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Treatment of Pressure Ulcers with Sequential Dressings

Am Fam Physician. 2002 Jul 1;66(1):159.

Pressure ulcers decrease quality of life and increase health care costs for afflicted patients. Treatment includes nursing care and the use of various wound dressings. Studies have shown that hydrocolloid dressings are effective in the management of chronic pressure ulcers. However, even these dressings will not be helpful if necrotic material remains, preventing development of granulation tissue. Wound debridement can be accomplished with calcium alginate dressings. Belmin and colleagues conducted a randomized, nonblinded study to determine if treatment with calcium alginate dressings followed by hydrocolloid dressings would bring about faster healing than hydrocolloid dressings used alone.

Patients from 20 geriatric hospital wards in France were included in the study if they had a sacral, pelvic girdle, or heel pressure ulcer that was no more than 50 cm2; if granulation tissue did not cover more than one half of the wound; and if there was no sign of active infection. Patients with serum albumin levels less than 2.5 g per mL (25 g per L) were excluded, as were patients taking corticosteroids. Patients were randomized to receive either the control treatment (eight weeks of hydrocolloid dressings) or the sequential strategy (calcium alginate dressings for four weeks followed by hydrocolloid dressings for four weeks). The study was not blinded because these treatments clearly appeared different. Hydrocolloid dressings were changed at least every three days; calcium alginate dressings were changed when they were saturated, or at least every two days. Before application of the dressing, the skin around the pressure ulcer was cleaned with sterile saline. The main end points were the change in surface area (surface area reduction) during treatment and the percentage of patients having a surface area reduction of at least 40 percent.

There were 110 patients included in this study: 57 in the sequential group and 53 in the control group. Pressure ulcers were mainly stage III and most often occurred on the heel and sacrum. At four weeks, 22.6 percent of the patients in the control group had achieved a surface area reduction of at least 40 percent, compared with 68.4 percent of the sequential group. At eight weeks, these figures were 58.5 and 75.4 percent, respectively. Nurses changing the dressings reported that pain and unpleasant odors were significantly lower in the sequential dressing group.

The authors conclude that treatment of pressure ulcers with calcium alginate dressings followed by hydrocolloid dressings (once calcium alginate–induced debridement has occurred) results in faster healing.

Belmin J, et al. for the Investigators of the Sequential Treatment of the Elderly with Pressure Sores (STEPS) Trial. 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 hydro colloid dressings alone. J Am Geriatr Soc. February 2002;50:269–74.


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