The TIELLE* dressing is composed of sev-eral layers, which all contribute to its overallmode of action of creating the optimal mois-ture level. These layers are the hydropolymer,the wicking layer and a polyurethane back-ing which is combined with a skin-friendlypolyurethane gel adhesive.

HYDROPOLYMER TO CONTROL THEWOUND ENVIRONMENT

The hydropolymer is a unique, patentedpolyurethane material composed of different-sized cells that are produced during a chemi-cal reaction (Figure 1). Once thepolyurethane has been formed, water is thendriven off to leave a soft, conformable, high-ly absorbent product. These gas bubbles cre-ate the cellular structure of the hydropolymer,consisting of:� Open cells, which allow fluid to pass

through the structure� Closed cells, which help in the mechanical

properties of the product.The hydropolymer is now ready to receive

and manage different levels of fluid from thewound and create an optimum moist envi-ronment. During the fluid-handling processless air is present on the structure of thehydropolymer as the cells become smaller(Figure 2). This phenomenon is a result of theexpansion of the cell walls due to fluid beingtaken into the hydropolymer structure. Theopen cells now help to allow fluid to spreadthroughout the structure by capillary action.The closed cells help to provide structure tothe hydropolymer.

The hydropolymer is highly hydrophilicand readily absorbs water into its structure.Water then binds chemically through hydro-gen bonding onto the polyurethane structure.Cell walls expand and the hydropolymer‘bubbles up’. In the wound environment this

Clinicians must select wound dressingsthat will provide an optimal environ-ment to facilitate the healing of each

particular wound (Seaman, 2002; Atiyeh andYonnovich, 2002). This may, for example,involve an antibacterial dressing, a protease-modulating matrix or means of providing theoptimum moist environment. The past 25years have seen massive development ofwound dressing technologies, from filmdressings through foam products to hydrofi-bres. The primary aim of these products is toachieve the optimal environment for woundhealing, while being cost-effective, easy to useand without any side effects such as skin reac-tions (Sasseville et al, 1997), pain (Briggs andTorra I Bou, 2003; Collier and Hollinworth,2000) and maceration (Cutting and White,unpublished observations, 2003).

Johnson & Johnson Wound Managementhas focused attention on the development ofa unique technology to create an optimalmoist environment on all types of wounds ofdifferent exudate levels (Fletcher, 2002). Thisobjective has been achieved with the dynam-ic fluid-handling technology of the TIELLE*range of hydropolymer dressings.

TIELLE* hydropolymer dressings:wound responsive technology

James Mellor, Stuart Boothman

AbstractWound healing may be compromised by many different factors. Certainunderlying illnesses, for example diabetes and malignancy, and wound-specific factors such as critical colonization, infection and protease imbal-ance can all delay or impair healing. Moist wound healing is now generallyaccepted in clinical practice to facilitate optimum healing under the cor-rect conditions of wound moisture. Johnson & Johnson WoundManagement have provided a solution for the clinician by developingTIELLE* hydropolymer dressings, which provide wound-responsive technol-ogy for patient care. This unique mode of action achieves positive out-comes for the patient and clinician in terms of cost-effectiveness, patientcompliance, healing rates and reduced rates of undesirable adverseeffects such as allergic skin reactions, wound pain and maceration.

14

James Mellor and StuartBoothman are ResearchScientists, Johnson &Johnson WoundManagement, Gargrave

PRODUCT FOCUS

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wound-responsive technology expands to bein direct contact with the wound bed.

Physical and chemical absorption properties As a result of its patented formulation thehydropolymer has a unique feature of absorb-ing fluid in two different ways:1. Physical absorption: fluid is taken into the

open cells of the structure as with anyordinary foam, allowing for a physicalabsorption. Examples of this type of phys-ical absorption are bathroom sponges andsome traditional foam dressings.

2. Chemical bonding of the water molecules:uniquely, the fluid then passes into thepolyurethane in the walls of thehydropolymer and is bound to thepolyurethane molecules.

The chemical structure of the hydropoly-mer (Figure 3) and of the fluid perfectlymatch to provide optimal absorption andmoist wound-healing capability. Foams donot have the same extent of ethylene oxideunits available to allow water binding totake place.

CLINICAL AND ECONOMICALRELEVANCE

The chemical binding of the fluid means thatonce fluid has entered the structure ofTIELLE* dressing, it cannot be squeezed outcompletely from the hydropolymer. Thewound remains moist, and fluid cannot moveback into the wound in the same way it doeswith foams. The expected clinical outcomesfrom using TIELLE* dressings include adecreased level of maceration, excoriation,leakage and number of dressing changes. Thehydropolymer will not gel out and leave par-ticles behind. This means little, if any, irriga-tion is needed in between dressing changesand there is no mess.

A randomized clinical trial comparingTIELLE* dressing with a leading hydrocol-loid (Thomas et al, 1997) showed that thewounds treated with TIELLE* dressing hadno cases of maceration. Statistically signifi-cant differences were also detected for dress-ing leakage (P<0.001 for leg ulcers andP=0.007 for pressure ulcers) in favour ofTIELLE* dressing. These results show theclinical relevance of the chemical bindingproperties of TIELLE* dressing. Clinical out-comes reflect the superior absorbency of

both the hydropolymer and the wicking layerof TIELLE* dressings and of the very highmoisture vapour transmission rate (MVTR).The MVTR allows the excess of fluid toescape through the polyurethane backing ofthe dressing.

Consequences of macerationMaceration of the tissues around the woundcan be a major problem in the managementof chronic wounds, leading to woundenlargement and being detrimental to woundhealing (Cutting and White, 2002a). The costof wound healing can be significantly

WOUND RESPONSIVE TECHNOLOGY

15

Figure 1. Hydropolymer before

contacting with fluid.

Figure 2. Hydropolymer during

the fluid handling process.

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16

increased by the choice of the wrong dress-ings to manage normal exudate levels.Excoriation due to exudate, and pain duringwear and upon dressing removal, can occur(Hollinworth, 2000). The consequences forthe patient are longer treatment time, addeddiscomfort, modified treatment regime anduncertainty about wound progress. For thehealth-care provider longer treatment times,additional material resources and possibleincreased staff costs result in increased costs(Cutting and White, 2002b).

THE WICKING LAYER: ABSORBINGEXCESS FLUID

The wicking layer of TIELLE* dressing is anon-woven viscose rayon mix (Figure 4). Itsprimary function is to facilitate moisturevapour transmission. Excess fluid from thedressing is spread across a large area of thebacking by the wicking layer in a controlledmanner (Figure 5). This spreading is primari-ly driven by a capillary action between indi-vidual fibres of the wicking layer. Spreadingfluid across a large surface area maximizesmoisture vapour transmission.

In 2001 Johnson & Johnson WoundManagement developed TIELLE* Plus dress-ing, which built on the clinical success ofTIELLE* dressing. This product has an addi-tional component: a super-absorbent materi-al was added to the wicking layer to provideextra absorbency. This extra absorbency isoften required on highly exuding woundswhere existing foam technologies were notproviding sufficient solutions to commonwound care needs such as increasing weartimes and preventing maceration.

The material in TIELLE* Plus, known asacrylate, can absorb over 300 times its bodyweight in fluid due to its gelling action andlarge surface area (Figure 6). The gelling ofthe acrylate is a fast process: 90% of the totalcapacity is saturated within 10 seconds, ifrequired in heavily exuding circumstances.

The driving forces behind the waterabsorbency of the polymer are osmotic pres-sure and hydrogen bonding. The difference inthe sodium ion (Na+) concentration betweenthe inside of the polymer and the solution inwhich it is immersed causes the fluids to flowin rapidly, trying to balance the number ofions inside and outside the polymer.

The viscose/rayon matrix of the wickinglayer can absorb up to 35 times its weight influid. This compares very favourably withother wound care materials such as hydrofi-bre, whose maximum is a level of absorptionup to 20 times (ConvaTec).

POLYURETHANE BACKING WITH ADHESIVE LAYER: THE REGULATORY BARRIER

The backing material used in TIELLE* dress-ings is a multi-function polyurethane layerwhich, while providing a simple barrier to the

Figure 4. TIELLE* dressing

wicking layer.

Figure 5. TIELLE* dressing

wicking layer, demonstrating

even distribution of fluid.

PRODUCT FOCUS

Hydropolymerstructure

Waterstructure

O

H HH HH HH HH

O O O

Other polyurethane foams, which do not have the same structure as hydropoly-mer, may not be able to bind as much water in the same way.

Figure 3. Binding of water to

the TIELLE* hydropolymer

chemical structure.

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external environment, is essential to the prod-uct’s mode of action to create the optimalinternal environment. A scanning electronmicroscope (SEM) picture clearly shows thebacking material with the adhesive (Figure 7).

The gel adhesive is spread in a continuouslayer across the soft, highly conformablepolyurethane material. This layer differs instructure from the hydropolymer, makingthe dressing shower-proof. The gel adhesiveis also made from polyurethane. Under nor-mal wound conditions this adhesive allows avery high degree of moisture vapour trans-mission away from the wound, as well as diffusion of gases (CO2 and O2), reinforc-ing the total fluid-handling capacity of the dressing.

The gel adhesive, together with the back-ing material, provides a barrier to bacterialcontamination either into the wound orfrom the wound for up to seven days(Boothman, 2002). The adhesive also offersa unique skin-friendly method of dressingremoval: it can be saturated and inactivatedwith moistened gauze to facilitate removal.If left for a short period of time, the moisturewill evapourate, returning the adhesive qualities of the dressing.

TOTAL PATIENT CARE

No matter what the skin condition or thelevel of exudates, the unique fluid-handlingsystem of TIELLE* dressing provides wound-responsive technology, allowing TIELLE* tobe shaped to different wound depths, sizesand skin types. The absorption of varyingexudate levels and regulation of an optimalmoist wound-healing environment allow thehealth-care professional to provide total careto the patient.

Johnson & Johnson Coronation Road, Ascot, Berks, UK SL5 9EY Tel (01344) 871000 Fax (01344) 872599 © Johnson & Johnson 2003

*Trademark of Johnson & Johnson

Atiyeh BS, Ionnovich J (2002) Management ofacute and chronic open wounds: the impor-tance of moist environment in optimal woundhealing. Curr Pharm Biotechnol 3(3): 179–95

Boothman S (2002) Bacterial BarrierCharacteris-tics of TIELLE* to the ProposedCEN Test Method (prEN 13726-5.2:2002)

Briggs M, Torra i Bou JE (2003) Understandingthe origin of wound pain during dressingchange. Ostomy Wound Manag 49(2): 10–12

Collier M, Hollinworth H (2000) Pain and trau-ma during dressing change. Nurs Stand 14(40)71–3

Cutting KF, White RJ (2002a) Maceration of theskin and wound bed 1: its nature and causes. JWound Care 11(7): 275–8

Cutting, KF, White RJ (2002b) Avoidance andmanagement of peri-wound maceration of theskin. Prof Nurse 18(1): 33–6

Fletcher J (2002) Exudate theory and the clinicalmanagement of exuding wounds. Prof Nurse17(8): 475–8

Hollinworth H (2000) How to alleviate pain atwound dressing changes. Nurs Times 98(44):51–2

Sasseville D, Tennstedt D, Lachapelle JM (1997)Allergic contact dermatitis from hydrocolloiddressings. Am J Contact Dermat 8(4): 236–8

Seaman S (2002) Dressing selection in woundmanagement. J Am Podiatr Med Assoc 92(1):24–33

Thomas S, Banks V, Bale S et al (1997) A com-parison of two dressings on the managementof chronic wounds. J Wound Care 6(3): 383–6

Figure 6. Acrylate fibre

showing large surface area.

WOUND RESPONSIVE TECHNOLOGY

Figure 7. Cross-section of

TIELLE* dreesing showing

hydropolymer foam backing

(left) and adhesive gel (right).

17

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