Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Promoting healing in static wounds

  • Comment

VOL: 97, ISSUE: 14, PAGE NO: 52

Kate Ballard, BSc, RGN, is a clinical nurse specialist (tissue viability), Guy's Hospital, London

Helena Baxter, MSc, RGN, is a clinical nurse specialist (tissue viability), Guy's Hospital, London

The wound-healing process can be adversely affected by many factors, including unrelieved pressure, radiotherapy and concurrent underlying conditions (Bale and Jones, 1997). Recent advances in wound care have resulted in the introduction of several innovative treatments for the management of wounds that will not heal - for example, vacuum-assisted closure and larval therapy. Interest in the use of growth factors, fibroblasts and keratinocytes to enhance the healing process is also increasing. At Guy's Hospital in London the use of hyaluronic acid has been found to be of benefit when used on such wounds.

The wound-healing process can be adversely affected by many factors, including unrelieved pressure, radiotherapy and concurrent underlying conditions (Bale and Jones, 1997). Recent advances in wound care have resulted in the introduction of several innovative treatments for the management of wounds that will not heal - for example, vacuum-assisted closure and larval therapy. Interest in the use of growth factors, fibroblasts and keratinocytes to enhance the healing process is also increasing. At Guy's Hospital in London the use of hyaluronic acid has been found to be of benefit when used on such wounds.

Hyaluronic acid
Hyaluronic acid is a naturally occurring biodegradable polysaccharide and a major component of human skin. It is non-immunogenic and has been used successfully for many years in ophthalmology (Balasz, 1983), the management of connective tissue disease (Goa and Benfiled, 1994) and the treatment of leg ulcers (Ortonne, 1996). However, recent research has been directed more specifically towards its role in wound-healing, where it has been shown to enhance angiogenesis (West et al, 1985) and the phagocytic response of macrophages (Bernake and Marwald, 1979; Ahlgren and Jarstrand, 1984).

Use as a wound contact material
ConvaTec have incorporated an ester of hyaluronic acid called hyaff into a wound contact material. Hyalofill-F is an absorbent fibrous fleece that becomes a hydrophilic gel when in contact with serum or wound exudate. This gel overlays the wound bed, creating a hyaluronic acid-rich tissue interface and moist wound environment.

Previous applications in wound-healing include using it to stimulate the wound bed before grafting with autologous keratinocytes. In animal studies Navsaria (1998) showed that on full-thickness wounds the 'take rates' of keratinocytes are significantly improved if Hyalofill-F is used in this way.

At Guy's Hospital, hyaff treatment has been used on various wound types, including pressure ulcers and leg ulcers. The most dramatic results have been noted when it is used for wounds that will not progress beyond the inflammatory stage of healing.

Treatment with hyaff is only necessary until there is a visible change in the wound bed. Two weeks or four applications is usually appropriate to initiate healing, and conventional moist wound-healing products can then be used.

It is important that appropriate supportive measures are used in conjunction with the hyaff dressing where this is indicated - for example, the use of graduated compression bandaging in the management of venous leg ulcers.

If the wound is infected, advice must be sought from a specialist. It may be more appropriate to use an alternative dressing until the infection is eradicated.

The case study (right) illustrates that despite the underlying pathologies and physiological problems, wound-healing can be achieved where previous regimes have failed. While anecdotal, the case study indicates that the use of dressings containing hyaluronic acid may play an important part in the healing of static wounds.

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.