How To Use Hydrocolloid Dressings... Properly!
Do not use hydrocolloid blister dressings on blisters with an intact or torn roof! If you put a hydrocolloid dressing on a blister with an intact or torn roof, they will rip the blister roof off upon removal.
Hydrocolloid dressings should only be used on deroofed blisters - blisters where the roof has been removed, leaving a red raw sore. Something like this (below).
These are deroofed blisters. This is the type of blister that you can use a hydrocolloid dressing on.
These deroofed heel blisters need a hydrocolloid dressing to heal quickly. As the raw blister base heals, it weeps. This weepiness combines with the dressing to provide the best environment for healing. And it prevents the dressing from sticking to the raw wound. That way it won't disrupt valuable healing tissue.
Avoid these 3 common hydrocolloid dressing mistakes
4 Examples of hydrocolloid blister dressings
Band-Aid Advanced Healing
BlisterPod: Read why we introduced our own brand of hydrocolloid blister plasters.
How to use hydrocolloid dressings successfully on blisters
Hydrocolloid dressings suffer a poor reputation, as highlighted below:
My team have dealt with hundreds of cases of Compeed that has almost morphed into "one" with the skin. It's really difficult to see where the Compeed finishes and where the skin begins. We actually recommend against it for long events for that reason. And if we see it in use, we speak up and discourage it.
Personally, my worst blister treatment experiences of all time have been removing this partially metamorphosed Compeed from badly blistered feet.
The open skin under the dressing stinks and the skin goes all wrinkly.
I completely understand these concerns. I've witnessed them myself, many times. Here's an example (below).
How to use a hydrocolloid the wrong way for a foot blister in an ultramarathon
This was from the 2015 ANZAC Ultramarathon in Canberra. This runner had applied Compeed when he saw a blister forming. The blister roof was intact at the time. Later, as he removed his sock, he realised the Compeed had melded with the sock and he couldn’t get the two apart. He also couldn't peel the Compeed from his blister. So as he took his sock off, the Compeed ripped the blister roof off.
If you've had a bad outcome with Compeed, there are three potential reasons why. I'm pleased to say, each is easily avoided.
1) Hydrocolloid blister dressings are not for blister prevention
There is an expectation that the hydrocolloid dressing alone will prevent a blister from developing and/or prevent it from getting worse. This expectation is wrong. Don’t use hydrocolloids for blister prevention – they are a blister treatment.
2) Only use hydrocolloids on deroofed blisters
Hydrocolloid dressings have an adhesive which make them stick. For this reason, do not put them on a blister with its roof intact, or with its roof torn. It will tear the roof off when you come to remove the dressing. Hydrocolloids need a weepy wound base to work their magic. The weepy stuff does two good things:
- It prevents the dressing from sticking to that part of the skin
- It partially dissolves to provide a gel that promotes healing
In my university days (some 25 years ago now) I was on the grinder doing some heavy orthotic modifications when my hand slipped and the grinder took a nasty gouge from my knuckle. I grabbed some Duoderm from the student clinic and used it as directed until it was healed. Within a week or so, the deep gouge had filled in and there was a nice pink area of healed skin in it's place. Not only that, the skin remained flexible enough so as not to limit flexion in the finger during and after healing - something that wouldn't have happened if I'd allowed the wound to dry out and scab over. It was remarkable. I still have a scar but it is quite underwhelming considering the size of the initial injury. If you don't believe me, the next time you have a weepy wound, get one of these dressings and try it.
3) Don't expect hydrocolloid dressings to stay on, on their own
Although hydrocolloids have an adhesive to make them stick to the skin, I don't expect it to work on feet - not well enough. On your arm, fine. On my finger, fine. But on your feet, not fine. Think about the in-shoe environment - it's sweaty in there, and that's a constant threat to adhesion. All it takes is for one edge of the dressing to roll-back a little and be exposed to the sock (annoyingly, it will stick like glue to the sock - see photo above).
I recommend Fixomull around the circumference of a hydrocolloid dressing. Leave the majority of the dressing area visible – we need to visualise the degree of weepiness to determine when to change the dressing. Plus, hydrocolloids allow wound gasses to evaporate through the dressing (whilst being waterproof from the outside).
Secure all hydrocolloid dressing edges with Fixomul to prevent roll-back. Resist the temptation to put Fixomul all over it - you need to see how the wound is interacting with the dressing to know when to change it.
How long do you leave a hydrocolloid blister dressing on for?
Good question! Hydrocolloids can be left on for a few days, or even a week. It all depends on how weepy the wound is. It can take a bit of practice to get this right. You don't want it on for a week if your deroofed blister is very weepy because you'll run the risk of the surrounding skin getting macerated (water-logged, white, rubbery). But there's no point removing it if the weepiness is only light. The weepy gel-like substance under the dressing will track toward the edge of the dressing with time. It might take 12 hours or it might take a week, but when it gets to the edge of the dressing, change it.
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