Film-forming barriers key to good adhesion

How to avoid skin stripping

By Liza G. Ovington, PhD, CWS

Program Director Wound and Continence Management

Columbia Homecare, Fort Lauderdale, FL

When using an adhesive dressing such as a transparent film or hydrocolloid in wound management, there are often two concerns related to the adhesive properties of the dressing:

1) Will the dressing adhere adequately to the patient’s skin (e.g., remain in place until time for dressing change)?

2) Will the removal of the adhesive dressing cause trauma to the patient’s skin, especially if it is changed often?

These concerns can be viewed as consequences of the degree of adherence of the dressing: Either the dressing does not adhere well enough, or it adheres to such an extent that it can cause damage upon removal.

Inadequate dressing adherence can result in the dressing falling off completely or in its edges or corners rolling up and perhaps catching on patient bedding or clothing and pulling off the wound. These occurrences can impact wound-healing outcomes if the uncovered wound becomes dried out or subject to physical trauma or environmental contamination. They also can affect cost-related outcomes in that the dressing is not used to its full absorbent capacity, and multiple dressings are used when fewer would have done the job.

On the other hand, if a dressing’s removal causes a stripping of the uppermost layers of the epidermis, this too can affect outcomes. Skin stripping can create weepy, irritated skin that is painful and may preclude the use of an adhesive until the skin heals.

Such skin stripping can be due to either the dressing’s aggressive adhesion to skin or a high frequency of application and removal or simply the fragility of the patient’s skin due to age or underlying disease process.

Both of these types of dressing adhesion issues can be ameliorated by the use of a protective, fil-forming barrier product in addition to the adhesive wound dressing. These skin barrier products are typically polymer solutions (usually non-water-soluble) that are sprayed, painted, wiped, or swabbed onto the periwound skin and allowed to dry.

During the drying time (usually less than 60 seconds), the solvent of the product evaporates and leaves behind a thin film of the polymer as a coating or layer on top of the skin. This film is usually permeable to oxygen and moisture vapor to allow perspiration to evaporate. The film coating acts as a smooth surface on which to anchor a subsequent adhesive dressing and also can act to protect the upper layers of the epidermis from being stripped during removal of the adhesive product.

The solvent portion of these products is often alcohol based, which is important to know if you plan to apply the product to already irritated or tape stripped skin or if you mistakenly allow the product to contact the wound itself: alcohol stings! (There is one film-forming barrier product on the market, by 3M Health Care, that does not sting even on broken skin. See table, above.)

Providing a uniform surface

It is important to remember that the skin is a dynamic surface: The upper layer of the epidermis is continually shedding, oil and sebum are continually being secreted onto the skin surface, and these factors combine to make skin a difficult surface for adhesion. The use of skin moisturizers, lotions, creams, and even some cleansing products that leave behind emollients can further complicate adhesion to skin.

Application of a protective film barrier product can provide a uniform, smooth, dry surface conducive to adequate adherence of a dressing and prevent edges from rolling. The same film barrier can serve to protect the skin when the dressing is removed. The adhesive of the dressing adheres to the film barrier rather than directly to the patient’s skin, and epidermal stripping is avoided. Removal or the film barrier may require the use of soap and water or the use of a specific removal product.

Caution: the general descriptive term "skin barrier product" may not always refer to film-forming barrier products as described above. Sometimes creams used in protection of the skin form irritation due to exposure to urine, feces, or simply excessive moisture are called barrier products. These products are usually "greasy" and often prevent adhesives from attaching to the skin. Three available film-forming barrier products to enhance adhesion and prevent skin stripping are listed at left.