Evolution in the Rainforest: The case for hydropolymer dressings

Advances in Skin & Wound Care,  Nov/Dec 2000  by Ovington, Liza G

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"IT IS NOT THE STRONGEST OF THE SPECIES THAT SURVIVE, NOR THE MOST INTELLIGENT, BUT THE ONE MOST RESPONSIVE TO CHANGE."

-Charles Darwin (1809-1882)

THE NUMBER OF TYPES, brands, and forms of semiocclusive dressings in the wound management arena can be likened to the number of species of plants in a rainforest. These multiple species inhabit the rainforest, creating a moist, humid environment. They look different from each other and they have different features; some are better used in one situation than in another. Although they compete with each other for resources, they live in relative harmony.

To the untrained eye, these plants/ dressings may seem similar and it may be confusing to find the right one for a given patient's wound. For the most part, health care professionals entering this rainforest can recognize common species-such as films, gels, hydrocolloids, and foams-and may even know something about their defining features and behaviors.

However, a new species of dressing has evolved in the rainforest and is finding its place amid the more established ones. This species is called hydropolymer adhesive dressing (TIELLE Hydropolymer Adhesive Dressing, ETHICON, INC, a Johnson & Johnson company) and its evolution, distinguishing features, and survival skills will be described in this article.

Evolutionary Need for the Hydropolymer Adhesive Dressing

Evolution is change in response to an unmet need. With all of the wound dressings available, it may appear that all possible wound management needs could be met and that there would be no driving need for a new dressing to evolve. However, if we examine the performance characteristics of some of the previously existing dressing categories in relation to the management needs of a moderately draining wound, the opportunity for a new species of dressing will become more apparent.

Transparent film dressings are adherent, requiring no secondary dressing. Most have no absorbent capacity and are not suitable for managing a draining wound in most cases (some film dressings do possess absorbent capacities).

Hydrocolloids are also adherent, requiring no secondary dressing; they can manage a moderate amount of drainage. Some hydrocolloids have a claim for moderately exuding wounds. However, they have a low rate of absorption, often melt down as they absorb drainage, and may cause skin stripping if used inappropriately because of their high level of adhesion. Hydrocolloid materials have also been associated with hypergranulation,1-3 thought to be a result of their occlusive properties,4 and with significant levels of odor.5

Alginates have a high rate of exudate absorption but require a secondary dressing for attachment to the patient. Alginates can leave fibers in the wound bed if drainage is insufficient to fully gel the material or if the secondary dressing allows the gelled material to dry out.

Foam products are capable of absorbing wound exudate and may or may not require a secondary dressing for attachment. Many exhibit a resiliency that can impact their conformability in anatomically challenging areas. Foams may also reach their absorbent capacity and become"full"; if so, external pressure to the dressing can cause the absorbed drainage to release back onto the wound bed.

Ideally, a moderately to heavily draining wound would benefit from a dressing that would conform to the wound area, offer rapid and sustained absorption, leave no fibers or particulate matter in the wound, not contribute to wound malodor, and adhere to periwound skin securely without causing damage on removal. The hydropolymer dressing provides all these benefits.

Distinguishing Features of the Hydropolymer Adhesive Dressing

The hydropolymer adhesive dressing was designed to meet the need of managing drainage produced by a moderately exuding wound by providing a nonparticulate wound contact layer, a high rate of absorption, a dynamic capacity for absorption, and a strong, yet mild, adhesive that is gentle to the skin. The dressing has 4 distinct functional components put together in an island configuration. These components include the following:

* an absorbent wound contact surface of polyurethane

* an internal wicking layer

* a polyurethane backing that is highly conformable, water resistant, and vapor permeable

* a polyurethane adhesive that is gentle to skin and easy to reposition.

The features and benefits of each of these components are described below.

Wound contact surface

The wound contact surface is called a hydropolymer-referring to a hydrophilic polymer, meaning that it has an affinity for water. The polymer is polyurethane, which is foamed to create closed cells. This foamed polyurethane may look like traditional foam, but it exhibits a distinctly unique behavior. The material swells and expands when fluid is absorbed, causing the wound contact surface to"puff out"and fill the irregular contours of the wound. Its hydrophilic nature gives it the ability to absorb 15 times its weight in fluid. Because the hydropolymer material does not melt down or contain any fibers or particulates, removal of the dressing will not normally create trauma or leave behind any foreign material in the wound bed.