solutions that contain water, surfactants and salt. Their purpose is to wash out or irrigate a wound with very mild pressure usually between 4-15 PSI. Wound cleansers wet the wound and help to thin down and wash off the exudate that has begun to collect in a wound. It is particularly helpful in washing exudate from areas where undermining has occured if the spray can be aimed at the area of undermining. Wound cleansers also help to wet necrotic tissue making it easier for blunt and sharp debridement to take place.

Pictures of two common wound cleansers are shown below :

Allclenz is a wound cleanser manufactured by Health Point

Dermagran is a wound cleanser made by Derma Sciences

Some Wound Cleansers, manufacturers and toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
BiolexBard1-800-526-4455UltraKlenzCarrington1-800-358-5205
Shur-ClensConvatec1-800-325-8005AllclenzHealthPoint1-800-441-8227
DebrisanJohnson & Johnson1-800-255-2500CuraKlenseKendall1-800-962-9888

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Hydrofibers

Hydrofibers is a wound care product that is an exudate absorber. Hydrofibers dressings are supposed to be able to absorb heavy exudate. These dressings need to be held in place by a secondary dressing such as a biocclusive dressing. Hydrofibers keep the wound moist yet absorb the excesive exudate in wounds that are very productive.

There is only one manufacturer of hydrofibers at the moment. ConvaTec is listed below :

Product Name
Manufacturer
Toll Free #
AquacelConvaTec1-800-325-8005

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Foams

Foam dressings are highly absorbant primary dressings usually made of a hydrophilic polyurethane foam. These dressings keep a moist wound environment but absorb the excess exudate sometimes seen in wounds. These dressings are useful for cavitating wounds because they can be placed in the wound to fill the wound bed while absorbing the continuous exudate seen in wounds during the inflammatory phase of wound healing. The foam dressings which are placed in deep wounds can remain for 3-4 days and must be secured in place by a biocclusive type dressing. Some of the foam dressing products have an adhesive backing at the margins of the dressing and therefore these cannot be packed into deep wounds. Foam dressings with adhesive backings are very useful for placing over wounds smaller than the absolute diameter of the dressing.

An example of a foam dressing is Dow Hickam's Flexan - a semipermiable adhesive foam product. See pictures A, B, C, & D.

A.
B.
Packaged Product
Schematic Of The Product
C.
D.
Application Over Sorbsan On A Wound
Application On A Wound

Some Foam products, manufacturers, and their toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
Reston3M1-800-327-5380Lyofoam ConvaTec1-800-325-8005
FlexanDow Hickam1-800-848-9234BiopatchJohnson & Johnson1-800-255-2500
CurafoamKendall1-800-962-9888AllevynSmith & Nephew1-800-876-1261
PolydermDeRoyal1-800-251-9864GentellGentell1-800-840-9041

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Hydrocolloids

Characteristics & Features : Hydrocolloid dressings contain a dressing matrix which absorbs exudate and creates a gel like dressing. The gel mileau may be retained inside the dressing where the matrix is located or the hydrocolloid gel may be formed in the wound. These dressings help the wound to autolytically debride itself.

The hydrocolloid dressing is impermiable to water vapor, oxygen and bacteria. These dressings are not adherent to the wound bed and can be removed without tearing the granulation tissue underneath. They are best applied to wounds that produce light to medium exudate or transudate. If the wound is not too wet, these primary dressings may remain in place for 3-4 days. These dressings can be placed on wet wounds and wet surronding skin and will remain intact because they can adhere to a moist area - a feature called wet tack.

Disadvantages : These dressings should not be applied over infected wounds. They should not be applied over wounds that are producing moderately heavy exudate. These dressings can develop a foul odor to them after having been applied for 2-4 days. Sometimes when they are removed, clinicians think the wound has become infected when, in fact, the odor is coming from the hydrocolloid dressing.

Some pictures of hydrocolloids appear below :

Duoderm is a hydrocolloid dressing made by ConvaTec
Duoderm out of the package
Duoderm is flexible and absorptive

Some Hydrocolloid products, manufacturers and their toll free numbers are listed below :

Product Name
Manufacturer
Toll Free #
Product Name
Manufacturer
Toll Free #
Tegasorb3M1-800-327-5380DuoDermConvaTec1-800-325-8005
HydrocolDow Hickam1-800-848-9234DermatellGentell1-800-840-9041
RestoreHollister1-800-323-4060Nu-DermJohnson & Johnson1-800-255-2500
CuradermKendall1-800-962-9888RepliCareSmith & Nephew1-800-876-1261

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Staging Pressure Ulcers

STAGE
DEFINITION
TREATMENT GOAL
Stage I
Non-blanchable erythema of intact skin. Discoloration of skin. Skin is unbroken, but inflamed. Maybe painful. Warm to the touch. Condition is reversible.Prevent buildup of skin moisture where pressure exists. Prevent skin breakdown. Initiate an aggressive turning and pressure relief schedule.
Stage II
Partial thickness breakdown in the skin involving partial loss of the epidermis and the dermis. Broken skin area is red and painful. Surronding skin out from the ulcer area is reddened. Ulcer is superficial with a shallow crater and adjacent blister formation possible. Initiate an aggressive turning and pressure relief schedule to relieve pressure and prevent friction and shear forces. Cleanse the area with a wound spray. If the wound is creating exudate, place an alginate, hydrocolloid, foams or hydrofibers into the wound and cover with a biocclusive dressing. If the wound drainage is heavy, cover with gauze or ABD pads and secure with tape. If the wound is dry, hydrate the wound bed with a hydrogel. Place a petroleum impregnated gauze like Adaptic over the wound to prevent the hydrogel from easily coming out of the wound bed. Cover the wound with gauze or a biocclusive. Change the dressing QD to BID. Control infection.
Stage III
Full thickness skin loss. Necrosis of the underlying tissues may be present down to but not past the fascia. The necrotic tissue may be yellow or black in color. The ulcer will be painful. May be creating exudate. May be infected.Initiate an aggressive turning and pressure reduction program. Debride the area of all necrotic eschar. Control infection. Cleanse the wound with a wound cleanser. If exudate is present, dress the wound to control the exudate using alginates, hydrocolloids, foams or hydrofibers. Cover with a biocclusive if the drainage is less than moderate to severe. Otherwise cover with ABD pads to absorb the drainage. Change QD to BID depending on the amount of exudate. If by chance the pressure ulcer is dry, then hydrate the wound using hydrogels or hydrogel impregnated sheets to keep a moist wound environment.
Stage IV
Full thickness skin loss acompanied by extensive lower layer tissue destruction of fascia, muscle. Destruction usually involves tissue loss down to the bones and joints. Necrosis and eschar formation will be extensive. Is painful.Initiate an aggressive turning and pressure reduction program. Control infection. Debride all necrotic tissue and eschar using sharp, blunt and enzymatic debridement techniques. Control exudate formation using products to control exudate (alginates, hydrocolloids, foams, hydrofibers). Cover with biocclusives or ABD pads where appropriate. Change the dressing QD to BID depending on the amount of exudate created.

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Last Updated On : 09 Septmeber, 1999


Page Created by :

David Arnall, Ph.D., P.T., FACSM, ES
Northern Arizona University
Physical Therapy Program
Box 15105, Flagstaff, Arizona 86011
Office Telephone : 1-520-523-7434
FAX : 1-520-523-9289
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