Editor’s Note: This WoundCon Fall 2023, Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCASA will present "Dressed for Success: Hydrogels Deep Dive" which will occur October 13. In this interview, Dr. Rudolph discusses some ways providers can use hydrogel dressings to facilitate wound healing.

How do hydrogel dressings help promote moisture balance in necrotic and sloughy wounds?

As we know, debridement is a critical aspect of wound management. It is critical to remove non-viable tissue to mitigate infection risks and promote moist wound healing. Typically, we think of enzymatic or sharp debridement as a first consideration; however, hydrogels can be effective for autolytic debridement.

By applying a hydrogel to a wound with necrotic tissue and covering it with an occlusive or semiocclusive dressing and leaving it in place for a few days at a time, it is possible to promote the body's own autolytic debridement processes. While this may be slower in some cases, it can be a cost-effective approach. It may also be beneficial for patients who cannot tolerate other debridement methods or may not be candidates for more aggressive debridement options.

How are hydrogel dressings helpful for managing diabetic foot ulcers specifically?

A moist wound environment that supports healing is critical for diabetic foot ulcer (DFU) management. Diabetics are at higher risk for infections due to impaired leukocyte function, which affects their ability to respond to infection. In addition, some have microvascular disease which also increases infection risk. Nearly 25% of diabetics will develop at least one DFU in their lifetime. Consequently, appropriate management is essential.¹

A hydrogel, especially one with antimicrobial properties such as silver, can be especially useful to maintain optimal moisture balance, promote moist wound healing, and decrease the risk of infection. Topical therapies such as hydrogels must be used in conjunction with a comprehensive program of glycemic control, offloading, nutrition, and management of comorbid conditions.

Do hydrogel dressings need a secondary dressing?

Hydrogels have a high moisture vapor transfer rate (MVTR) and will require a secondary dressing to help maintain an adequate moisture balance in the wound environment. Secondary dressings such as foam dressings, transparent film dressings, hydrocolloids or gauze are usually necessary in order to help maintain a moisture balance and prevent the wound from drying out. When combined with the appropriate secondary dressing, hydrogels can remain in the wound bed for several days at a time and may only need to be changed every 2-3 days. Frequency will be dictated by exudate volume. Wounds with less exudates will require less frequent dressing changes.

What advice would you give a novice wound care professional interested in using these dressings for a patient?

As a clinician new to wound care, it is important to keep the principle of wound management or wound hygiene in mind: Cleanse, debride, refashion the edges, and dress the wound. In terms of choosing wound dressings, it is important to match the characteristics of the wound/what the wound needs with a dressing that can address that need. Not every product on the market is appropriate for every type of wound. Hydrogels have an important role as a wound dressing because they are easily available, cost effective and user friendly.

They are useful for donating moisture to a dry wound, they can help with autolytic debridement when used with an occlusive dressing and help with maintaining an adequate moisture balance in many wounds with no exudates to moderate exudates. They can be used on chronic vascular ulcers, pressure injuries, dehisced surgical wounds, burns and traumatic wounds. They are limited in their ability to absorb exudates so one should consider a more absorbent product such as an alginate or hydrofiber for more heavily draining wounds.

Reference

1. Oliver TI, Mutluoglu M. Diabetic Foot Ulcer. In: StatPearls [Internet]. StatPearls Publishing; 2023: https://www.ncbi.nlm.nih.gov/books/NBK537328/

About the Author

Dr. Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN is a nurse practitioner board-certified in Gerontological advanced practice nursing and as a wound, ostomy and continence nurse. Dr. Rudolph is currently working at South Texas Wound Associates. She has been a nurse for more than 30 years with experience in trauma care, acute care, home care, hospice, long term care, rehab, and wound care. She is very passionate about caring for adults and older adults with complex medical and wound needs. She has been a faculty member for several schools of nursing and is currently adjunct faculty at the University of Texas Health Science Center in Houston. She has presented multiple lectures and has published articles and book chapters on a variety of topics.