Hydrogel dressings are used in a variety of wound types and they are designed to hold moisture at the wound surface, providing the ideal environment for wound cleansing and autolytic debridement, where the body’s own enzymes debride dead tissue (necrosis) (Moody, 2006). They are particularly useful in dry, necrotic wounds.
The moisture donated by hydrogel dressings can help to soothe the wound and reduce pain. They are also able to absorb a certain amount of exudate, thereby providing moisture balance at the wound surface (Hoffmann, 2007).
The high moisture content of hydrogel dressings can also provide a barrier to microorganisms and help to prevent infection (Moody, 2006).
How do hydrogels work?
Hydrogels are produced as a gel with little firm structure (known as amorphous dressings), or as flat sheets with a gel component added (Morris, 2006). Despite the fact that hydrogels contain high levels of water themselves, they are usually made up of a three-dimensional network of hydrophilic polymers, which are able to absorb moisture, such as wound fluid (exudate). Different hydrogels contain varying amounts of water, but none of them dissolve in the wound entirely, rather donating moisture to the wound bed (Moody, 2006).
Amorphous hydrogels require a secondary dressing to keep them in place, whereas flat sheet hydrogels are designed to maintain their shape even as they absorb moisture (Vernon, 2003).
Hydrogels are designed to donate or absorb moisture and provide an ideal moist healing environment.
Why is a moist wound environment important?
Maintaining a moist rather than a dry environment in the wound bed helps to promote wound healing, as it prevents dehydration of tissue and subsequent cell death, promotes angiogenesis (the growth of new blood vessels), and helps to erode dead tissue (Field and Kerstein, 1994).
There are a number of hydrogel products available – how can I choose the correct one?
Each patient will have different wound care needs that have to be considered when choosing the right product – the following questions will help with dressing selection.
What type of wounds can a hydrogel be used on?
Hydrogels can be used in dry, necrotic wounds to rehydrate the wound bed and provide a moist wound environment for healing (Field and Kerstein, 1994). However, hydrogels can also be used on sloughy, granulating (where new tissue connective is forming) and epithelialising wounds (where new skin is forming) (Moody, 2006).
Hydrogels can absorb a limited amount of exudate. However, as they donate as well as absorb moisture to a wound, they are not suitable for highly exuding wounds where there is a danger of maceration to the surrounding skin, or the ‘overloading’ of secondary dressings (Hampton and Collins, 2003).
Hydrogels can also be used on:
- Pressure ulcers
- Surgical wounds
- Skin tears
- Diabetes-related wounds.
Is the wound infected?
Hydrogels can be used in infected wounds, as long as the patient is receiving systemic antibiotics and the dressing is changed regularly (Moody, 2006).
However, caution should be exercised in patients who have peripheral vascular disease or if the wound contains gangrenous tissue, as the increase in moisture may spread infection (Jones, 1999).
Is the patient in pain?
As they do not contain an adhesive, hydrogels can be an option for patients experiencing pain, as there is little trauma at dressing change. It should be remembered that if a secondary dressing is used to hold a hydrogel in place, this might have an adhesive component.
Does the wound need debriding?
Hydrogels are designed to donate moisture to the wound, which provides a moist wound healing environment and, depending on the precise properties of the dressing, will aid autolytic debridement. Hydrogels can also be used together with sharp debridement (Vernon, 2000).
Is the wound in an awkward area?
Some hydrogels are conformable, which means that they can be fitted to different wound sizes and in hard-to-dress locations. Amorphous hydrogels can also fit into diverse wound shapes, but they have to be kept in place with a secondary dressing.
Some sheet hydrogel dressings can also be cut to fit in awkward areas (Hoffman, 2007).
Is maceration a problem around the wound?
In highly exuding wounds the application of a hydrogel can cause an increase in moisture, which can have a negative effect on the surrounding skin, potentially increasing maceration (Moody, 2006).
Points to remember when applying a hydrogel
Because of their versatility, hydrogels can be applied to a range of different wound types and the type of hydrogel chosen will depend on the wound, for example, an amorphous gel can be applied to deeper wounds, or a flat sheet hydrogel cut to fit a particularly awkward shape.
It is important to remember that an amorphous hydrogel will need a secondary dressing to hold it in place.
Remember that hydrogels are not suitable for highly exuding wound as they provide increased moisture.
Removing a hydrogel
Hydrogels are easy to remove as they do have an adhesive component, making them ideal for fragile or torn skin and for ensuring pain-free dressing changes.
Due to their composition and high water content, hydrogels do not leave fibres and adhesive material in the wound on removal.
Although cost-effectiveness is important, choosing the cheapest hydrogel dressing is not necessarily the best thing to do, as dressing choice should always be guided by the patient’s needs. If a dressing fails to perform well, more frequent dressing changes will be needed incurring greater nursing time.
Patient choice and preference should always be considered. This helps to build up a good nursing–patient relationship and is in line with national policy.
- Moist wound healing
- Antimicrobial properties
Moody A (2006) Use of a hydrogel dressing for management of a painful leg ulcer. Wounds June: 12–17
Morris C (2006) Wound management and dressing selection. Wound Essentials 1: 178–83
Field FK, Kerstein MD (1994) Overview of wound healing in a moist environment. Am J Surg 167(1A): 2S–6S
Hampton S, Collins F (2003) Tissue Viability. Whurr, London
Hoffmann D (2007) The autolytic debridement of venous leg ulcers. Wound Essentials 2: 68–73
Jones V (1999) Use of hydrogels and iodine in diabetic foot lesions. Diabetic Foot 2(2): 47–52
Vernon T (2000) IntraSite gel and IntraSite Comformable: the hydrogel range. Br J Comm Nurs 5: 10, 511–16