Sequential Treatment with Calcium Alginate Dressings and Hydrocolloid Dressings Accelerates Pressure Ulcer Healing in Older Subjects

A Multicenter Randomized Trial of Sequential versus Nonsequential Treatment with Hydrocolloid Dressings Alone

Belmin, Joël MD
Meaume, Sylvie MD
Rabus, Marie-Thérèse MD
Bohbot, Serge MD

^*Department of Geriatric Internal Medicine, Hôpital René Muret and Université Paris Nord, Sevran, France
^†Department of Gerontology, Hôpital Charles Foix, Ivry-sur-Seine, France
^‡Department of Gerontology, Hôpital Dupuytren, Draveil, France
^§Laboratoires Urgo, Dijon, France

Address correspondence to Prof. Joël Belmin, Service de Médecine Interne Gériatrique, Hôpital René Muret, Avenue du Dr Schaeffner, 93270 Sevran, France. E-mail: [email protected]

DuodermE^® is the same product as DuodermCGF^® in the United States, GranuflexE^® in the United Kingdom, and Varihesive^® in Germany. Algoplaque^® is the same product as Sorbex^® in the United States.

Journal of the American Geriatrics Society 50(2):p 269-274, February 2002.

OBJECTIVES:

To compare the efficacy of a sequential strategy combining calcium alginate and hydrocolloid dres-sings treatment of grade III or IV pressure ulcers (PUs) and the efficacy of nonsequential strategy with hydrocolloids alone.

DESIGN:

An open, randomized, multicenter parallel-group trial.

SETTING:

Twenty geriatrics hospital wards.

PARTICIPANTS:

One hundred ten older patients with grade III or IV PUs.

INTERVENTION:

The control strategy consisted of applying hydrocolloid dressings (DuodermE) for 8 weeks; the sequential strategy consisted of applying combined calcium alginate dressings (UrgoSorb) for the first 4 weeks and hydrocolloid dressings (Algoplaque) for the next 4 weeks.

MEASUREMENTS:

PU surface areas were measured weekly by ulcer tracing. The endpoints were the mean absolute surface area reduction (SAR) during the 8-week study period and the number of patients achieving a 40% or more SAR (SAR₄₀).

RESULTS:

Fifty-seven and 53 patients were randomly allocated to sequential and control strategies respectively. Baseline patient characteristics and PU ulcer features at inclusion were similar in the two groups. Mean ± standard deviation SAR was significantly larger in the sequential treatment group (5.4 ± 5.7 cm² and 7.6 ± 7.1 cm² at 4 and 8 weeks) than in the control group (1.6 ± 4.9 cm² and 3.1 ± 7.2 cm², P < .001). In the sequential treatment group, 68.4% of the patients reached SAR₄₀ at 4 weeks and 75.4% at 8 weeks, proportions significantly larger than in the control group (22.6% and 58.5%, respectively, P < .0001). Dressing tolerance was good in both strategies.

CONCLUSIONS:

In grade III or IV PUs, treatment using first calcium alginate dressings and then hydrocolloid dres-sings promotes faster healing than treatment with hydrocolloid dressings alone. J Am Geriatr Soc 50:269–274, 2002.