I
prae
l..""""""
~
i
I
Are modern wound dressings
a
!I
Tab
1
o
sam
'mo
oc
ut
w
nt1960s
two
landm
he
studi
estab
L
S
M
B
hyd
was
mo
eff
alt
th
ov
all
diff
not
sig
(p=
A
l
stud
by
Co
ate
et
al.
16
co
electro
datab
(EMB
Med
and
Cina
was
condu
using
the
Coch
Wou
Gro
OR
gauze
OR
'tape
AND
gauz
AND
(wou
OR
ulcer*
burn*
clinic
(eco
cast
effect
need
per
ulc
ove
the
12
stu
pe
w
al.4
calc
the
cas
to
US
he
al
thsy
A
rof
moist
woun
eview
heali
dress
in
the
A
cana
os
of
Du
C
clinical and cost-effective
alternative to the use of gauze?
Modern dressings are significantly
:1
'II,
,;
I';
!II
t'i
'i1
'
more expensive per unit than traditional
I'
alternatives,butresearchbasshownthemtobemorecosteffectiveasthey
il
"
"
1:1
are associated
faam dressing;
with taster healing
gauze; co st effeetive;
rates and fewer dressing
moist wound
,I
changes
"i
'11
healing
:1
,I
I
A.M.Jones.MSc,MBA,CompanyDirector,MSC
conditions.Ho
evidence
comparing
(dressing*
dressings
If kept moist with saline, gauze is an effective wound
dressing1Z,13 and can achieve similar healing times as
occlusive dressings.I4-16
management
sites17 included
wound-healing
of
split-thickness
skin-graft
It concluded
that
58 RCTs.
produets
healing,
pain/comfort
the author
commented
perform
the
form
to the
performance
accurate
same
were
and infection
that, since
level,
of generic
clinical
group over another.
superior
there
guidelines
donor
moist
in terms
of
rates. However,
not all produets
is a need
groups
to review
of dressings
on the
Yorkshire,UK;
hydrocolloid
dressing
(Comfeel
function
showed
and Cost-
Effectiveness Specialist,
Escuela Intemacional de
AIta Dirección
Ulcus,
Hospitalaria,
the
healing
distribution
that
Madrid,
Spain.
Email: annie.
the
jones@virgin.net
to
IWinter,G.D,Formation
efficacy and cast effeetiveness of moist gauze dressings and a hydrocolloid
wafer dressing (DuoDERM
of the scab and the rate of
epithelialization of superficial
wounds in the skin of the
ConvaTec). Only one ulcer healed in the
moist gauze dressing group, while 11 healed in
the hydrocolloid group.
CGF,
young domestic pig. Nature
1962; 193: 293-294.
2 Hinman, CD., Maibach,
effeetiveness
H.Effectofairexposure
Cast
and
In a cost-effectiveness
analysis conducted in the US4
the product with the lowest acquisition price (gauze)
proved the most costly due to the higher nursing
casts associated with the more frequent dressings
changes
($996 for gauze versus
$152-170
for
hydrocolloid)
and to the number of ulcers treated
with gauze that remained unhealed af ter 12 weeks
of care. The average number of dressing changes
occlusion
experimental
on
human
wounds. Nature
377-378.
skin
1963; 200:
3 Bradley, M., Cullum, N.,
Nelson,EAetal.Systematicreviewsofwoundcare
were:
occlusive
I
Economies,
Procurement
management:
(2)
dressings
and topical agents used in
the healing of chronic
wounds. Health Technol
171 for gauze and 26 for the hydrocolloid.
For a hypothetical managed-care plan, Kerstein et
Cost and cost effectiveness
of venous and pressure
uleer protocols of care. Dis
each year of managing ulcers over a 12-week period
to be $1.9 million less for pressure ulcers and $5.8
million less for venous ulcers using modern dressings when compared with gauze.
Colwell et al.16demonstrated that the average cast
per hydrocolloid case was $53.68 versus $176.90 for
moist gauze.
2001;9:
11,651-663.
5 Lewis,
R., Whiting,
p., ter
systematic
review
of
the
clinical effectiveness and
cost-effectiveness
of
debriding agents in treating
surgical wounds healing by
secondary intention. Health
use of one
(ConvaTec)
versus
saline
gauze
found
that
the
14,1-131.
~
modern
used
of
Assess1999;3:17,1-35.4Kerstein,M.D.,Gemmen,E.,vanRijswijk,L.etal.
versus
terms
Gauze versus hydrocolloids
Clinical effeetiveness
ManageHealthOutcomes
Gauze
search
d
Riet,G.Arapidand
were searched, as were congress abstracts and presentations, for clinical studies and case reports on
the use of dressings in clinical practice. The search
The
I
North
References
the
use, in clinical practice, of gauze and different
generic groups of modern dressings, to assess their
clinical benefits and cast effectiveness. The major
guidelines.u
Malton,
TechnolAssess200I;5:
to provide
optimal
healing
This article
reviews
the
Ltd,
Almetal.14undertookaRCTcamparingan
I
dressings. Each bas advantages and disadvantages.
Comparative
qualities are shown in Table 2.18,19
Coloplast)withwetsalinegauze.Analysisof
the concept of moist wound healing and heralded the development
of modern dressings.1,2
However, despite the publication
of a number
of systematic reviews,3-6 there is na consensus
on which dressings are most clinically and cast
effective. This is due in part to the difficulty of
conducting
large randomised
controlled
trials
(RCTs) as patients with wounds are not a heterogeneous group and aften have complex underlying
pathologies.
It is also ethically
questionable
to
conduct trials with dressings such as gauze that fail
jOURNALOFWOUNDCAREVOL15,NO2.FEBRUARY2006
65
--
----
I
hydr
dres
was
one
tha
of
gau
Usin
natio
nurs
sala
in
the
US
at
the
tim
Mo
rec
M
;m
G
u
a
of
car
wa
cli
la
Of
the
thr
re
st
b
t
in
h
Allev
(Smi
&
N
ep
ma
wi
a
h
w
f
t
b
y
o
Tiell
Oohn
J
ohn
Aigis
M
(
&Ne
Srn
A
H
Te
A
(H
o
d
e
Trans
films
OpSi
Flex
(Sm
&
N
ep
Tega
(3M
An
ad
stu
co
g
w
f
dre
wa
id
in
th
re
C
NU-G
&
J
ohn
(amor
Instr
(Smi
N
ep
PuriI
Gel
(Col
RC
no
dif
w
f
b
th
t
o
(Smi
&
N
eph
Abs
exu
Ad
(S
&
N
o
p
g
FIBR
Plus
Ooh
&
J
ohn
(p<
Th
fa
dr
w
a
w
Actis
Silve
oho
practice
median
nursing
time
(1992), the median
Table
I. Examples
Category
ofmodern
Brand
with
use of the
casts per ulcer were $15.90
occlusive
name
associated
w()ûnd
those treated with hydrocalloid
those given gauze (p=0.04).
for
cast-effectiveness
the
casts
Foams
on a typical European
patient
cohort,
exudate
(Coloplast)
more
exudate
(Bertek)
moisture
effective.
versus
foam
effectiveness
agents
used
studies
that
to treat
dressings
surgical
compared
wounds5
silicone
included
faam
four
dressings21-24
BIOCLUSIVEOohnson&Johnson)
Maintain
cast
Gauze
Clinical
Tegagen(3M)
Absorb
Sorbsan
determine
Function
(manufacturer)
tors, modelled
Aiginates
to
associated with pressure and leg ulcer care protocols,
and established that the most expensive element
care dressings
Absorb
Biatain
model
and $25.31 for
and
Hydrocolloids
Aquacel
Maintain
(ConvaTec)
Comfeel
one
that
ings25 with
the outcome
moisture
Hydrate tissues
Hydrogels
Novogel
(Ford)
Hydrate and
(sheets)
IntraSite
Comformable
soothe
tissues
study
arms,
faam
dressings
Another
although
were
study,
the
'more
authors
published
donor
stated
comfortabIe'
sites
in
than
that
the
gauze.
duplicate,1O,27
treated
with
of
Allevyn
FIBRACOLOohnson&Johnson)
may
Medifill
Oasis
(Biocore)
prornote
reported that, by dar 7, 41 of the Allevyn Adhesive
sites and 16 of the gauze sites had completely healed
granulation
(Cook)
Carboflex
(ConvaTec)
significantly less pain on removal than the gauze.
In the management
of acute wounds,
such as
donor sites, modern dressings have been found to
and wound odeur
of occlusive
dressings
Hoist
saline
gauze
(adapted
frol'n Helfman
et al.18 andWitkowski
Hydrogels
et al.19)
Aiginates,
Biomembranes
Polymer
Polymer
films
foalTls
+
+
+
:f:
+
Hydrocolloids
granules
Pain relief
+
+
Maceration of
:f:
:f:
Oxygen permeable
+
+
+
+
-
+
+
Water permeable
+
+
+
+
-
+
+
+
-
+
+
:f:
+
:f:
+
surrounding skin
, Absorbent
Damage to epithelial cells
+
Transparent
-
-
-
-
+
-
+
-
+
+
+
+
:!:representsinstaneeswheresamestudieshavereportedpositiveoutcomesandethersnegativeoutcomes
Easeofapplication
Resistant to bacteria
dress-
3 summarises
review13 of dressings and topical agents for surgical
wounds healing by secondary intention. In this small
partial-thickness
Table 2. Properties
faam
Table
(ConvaTec)
Hydrogels
Carbon-contaioing
polyurethane
gauze.
(Coloplast)
Granuflex
Collagen
compared
traditional
measures.
jOURNALOFWOUNDCAREVOL15,NO2,FEBRUARY2006
66
+
Table
3.
Foam
versu
gauz
dress
resu
tor
reso
and
oth
out
me
Res
use
(no.
of
arms)
No.
of
inpa
day
No
McM
1980"
and
fou
in
faa
gr
re
diffe
23.8
il1
faa
gauz
grou
~.
exc
No.
of
hom
visi
Day
to
hos
disc
No
sign
Mea
time
Dis
on
dr
D
w
l
o
N
s
i
di
fa
diffe
8.5
day
in
faa
No.
of
hom
visi
No
tha
faa
gro
(0
no
grou
than
in
faam
gro
at
wee
3(0.2
me
tw
in
g
aft
INo
w
in
Al
Ca
gr
e
dif
be
practice
I
Study,
design,
sample
size
Silicone
foam
Duration
Condition
Dressing
comfort:
Other
and
outcomes
performance
versus
gauze
Macfieand
Perineal
dressings
wounds
Pain: 15 patients in gauze group
Until.healing
significant
(p>0.05)
RCT,n=50(2)
analgesia
group
versus
22.8 days in
Significantly(p<O.OOI)less
convalescence
in faam
group
(14.1)
than
gauze group (46.9)
Walker
199122
Pilonidal
et al.,
wounds
sinus
Until healing
and
incised
RCT,n=75(4)
difference
betWeen
groups
abscesses
Williams
et
Untilhealing
Pilonidal
al.,
sinus wounds
198123
removal:t
Significantly
group versus 7.3 days in
gauze group
Significantly
greater
(2.9) than faam
in
group
group 45.1 versus
gauze group 38.6
(lA)
RCT,n=80(2)
gaUze group
(p<0.05)
greater in gauze group
(35.1) thal1 faam group (4.6)
Eldrup198526RCT,n=33(2)
Pilonidal
sinus wounds
difference
Until healing
n=12 (2)
Polyurethane
RCT,n=43,(2)
Meyer,
199725
No. of dressings used:
than in gauze group (868).
Variance
notmeasured
foam versus
Foam
comfortabie,
reported
LessinfoalTlgroLjp(20)
Ricci et al., 199824
Controlled trial
Comfort:
Until healing
Pilonidal
sinus wounds'
stated
as more
but no data reported
Pain: Reported pain-free in faam
group; gauze reported as pajnful,
and bleeding occurred
Return
to work:
Foam group 12
days; gauze group
23 days.Variance
not measured
gauze dressing
Abdominal
surgery or
abscess incision
No.
of dressing
Approximately
changes:
three
times
PaiJ)t
at week
greaterin
gauze
4: Significantly
No. of wounds
group
closed surgically:
Four ,InAllevyn
Cavity group and
(1.82)
more frequent in gauze
measured
and 4 (mean
0.14/0.39)
Erythema:
Significant
reduction
(RR=2.1,95%
0.5
3 weeksin
gauze
Necrosis,
secretion
odour, putrid
and itching:
Cl,
9.15)
group
Infection:
(not
frequently
at any
week in Allevyn
Cavity group, 3
weeks in gauze
group
jOURNALOFWOUNDCAREVOL15,NO2,FEBRUARY2006
~67
tMeasuredusingvisualanaloguescale(VAS)RCT=randomisedcontrolledtrialRR=relativeriskCl='confidenceintervalAdaptedtromlewisetal.5andBradleyetaL'4weeks
tilTle in study)
reported
Significant
reduction after I
I
N.A.,
M., Sheldon,
T.ASystematicreviewof
Majid,
agents
used
forchronicwounds.BrJ
antimicrobial
Surg 200 I; 88: 1,4-21.
7 Dyson, M.,Young, S.,
Pendie, c.L. et al.
Comparison of the effects
of malst and dry conditions
on dermal repair.J Invest
Dermatol 1988; 91: 5,
434-439.
8 Alvarez, O.M., Mertz,
P.M.,
Eaglstein,w.H.The
effect of occlusive dressings
on collagen synthesis and
re-epithelialization
in
superficial wounds.J Surg
Tabl
4.
Cast
effee
of
trad
ver
mo
dre
Sp
an
the
UK
fo
ba
tr
a
m
Two
syste
revie
hav
sho
that
mo
sal
irr
flu
w
c
lo
a
Calg
Vest
its
use
was
asso
with
18.
few
Th
lac
of
ev
fr
w
R
Gate
and
Holl
stud
40
pati
wh
had
cove
or
Intra
Gel
(Sm
&
N
faa
ep
.
T
fac
tha
no
sin
pr
is
su
h
f
a
woun
filler
(AIl
Cav
Sm
&
N
ep
ew)
and
BIOC
dres
Ooh
&]o
in
the
cas
of
ul
m
pth
exp
dre
ile
co
st
nacA
Traditional
France
dressings
Modern
Spain
3.82
dressings
France
Tatal casts of materials*
3.21
Nursing cast per visit
10.08
II.OO
fIS.OO
10.08
II.OO
fIS.OO
Cast per dressing change
13.29
14.82
f17.06
16.S8
19.41
!22.94
2S
Average number of dressings changes
2S
332.2S
Average cast per clased ulcer
!2.06
Spain
UK
S.M., CulIurn,
UK
6 O'Meara,
6.S0
2S
370.S0
8.41
3
!426.S0
!7.94
3
49.74
3
S8.22
f68.82
*Forthetraditionaldressingstreatmentoption,itwasassumedthatfourtofivegauzes(dependingonthepacksize)areused;eneasa
practice
cover, with the remaining three to four soaked with irrigation fluid
Res1983;35:2,142-148.
Sources:
c.,
France:ProductpricesfromNamenclatureLPPRPansements2004.labourcastsfromNamenclatureGenera'desActesPro(essiane/s(NGAP)
9 Vcgt, P.M.,Andree,
and wet
skin wound
repair.Ann
Plast Surg
1995; 34: 5,493-499;
discussion
499-500.
L., Reali, U.M.,
Borgognoni,L.etal.Comparisonoftwo
10 Martini,
dressings
in the
management
of partialdonor
sites.J
WoundCare1999;8:9,
thickness
I1CochraneWounds
457-460.
Group.A
Step
by
Step
WoundsGroup.Cochrane
Guide for Completing a
Cochrane Review with the
Collaboration.
www.york.
ac. u k/h ealthsci en cesl gs pl
themes/woundcarel
UK:
Product
prices
Product
from
prices
from
Namenclótar
the
Drug
de
y
E(ectas
Tariff,August
2004.
labour
casts
from
nduct%20a%2Oreview.htm,Accessed3March2005.
Munro,
a(
Health
and
Socio!
Care
2003,
by
Ann
Netten
and
gauze,1O,27,28
models of
dressings, based on Gates and Holloway's model,31
The cast of materials,
including
clean ser/dressing
pack, gauze, faam, hydrogel,
fixing material and
ern dressings have advantages over gauze in terms
of healing, pain/comfort
and infection rates, patient
These data clearly illustrate that dressing acquisisatisfaction and use of nursing resources.
tion casts represent only a part of the total cast of
wound
Cast
unit
B.H.Thecastandefficacyoftwowoundtreatments.AORNJ2003;77:5,984-
Casts
be statistically
superior to tape and
confi.rming the findings of experimental
moist wound healing.s,s,9,29
effectiveness
acquisition
cast of the faam
dressing
management
-
nursing
time and
the
number of dressing changes represent a significant
contribution.4.S,16,32 Despite the higher acquisition
casts of faam dressings, their use is associated with
fewer dressing changes.
of grade 11and III pressure ulcers. Despite the higher
Capasso,Y.A,
Unit
lesley Curtis at the Personal Social Services Research Unit
Kraft et al. 30 compared
the co st effectiveness
of
gauze and faam dressings
in the management
Wounds/How%20to%20co
12
Spain:
Accesarias,May2004.labourcaststromanindependentagencystudy
Breuing,K.etal.Dry,
fee schedule
malst,
(Epi-Lock,
Discussion
er dressing
992,995-997,1000-1004.
13Vermeulen, H., Ubbink,
D., Goossen,A et al.
Dressings and topical
agents for surgical wounds
healing by secondary
intention.CochraneDatabaseSystRev2004;2:
14Alm,A,Hornmark,
Fall,
P.A
et
al. Care
DermVenereolSuppl
compresses.Acta
ChrischilIes,E.A.
(Stockh) 1989; 149: 1-10.
15 Xakellis, G.c.,
PhysMedRehabil1992;73:
Hydrocolloid versus salinegauze dressings in treating
pressure ulcers: a costeffectiveness analysis.Arch
5,463-469.
the
24-week
study
period,
making it a cost-effective alternative to gauze.
undergone
nal
either
a Caesarean
hysterectomy.
They
section
received
evaluating
the clinical and cast effectiveness
of
wound-care products is due to a number of factors:
The
heterogeneity
and
complex
underlying
pathologies
of many patients with chronie wounds
The difficulty of blinding any treatment
involving
.
.
or an abdomi-
either
a wet-ta-dry
a physical dressing
of pressure sores: a
controlled study of the use
of a hydfocolloid dressing
compared with wet saline
gauze
over
dressing (saline-soaked gauze sponges and a gauze
CDO03SS4.
AM.,
changes
Wounds
in
the
faam
dressing
group
underwent
wound types or all stages of the healing process.
Considering the acquisition co st of dressing products but ignoring the number of dressing changes or
sec-
ondary closure in 5.1 days versus 8.5 days for the
gauze, and required three versus 25 dressing chang-
home visits made when
impact of care procedures
es. Average co st savings with the faam re gim en were
$572.60 (1992 values) per closed wound, and would
have been greater had analgesia and extended hospital staf been included in the calculation.
Fig 1 illustrates differences between the number
of dressings used and home visits associated with
faam and gauze dressings in three studies.21,23,31
Table 4 gives comparative
co st data for France,
assessing the
is misleading,
monetary
especially
er one when the complete episode of care is taken
into account. Any decrease in the healing time is
likely to promote bath social and economie advan-
tages for the patient by ensuring a shorter duration
of pain and discamfort, as weIl as early mobilisation
jOURNALOFWOUNDCAREVOLIS,NO2,FEBRUARY2006~--
68
rbut
A
study
ecent
used
activ
cost
Fig
I.
Foa
ver
gau
cle
ag
pe
w
ty
confir
the
impo
of
inclu
both
labo
also
were
signif
more
co
st
effec
(wh
Finall
althou
resea
and
eval
is
sugge
they
are
super
to
tape
gauz
How
ever,
the
lack
of
wellRCT
mak
it
difBox
I.
Sum
of
the
ma
fin
At
presen
it
is
impo
to
selec
the
'best
The
liter
sho
tha
hyd
an
fa
dr
ar
m
c
a
rate
mea
the
ove
cas
of
tre
isl
matio
to
aid
select
of
the
most
appr
practice
and thus a return
to work or usual activities.
ing to investigate the co st effeetiveness of traditional wound management
in patients with grade 11
and III pressure ulcers. This included the effect of a
treatment
algorithm
in the
analysis.
The
. Gates3'
(with
used
with
or
an
without
a treatment
appropriate
11 Williams23
Macfie21
40
30
20
algorithm)
treatment
11
50
findings
and acquisition costs in economie analyses.
The authors reported th at when the costs of labour
were included,
modern
dressings used not only
achieved better clinical outcomes than gauze and
ointment
I
10
regimen)
(p=0.02 and 0.002 respectively).
0
Number
ficult to develop evidence-based
clinical guidelines.
After a thorough
assessment of the patient and
wound type, the best existing advice is to select the
product with the most ideal characteristics.
This review
a
generic
group
su eh
as
Foreman,
comparison
of the
and cost-effectiveness
two
methods
of
efficacy
of
surgical
secondary
Macfie,J.,McMahon,
M.J.The
management
of
perlneal
wound
open
a
faam
healing
intention.
by
In:
and achieve
better
to the
and
hydrocellular
in the treatment
of partial-thickness
graft
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