Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.
By Jeffrey Levine MD
While I’m on rounds with students I like to ask, "What is the active ingredient of hydrogel?" My query is usually met with puzzled looks. It's a trick question, because the term "active ingredient" generally applies to pharmacologic agents that undergo metabolic change in biologic systems. The active ingredient of hydrogel which gives this substance its name is water. Compounds are added to thicken the mixture and provide viscosity, such as glycerine. Other ingredients common in cosmetics, such as aloe vera, methyl paraben, hydrogenated castor oil, and propyl paraben, are added to hydrogel depending on the manufacturer.
An Overview of Hydrogel Dressings
Hydrogel is supplied in an amorphous form in tubes, impregnated into gauze, or in a gel-saturated fiber mesh. Because hydrogel is not a pharmaceutical as defined by the FDA, it does not require a physician prescription. Due to its classification, the FDA does not require controlled clinical trials that prove its efficacy, and there is no reliable research comparing it to other wound care modalities, or even its predecessor, moist gauze.
Hydrogel is a popular treatment for sacral and buttocks wounds which always has me puzzled, as these are areas prone to moisture-associated skin damage (MASD) and incontinence-associated dermatitis (IAD). Adding moisture to the perineal area not only increases the risk of IAD, but adds to the propensity to develop yeast and other infections. Moisture balance is an important component of wound bed preparation, but if a wound is too moist the skin becomes fragile and prone to bacterial colonization and infection.
When to Use Hydrogel
I understand the rationale for application of hydrogel, as it renders the wound bed moist which promotes epithelialization and other aspects of healing. It is also marketed to reduce wound pain and fill dead space. Despite the marketing claims, I often wonder if this modality is overused, particularly in areas that are already moisture-prone such as the perineum.
Hydrogel is often used on eschar with the intent of adding moisture, thereby making the eschar easier to remove. This could be a form of autolytic debridement, however eschar is essentially dead tissue. Hydrating this tissue can render it a desirable substrate for proliferation of pathogenic bacteria.
As with any wound care modality, topical treatment must be accompanied by frequent visual inspection and documentation of the wound as it evolves. Any sign of worsening such as pain, increased drainage, purulence, odor, slough, or systemic symptoms such as fever should result in re-evaluation of treatment in progress. Hydrogel certainly has its place in the wound care armamentarium, but we need to exercise caution when using it in moisture prone areas. The last thing we want is to worsen a wound by causing maceration or promoting infection.
About the Author
Dr. Jeffrey Levine is a board-certified internist and geriatrician with over thirty years of experience in wound care in hospitals, nursing homes, and home care environments. He is a voluntary attending physician at the Mount Sinai Medical Center in Manhattan, and Associate Professor of Geriatrics and Palliative Care at the Icahn School of Medicine at Mount Sinai. He received his fellowship training in geriatrics at the Mount Sinai Medical Center where he began his interest in chronic wounds. He is an elected board member of the National Pressure Ulcer Advisory Panel (NPUAP).
Dr. Levine’s interest in pressure ulcers began in the 1980s during his geriatric training when he noticed that many of his nursing home patients had pressure ulcers but there was little reliable information on treatment methods. This motivated him to study not just prevention and treatment of chronic wounds, but to delve into the rich history of wound care over the centuries. He has since published a number of articles on historical topics ranging from wound care in ancient Egypt through the 20th Century.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.