Treating a thermal burn? Sheet hydrogels can help

By Liza G. Ovington
Program Director
Wound and Continence Management
Home Health Care Division, Southeast Florida
Columbia Healthcare Corp.
Ft. Lauderdale, FL

If you are looking for a wound product with a gelling tendency, hydrogels have an advantage in that they start out that way. The hydrogel category of dressings is subdivided into two formats:

• hydrogels that are shapeless or amorphous;

• hydrogels that are in a wafer or sheet form.

The two formats have somewhat different features and uses with respect to wound care. This month we will focus on the sheet hydrogels.

This product is a unique material similar to soft contact lenses. Sheet hydrogels consist of a small amount of a cross-linked polymer (anywhere from 6% to 30%), which physically entraps water to form a solid sheet. Depending on the amount of water entrapped, the sheet hydrogels may feel moist. However, squeezing or compressing the hydrogel sheet will not release any of the water because it is bound within the polymer network. In spite of their high water content, hydrogel sheets can absorb a slight to moderate amount of drainage by swelling.

Hydrogel sheets are available with or without adhesive borders. Borderless hydrogel sheets may be kept on the wound by taping around the perimeter, covering entirely with a larger film dressing, or wrapping with stretch gauze or a tubular bandage. In the bordered products, the adhesive border is usually of a film or foam composition. Some brands of sheet hydrogels are available in sterile and non-sterile versions. The non-sterile versions are much less expensive than the sterile ones due to the cost of the sterilization method (usually gamma irradiation).

The sheet hydrogels possess a unique cooling ability due to their architecture, which is of great benefit on thermal burns and other painful wounds. Patients often report the hydrogel dressing to be "soothing." The hydrogel sheets are particularly gentle and will not disturb fragile granular or epithelial tissue. They are suitable for use on healthy, granulating tissue, skin tears, second-degree burns, or many partial thickness defects. Hydrogels can also be very useful in the treatment of dermatitic skin.

Hydrogels also can be slippery in use. The borderless versions may be difficult to retain with a secondary dressing on a high friction location. This slipperiness decreases with decreasing water content.

Some sheet hydrogels come packaged between two thin sheets of plastic or acetate film. At least one of these films (usually the one on the wound site) must be removed before placing the hydrogel in contact with the wound bed. If the supporting films are removed from both sides, these sheet hydrogels can be used to line or lightly pack a full thickness wound.

While hydrogels have an inherent cooling effect, some patients and clinicians store them in the refrigerator to enhance this particular effect, which is especially advantageous in treating burns.

Editor’s note: For a list of available hydrogel dressings along with their manufacturers and toll-free telephone numbers, see chart, p. 44. n