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Progress in Practice: Next Generation Foam Technology
Progress in Practice: Foam Technology, a new sponsored column for 2013, will familiarize Ostomy Wound Management readers with advancements in and practical application of foam dressings. This first column was excerpted with permission from authors from Wounds UK 2012;8(4supplement):3–7.
The Role of Foam Dressings
Foam dressings have been commercially available for more than 30 years for the management of exuding wounds. The composition and mode of action among foam dressings varies,1 with different methods of absorption and physical performance characteristics.2 Developments in foam dressing technology have focused on increasing moisture vapor transmission rate and absorbency to provide higher fluid handling capacities and on improving adhesive characteristics, primarily by moving from acrylic-based adhesives to atraumatic silicone-based adhesives. Recently, the use of foam dressings in clinical practice has been debated, with considerable confusion about their role and value in wound management.3 With a range of alternative dressings now available to clinicians, some may argue wounds can be managed effectively without foam dressings, while others state that a foam dressing should always be included in formularies because it can manage exudate effectively when used appropriately.3 However, high-quality evidence to support decision-making often is lacking, and strategies are needed to support and educate nurses in measuring and monitoring clinical outcomes to help assess the effectiveness of foam dressings.3
Hydrofiber® Family of Dressings. Hydrofiber® Technology is a patented technology in which fibers of high-quality cellulose are carboxymethylated, altering their structure to allow better absorbency and retention of fluid. These fibers then are processed to mesh them together to form a stable fleece layer. When exposed to fluid, the fibers swell to form a clear, soft, cohesive gel structure that closely conforms to the wound bed. As the fibers swell, the fluid and its contents (eg, bacteria and other inflammatory cells and enzymes) are trapped and held within the dressing. In addition, the gelling action prevents lateral spread of fluid through the dressing to reduce the risk of maceration and promote a moist wound healing environment.4
The foam dressing debate, coupled with the identified potential to further enhance the performance capabilities of foam dressings, has driven the development of a new foam dressing incorporating Hydrofiber® Technology aimed at extending the use of foam dressings across a wide range of wound types.
A New Foam Technology
Dressing development. The new AQUACEL® Foam dressing, (ConvaTec, Skillman, NJ) comprises a protective polyurethane film top layer, an absorbent polyurethane foam pad, and an integral Hydrofiber® interface with a silicone adhesive border. A specific hydrophilic polyurethane foam material was selected to match the hydrophilic nature of the Hydrofiber® wound interface and to ensure one-way fluid transmission from the gelled wound contact layer, up into the foam layer and then up to the polyurethane film surface for moisture vapor transmission.
The gelling AQUACEL® Foam interface provides a moist wound environment with no adhesive barrier between the AQUACEL® Foam interface and the wound surface. This is designed to provide an intimate contact with the entire wound surface.5,6 This gelling wound interface also is designed to help soothe and reduce pain associated with the wound.7-9
Clinician and patient needs were assessed in terms of clinical performance, cosmetic attributes, and touch/feel acceptability. Dressing color was matched to the most preferred color shade cited by clinician review panels, dressing shape was designed to best accommodate body contours, and specially shaped dressings were designed for the difficult-to-dress heel and sacral areas. Dressing feel was assessed to ensure the wearer would experience minimum sensation that he/she was wearing a dressing and to ensure the dressing’s ability to minimize pain during wear and dressing removal.10
Dressing performance. Laboratory studies were conducted to measure the dressing’s fluid absorbency, fluid retention, total fluid handling capacity, moisture vapor transmission rate, adhesiveness, and bioadhesion characteristics (ie, the in vitro adhesion of biological material to the dressing surface, which is predictive of in vivo tissue adhesion to a dressing and the potential for a dressing to cause tissue trauma at dressing change5,10). This new foam dressing design has been shown in in vitro testing to provide fluid handling capacity5 equivalent to other market-leading foam dressings, but it was found to have superior fluid-retention capabilities; effective control of lateral fluid spread aimed at protecting periwound skin from maceration6,11; and a low-friction coefficient outer dressing surface to provide protection to the underlying skin and wound tissue from external shear forces.10 The AQUACEL® Foam dressing also was found to be superior in terms of intimate contact (no or very little dead space between the wound and the dressing, where fluid may accumulate and bacteria may proliferate4) with a simulated wound surface. The advanced silicone adhesive used within the AQUACEL® Foam dressing was shown in vitro to have a higher level of adhesiveness (predictive of dressing wear time), coupled with an atraumatic level of bioadhesion to keratinocyte cells (predictive of gentle, atraumatic dressing removal).10
Additional laboratory studies10 reported the dressing retains its structural integrity after cutting, even when saturated with fluid; the silicone adhesive border can be repositioned and re-adhered to the skin during application, even after prior adhesion to surgical gloves; the dressing acts as an effective barrier to viruses and bacteria to assist in infection control programs; the dressing is waterproof, protecting the wound from incontinence episodes and allowing patients to shower and bathe; and the dressing can be left in place with no effect on magnetic resonance imaging (MRI). 
Selecting the Appropriate Dressing
Effective exudate management can reduce time to healing, reduce exudate-related problems such as periwound skin damage and infection, improve patient quality of life, and reduce dressing change frequency and clinician time, with the overall result of improving healthcare efficiency.12 A comprehensive assessment should underpin effective exudate management and ideally should be integrated within a general wound assessment.13 This assessment should identify the etiology of the wound, which may indicate the need to use more than a topical dressing — eg, compression bandaging for a venous leg ulcer patient. The patient’s nutritional and hydration status also need to be considered, because a heavily exuding wound affects fluid balance and nutritional status, increasing demands for both food and fluids.14 In addition, an inappropriately managed exuding wound can lead to distress due to painful, macerated skin and wet clothing, factors that can affect the relationship between the patient and his/her healthcare professional.15 Consequently, an appropriate wound dressing that meets the individual patient’s needs in exudate management is vital to the wound management plan. Considerations for a dressing to manage exudate include:
• Does it remain in situ and intact without leaking throughout wear time?
• Is it comfortable, conformable, and flexible?
• Will it cause allergy or sensitivity?
• Does it retain exudate when used in conjunction with another therapy, such as compression bandaging?
• Is it capable of sequestering bacteria and other exudate components?
• Is it easy to apply and remove, without causing skin trauma/discomfort?15
Choosing the appropriate dressing may help improve clinical outcomes, reduce costs, and improve patient quality of life and concordance.16 Clinicians need to ensure that patients have the appropriate dressing for effective exudate management.
In subsequent issues, this column will provide case examples, insights, and clinical perspectives regarding this next-generation foam dressing technology and how it will maximize progress in your practice.
Progress for Practice: Foam Technology is made possible through the support of ConvaTec, Inc, Skillman, NJ. The opinions and statements of the clinicians providing Progress for Practice are specific to the respective authors and not necessarily those of ConvaTec, Inc, OWM, or HMP Communications.
This article was not subject to the Ostomy Wound Management peer-review process.
1. Sussman G. Technology update: understanding foam dressings. Available at: www.woundsinternational.com/product-reviews/technology-update-understanding-foam-dressings/page-110/12.
2. Thomas S. Laboratory findings on the exudate-handling capabilities of cavity foam and foam-film dressings. J Wound Care. 2010;19(5):192–199. 2010
3. White R, Gardner S, Cutting K, Waring M. Wounds UK debate: what is the current status of foam dressings? Wounds UK. 2012;8(3):21–24.
4. Queen D, Walker M, Parsons D, Rondas A. AQUACEL Ag dressings made easy. Available at: www.woundsinternational.com/pdf/content_9845.pdf.
5. Pritchard D, Jones L, Brewer C, Martin J, Shaw H, Cochrane C. Performance characterization of a new foam dressing. Poster presented at the European Wound Management Association. Vienna, Austria. May 23–25, 2012.
6. Robinson BJ. The use of a Hydrofiber dressing in wound management. J Wound Care. 2000;9(1):32–34.
7. Armstrong SH, Brown DA, Hill E, Ruckley CV. A randomized trial of a new Hydrofiber dressing, AQUACEL and an alginate in the treatment of exuding leg ulcers. Presented at the 5th European Conference on Advances in Wound Management. Harrogate, UK. 1995.
8. Barnea Y, Amir A, Leshem D, et al. Clinical comparative study of AQUACEL and paraffin gauze dressing for split-skin donor site treatment. Ann Plast Surg. 2004;53(2):132–136.
9. Caruso DM, Foster KN, Blome-Eberwein SA, et al. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns. J Burn Care Res. 2006;27(3):298–309.
10. Data on file. ConvaTec 2012.
11. Bishop SM, Walker M, Rogers AA, Chen WY. Importance of moisture balance at the wound-dressing interface. J Wound Care. 2003;12(4):125–128.
12. Gardner S. How to guide managing high exudate wounds. Available at: www.wounds-uk.com/pdf/content_10474.pdf.
13. Ousey K, Cook L. Wound assessment made easy. Available at: www.wounds-uk.com/pdf/content–10469.pdf.
14. Johnstone E. The role of nutrition in tissue viability. Wound Essentials. 2007;2:10–21.
15. World Union Wound Healing Societies. Principles of best practice: wound exudate and the role of dressings. A consensus document. London, UK: MEP Ltd;2007.
16. Romanelli M, Vowden K, Weir D. Exudate management made easy. Available at: www.woundsinternational.com/pdf/content _8812.pdf. et al.
