Pressure ulcers, often called bedsores or pressure injuries, are localized injuries to the skin and underlying soft tissue, typically over a bony prominence. They develop from prolonged pressure or friction that compromises blood flow to the area. Specialized wound care is essential for managing these injuries, and hydrocolloid dressings are a common solution. This type of dressing provides a controlled environment designed to support the body’s natural tissue repair process.
Defining Hydrocolloid Dressings
Hydrocolloid dressings are composed of gel-forming agents laminated onto a flexible, water-resistant outer layer. The inner layer, which contacts the wound, typically contains hydrophilic ingredients such as pectin, gelatin, and sodium carboxymethylcellulose (CMC). These components absorb moisture and are attracted to water.
The outer layer is usually a polyurethane film or foam that acts as a semi-permeable barrier. This film prevents external contaminants like bacteria and water from entering the wound bed while allowing some moisture vapor to escape. The dressing is self-adhering, securing itself to the intact skin around the wound without needing additional tape.
When the dressing absorbs wound fluid (exudate), the hydrophilic particles swell and transform into a soft, cohesive gel. This gel formation is often visible through the dressing as a milky or opaque bubble. The resulting gel forms a moist layer that rests against the tissue but does not adhere to the delicate wound bed.
How They Facilitate Wound Healing
Hydrocolloid dressings support healing by creating and maintaining an optimal microenvironment directly over the wound. They are categorized as occlusive or semi-occlusive because they seal the wound off from the external atmosphere. This sealing action provides two primary benefits: maintaining moisture and promoting autolytic debridement.
The moist environment accelerates cell migration and proliferation. Keeping the wound bed hydrated allows new epithelial cells to move more easily across the surface to close the wound, a process known as epithelialization. Maintaining a consistent temperature under the dressing also supports cellular function, as wounds heal faster when insulated from external temperature fluctuations.
Hydrocolloid dressings facilitate autolytic debridement, the body’s natural method of clearing dead tissue. This process uses the body’s own enzymes to dissolve non-viable tissue, such as slough or fibrin. By trapping the wound fluid, the dressing concentrates these natural enzymes and moisture against the wound bed, accelerating debris breakdown without damaging healthy tissue.
The resulting gel layer serves as a protective cushion over the healing tissue, guarding it from mechanical trauma and friction. This protection is helpful for pressure ulcers located over bony prominences subject to repeated shear forces. The dressing also provides a barrier against bacteria, reducing the risk of external contamination.
Determining When to Use Them
Selecting a hydrocolloid dressing depends on the pressure ulcer’s stage, drainage level, and presence of infection. These dressings are indicated for superficial, non-infected pressure ulcers classified as Stage 1 or Stage 2. Stage 1 ulcers involve non-blanchable redness of intact skin. Stage 2 ulcers show partial-thickness loss of the dermis, presenting as a shallow open ulcer or blister.
The dressing has moderate absorption capacity, making it best suited for wounds with scant to light drainage. A thin hydrocolloid over a Stage 1 injury reduces friction and shear forces, aiding in early management. For a Stage 2 ulcer, the dressing maintains the moist healing environment and protects the exposed tissue.
Hydrocolloids have specific contraindications. They should not be used on wounds with heavy exudate, as saturation and leakage can cause maceration of the surrounding healthy skin. They are also not recommended for wounds showing signs of infection, such as increasing redness, swelling, or purulent drainage, unless used alongside systemic antibiotics under professional guidance.
Wounds with exposed bone or tendon, or those with tunneling or sinus tracts, are unsuitable. These are typically deep, full-thickness injuries (Stage 3 or 4) requiring more robust debridement and higher absorption capacity dressings. Additionally, the opaque nature of most hydrocolloids makes monitoring the wound bed for worsening difficult.
Practical Guide to Application and Removal
Application
Proper application ensures the hydrocolloid dressing functions as intended and adheres securely. The first step involves thoroughly cleaning the pressure ulcer with a prescribed wound cleanser or saline solution to remove debris or residue. The skin surrounding the wound must then be carefully patted dry, as moisture prevents the adhesive from forming a proper seal.
The dressing should be sized so the adhesive pad extends at least one inch beyond the wound edges onto the healthy periwound skin. Warming the dressing slightly between the hands before removing the backing paper can improve initial tack and conformability. Once applied, smooth the dressing carefully from the center outward to eliminate wrinkles and ensure a complete, airtight seal.
Wear Time and Removal
Hydrocolloid dressings are designed for extended wear, typically remaining in place for three to seven days, depending on the wound exudate level. The dressing must be changed if the gel formation reaches within one centimeter of the edge, indicating saturation and leakage risk. A foul odor or increased pain beneath the dressing may signal an infection, necessitating immediate removal and assessment by a healthcare provider.
When removing the dressing, use a gentle technique to prevent trauma or stripping of the surrounding fragile skin. Press down on the intact skin while slowly peeling the dressing back parallel to the skin surface, avoiding upward pulling. Any residual gel-like substance or odor on the wound bed is usually just the dressing material and absorbed exudate, which should be gently cleaned away before applying a new dressing.