Pressure ulcers, also known as bedsores, are localized injuries to the skin and underlying tissue, typically over a bony prominence. They result from prolonged pressure, often combined with shear or friction, disrupting blood flow. These ulcers are a common concern for individuals with limited mobility, and their effective management is important for preventing complications. Hydrocolloid dressings are a frequently utilized and effective option in their care.
Understanding Hydrocolloid Dressings
Hydrocolloid dressings are specialized wound care products designed to interact with the wound environment. They are primarily composed of gel-forming agents such as gelatin, pectin, and carboxymethylcellulose, embedded within an adhesive polymer matrix, forming the inner layer.
The dressing includes a flexible, waterproof outer layer, usually made of polyurethane film or foam. This outer layer serves as a barrier against external contaminants, including bacteria and water. The materials provide flexibility and conformability, allowing them to adhere well to various body contours. Their occlusive nature creates a sealed environment over the wound.
Mechanism of Action for Healing
Hydrocolloid dressings facilitate wound healing by creating an optimal moist environment, which is conducive to the body’s natural restorative processes. When the dressing comes into contact with wound exudate, the hydrophilic components within the dressing absorb the fluid and swell, forming a soft, cohesive gel. This gel layer maintains a consistently moist interface between the dressing and the wound bed.
Maintaining moisture supports autolytic debridement, where the body’s own enzymes naturally break down and remove dead or devitalized tissue from the wound. This process is selective, targeting only non-viable tissue, which helps to preserve healthy surrounding tissue. The moist environment also promotes the proliferation and migration of cells involved in wound repair, aiding in faster closure of the wound.
When to Use Hydrocolloid Dressings for Pressure Ulcers
Hydrocolloid dressings are suitable for specific types of pressure ulcers and require a thorough wound assessment. They are typically indicated for shallow pressure ulcers, particularly Stage 2 ulcers, which involve partial thickness skin loss. This includes shallow open ulcers with a red-pink wound bed, or intact or ruptured serum-filled blisters. These dressings can also serve as a prophylactic measure for intact skin at risk of breakdown, providing cushioning and reducing shear forces.
However, hydrocolloid dressings are not appropriate for all wounds. They should not be used on heavily exuding wounds, as their absorptive capacity is limited, which can lead to maceration or leakage. These dressings are also contraindicated for infected wounds because their occlusive nature can trap bacteria and worsen the infection. Deep wounds, such as Stage 3 or 4 pressure ulcers extending into muscle or bone, require different management strategies. A healthcare professional should always assess the wound to determine the most suitable dressing type.
Practical Application and Care
Before applying the dressing, the wound and surrounding skin must be gently cleaned with a suitable wound cleanser, such as normal saline, and then thoroughly dried. This cleaning prepares the wound bed and ensures optimal adhesion. The skin around the ulcer should be free of excess moisture or residue from cleansers.
The dressing should extend at least one inch beyond the wound margins to ensure good adherence to healthy skin and contain any exudate. When applying, place the adhesive side directly over the wound, smoothing it from the center outwards to eliminate wrinkles and ensure full contact. Dressings should be changed when signs of leakage appear, if the edges begin to roll or lift, or when the gel formation under the dressing becomes excessive, indicating saturation. Gentle removal, by peeling back an edge slowly and parallel to the skin, helps prevent trauma to the newly formed tissue or surrounding skin.