Are All Alginate Dressings Equivalent?

Abstract

Alginate dressings are widely used in wound treatment for their healing and hemostatic properties and their capacity to drain exudate. However, a clear understanding of the heterogeneity within this class of dressings is lacking. Numerous sources of variability exist between alginate dressings: their composition (% of calcium alginate relative to other components), the ratio of D-Mannuronic and L-Guluronic acids in the alginate fraction, their purity (presence of toxic contaminants), and the shape of their fibers (surface and thickness). These parameters affect the performance and safety of alginate dressings, which may thus not be interchangeable in clinical practice. Therefore, clinicians must be aware of these differences to ensure optimal treatment and avoid complications or suboptimal healing. The objective of this study was to compare six alginate dressings to conclude or not on their equivalence. The results obtained demonstrate considerable variability between alginate dressings in the assessed characteristics: composition, Ca²⁺ release, level of cytotoxicity, fiber shape, draining capacity, and their resistance to traction. Algostéril, the only pure calcium alginate rich in G, releases a specific dose of Ca²⁺ and is the only non-cytotoxic dressing. With its multilobed fibers that are statistically the thickest, it provides the best draining capacity and greatest resistance to traction. These results demonstrate that alginate dressings are not equivalent. Each dressing is distinct, and consequently the clinical performance of one cannot be transposed to the others. Therefore, each alginate dressing should demonstrate its own efficacy, in a given indication, through a clinical trial.

Keywords: alginate; calcium; cytotoxicity; drainage; tensile strength; wound dressings; wound healing.