Sequential treatment approach accelerates pressure ulcer healing

NEW YORK (Reuters Health) – Treating pressure ulcers with a calcium alginate dressing for 4 weeks prior to switching to a hydrocolloid dressing promotes faster healing than treatment with hydrocolloid dressing alone, according to results of a French study.

Dr. Joel Belmin, of the Hopital Rene Muret in Sevran, and colleagues randomly assigned 57 patients who were 65 years or older to the sequential strategy and 53 controls to treatment with hydrocolloid dressing alone. The ulcers had passed through the subcutaneous tissue, but their surface area did not exceed 50 cm squared, and granulation tissue did not cover more than 50% of the ulcer surface.

In the control group, hydrocolloid dressings were applied approximately every 3 days for 8 weeks. In the sequential group, calcium alginate dressings were applied approximately every 2 days for 4 weeks, then hydrocolloid dressings every 3 days for 4 more weeks. The results appear in the Journal of the American Geriatrics Society for February.

In the sequential treatment group, 68.4% achieved the study endpoint of a 40% reduction in surface area at 4 weeks, and 75.4% at 8 weeks. In the control group, the endpoint was achieved by 22.6% at 4 weeks and 58.5% at 8 weeks, a significant difference between groups (p < 0.0001).

Four weeks of treatment resulted in a 47.3% average reduction in surface area in the sequential group and a 14.6% reduction in the control group. Healing rates were similar during the last 4 weeks of the trial, 35% and 33%, respectively.

Nurses treating the patients reported that pain during dressing removal and odor from the ulcer were significantly greater in the control treatment group.

According to the authors, alginates absorb wound exudate to form a nonadherent gel. This gel appears to activate macrophages, which clear necrotic debris and stimulate angiogenesis. The downside of alginates is their propensity to stimulate fibroblast proliferation and reduce the number of microvascular endothelial cells and keratinocytes.

Dr. Belmin's team recommends that alginate dressings be used for a limited time to prevent excessive granulation.

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