S24 Clinical focus
Hydrogel dressings and their
application in burn wound care
Abstract
After a burn injury, skin loses its protective
properties, leaving the body open to a number
of complications. The gold standard treatment
for burn wounds is autologous skin grafting;
however, this may not always be an option, due
to insufficient amounts of donor skin. Wound
dressings can be used as a primary treatment
in those patients who are unsuitable for skin
grafting. Many different materials are used to
make the dressings; current materials include
■ Burns  ■ Hydrogels  ■ Peptides  ■ Wound dressings
W ound healing after a burns injury is a global
medical concern. Burns are among the leading
causes of disability, with 27 million burns
annually requiring professional treatment. Of these, 7
million patients will require hospitalisation (World Health
Organization (WHO), 2014). The skin is the largest organ
in the human body, and it plays a vital role in fluid balance,
temperature regulation, immunity and protection. After a
burns injury, skin will lose these protective properties, which
leaves the body susceptible to a number of complications. The
most important of these are a vulnerability to infections and a
loss of bodily fluids (Gierek et al, 2013).
The gold standard treatment for burns wounds is
autologous skin grafting. This is when the patient’s own skin
is taken from a non-injured area of the body (donor site) and
transplanted onto the wounded area (recipient site) (WHO,
2014). However, this may not always be an option, due to
insufficient amounts of donor skin and risk of chronic wound
development. This is especially true when there are large and
extensively injured areas. Patients can also be unsuitable for
skin grafting. This can be for a number of reasons, including
Kiran Dhaliwal
Plastic surgeon, UCL Centre for Nanotechnology
and Regenerative Medicine, London
rmhkdha@ucl.ac.uk
Nicholas Lopez
Biochemist, UCL Centre for Nanotechnology and
Regenerative Medicine, London
Accepted for publication: July 2018
hydrocolloids, alginates, hydrogels, collagen
and hyaluronic acid. There is currently no gold
standard of burns dressing that is universally
accepted. However, hydrogels have been
shown to exhibit a great number of beneficial
properties and are the most favourable for
use in burns patients. We discuss the use of
hydrogel dressings, including their properties
and clinical application.
lack of suitable donor skin, unsuitability for skin harvesting
surgery due to the current physiological condition of the
patient, or other pre-existing co-morbidities. This is where
biomaterials play an important role. Wound dressings can be
used as a primary treatment in patients who are unsuitable for
skin grafting and can aid wound healing in patients who have
a skin graft.
Partial and full thickness burns are complex wounds that
are often difficult to manage. Recovery can take up to 10
weeks, with a high risk of scarring (Banwell, 2009). Although
it is clear that the gold standard treatment for skin grafting is
autologous skin grafts, the ideal burns dressing is much more
difficult to define.
The Food and Drug Administration have classified wound
dressings into five main categories (Figure 1). Many different
materials are used to make the dressings. Current materials
include hydrocolloids, alginates, hydrogels, polyurethane,
collagen, chitosan, pectin and hyaluronic acid (WHO, 2014).
There is currently no gold standard of burns dressing that is
universally accepted. Wound healing is a complicated process
that involves many underlying physiological processes; therefore
the material needs to have a wide range of properties. Studies
have shown that the most important properties of a burns
wound dressing that have been identified by clinicians, included
non-occlusive dressings that are easily sourced, inexpensive and
transparent (Figure 2) (Selig et al, 2012). Although no material
is able to encompass all of these properties, hydrogels have been
shown to exhibit a great number of them, and are the most
favourable for use in burns patients.
Hydrogels are three-dimensional networks of hydrophilic
© 2018 MA Healthcare Ltd
polymer chains that are water insoluble. Their mechanical
and chemical properties can be easily tailored for specific
applications by changing the building blocks and processing
techniques used for manufacturing.
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S26 Clinical focus

can also cool the wound area. This is an ideal environment

for wound healing, without affecting the permeability and

1
Non-resorbable gauze/sponge dressings
gaseous transfer of the traditional dressing.
for external use
The building blocks of peptides are amino acids. These
are natural materials that do not induce an immunogenic
response. They are also easily degraded into non-toxic by-
2 Hydrophillic dressings products that are eliminated by the body. Furthermore, they
are able to absorb wound exudates which means they can be
changed less frequently and can be easily made into any shape.

3
This is useful given the variability in the size and shape of
Occlusive wound dressings
wound dressings.
An important, unique property of these materials is their
ability to facilitate autolytic debridement of necrotic tissue.
This is particularly important in burns wound healing as
4 Hydogel wound and burns
dressings it aids regeneration and reduces the risk of hypertrophic
scarring and risk of infection.
The transparency of the material can be determined by

5
Interactive wound and burns dressings
Figure 1. Food and Drug Administration
classification of wound dressings (WHO, 2014)
the peptide concentration. At low peptide concentrations,
the hydrogels are colourless and transparent. This allows the
burn wound to be observed without the dressing having to be
removed and the wound re-dressed each time it is observed.
Clinical application

Hydrogel peptides have been successfully synthesised into

wound dressings and have been shown to aid wound healing.
A recent study found that ultrashort hydrogels accelerated
Non-adherent wound healing compared to the commonly used Mepitel
Infrequent
changes dressing. Two different ultrashort peptides were tested on a
partial thickness burn in rats. The peptide hydrogels were
Reduces pain
found to promote re-epithelialisation and wound closure
Absorbent
significantly more quickly in the peptide hydrogel group
Inexpensive (p=0.026). Several important pro-inflammatory cytokines
were up-regulated in the peptide hydrogel dressing, and
Easily removed
their concentrations were comparable to that of healthy skin
Easily
manufactured (Loo et al, 2014). Although studies showed improved wound
Antimicrobial healing, research is still in its infancy and studies have only
activity
Range of sizes
been carried out in animal models. Further research is needed
if they are to be successfully translated into human models
Self adhesive and clinical practice.
It has also been found that sealed peptide formulations
can be stored at room temperature for long periods of time
Figure 2. The properties of an ideal burns dressing without significant changes to the mechanical and chemical
properties. This an important consideration of any biomaterial
Peptide hydrogels are formed from peptides. They are in a medical application; the cost of manufacturing, processing
versatile, natural building blocks. They can be designed to and storage will ultimately play a large role in determining
form a specific secondary structure by changing the amino whether a product will be used as a standard treatment in the
acid sequence. This allows for the design of self-assembling clinical setting (Loo et al, 2014; Shafer et al, 1996).
biomaterials with three-dimensional (3D) macromolecular It is important to consider the antibacterial properties of
architectures, specific nanoscale features and modifiable any biomaterial that is in close contact with the body. This is
physical properties (Lakshmanan, 2013). New classes of particularly important for burns wound dressings, where the
short and ultrashort peptide hydrogels have recently been skin barrier is breached and the risk of infection is elevated.
© 2018 MA Healthcare Ltd

developed. They are classified as <20 AA for short and <7 AA
for ultrashort.
Hydrogels are ideally placed to be used in the application
of wound dressings due to their unique properties. The high
water content of hydrogels provides a moist environment and
Peptide hydrogels are superior to traditional materials for
wound healing applications because they can be designed
to provide natural antibacterial properties, circumventing
the need to encapsulate therapeutic molecules (Shafer et al,
1996). This inherent antimicrobial activity has been shown to

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 Clinical focus S27

exhibit selective antimicrobial activity against gram-positive sequences, challenging the importance of aromatic interactions in
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This antibacterial property of the hydrogel can be further synthesis of size-controlled, stable silver nanoparticles within ultrashort
increased by the incorporation of antibacterial materials. peptide hydrogels and their anti-bacterial properties. Biomaterials. 2014;
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Salick DA, Kretsinger JK, Pochan DJ, Schneider JP. Inherent antibacterial
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was a sustained release of silver nanoparticles over a 14-day Selig HF, Lumenta DB, Giretzlehner M, Jeschke MG, Upton D, Kamolz LP.
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strains.CWC burns.2012.04.007
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Banwell EF, Abelardo E, Adam D et al. Rational design and application of peptide (CG 117-136) of human lysosomal cathepsin G is dependent on
responsive alpha-helical peptide hydrogels. Nat Mater. 2009; 8(7):596-600. arginine content. Infect Immun. 1996; 64(11):4842-5.
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J Surgery. 2013; 85(6):354-359. https://doi.org/10.2478/pjs-2013-0054 hydrogels for the acceleration of healing of burn wounds.
Lakshmanan A, Cheong DW, Accardo A, Di Fabrizio E, Riekel C, Hauser Biomaterials. 2014; 35(17): 4805–4814. https://doi.org/10.1016/j.
CAE. Aliphatic peptides show similar self-assembly to amyloid core biomaterials.2014.02.047

Empowerment Through Reflection

Edited by TonyAbou
Ghaye
t the book
and Sue Lillyman
Revised, restructured and
updated throughout, this
Empowerment Throu second edition of
gh Reflection presents a
This second editionused Empowerment
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e and issues that relate
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werment Through Reflec
which practice can be impro tion illustrates ways in
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how healthcare professionals can use
Reflection 2nd Edition

t the editors

Through
Tony Ghaye Cert Ed, BEd
reflective practice toDirectwork through
or of a social a diverse
(Hons), MA (Ed), PhD, FRSA
enterprise called Reflec range
is the Founder
tive Learning-International.
ofand
currently involved in a numb He is
empowerment issues, lives and including
livelihoods. participation,
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rights,
ts that aim to improethics,
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Sue Lillyman MA, BSc (Nurs

Reflection
the empowermentcurren of tly
people
a Senior Lectuwith life-limiting
ing), RGN, RM, DPSN, PGCE(
rer at the University of Worce
conditions,
FAHE) , RNT is
authored numerous texts ster and has co-
empowering young people and issues that relate to ageing.
on reflective practice.

The richness and complexity

Other titles in theof serieempowerment
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2nd edition
Reflection: principles and
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Edited by Tony Ghaye and

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