Sequential treatment with calcium alginate dressings and hydrocolloid dressings accelerates pressure ulcer healing in older subjects: a multicenter randomized trial of sequential versus nonsequential treatment with hydrocolloid dressings alone

J Am Geriatr Soc. 2002 Feb;50(2):269-74. doi: 10.1046/j.1532-5415.2002.50058.x.


Objectives: To compare the efficacy of a sequential strategy combining calcium alginate and hydrocolloid dressings treatment of grade III or IV pressure ulcers (PUs) and the efficacy of nonsequential strategy with hydrocolloids alone.

Design: An open, randomized, multicenter parallel-group trial.

Setting: Twenty geriatrics hospital wards.

Participants: One hundred ten older patients with grade III or IV PUs.

Intervention: The control strategy consisted of applying hydrocolloid dressings (DuodermE) for 8 weeks; the sequential strategy consisted of applying combined calcium alginate dressings (UrgoSorb) for the first 4 weeks and hydrocolloid dressings (Algoplaque) for the next 4 weeks.

Measurements: PU surface areas were measured weekly by ulcer tracing. The endpoints were the mean absolute surface area reduction (SAR) during the 8-week study period and the number of patients achieving a 40 or more SAR (SAR40).

Results: Fifty-seven and 53 patients were randomly allocated to sequential and control strategies respectively. Baseline patient characteristics and PU ulcer features at inclusion were similar in the two groups. Mean +/- standard deviation SAR was significantly larger in the sequential treatment group (5.4 +/- 5.7 cm2 and 7.6 +/- 7.1 cm2 at 4 and 8 weeks) than in the control group (1.6 +/- 4.9 cm2 and 3.1 +/- 7.2 cm2, P< .001). In the sequential treatment group, 68.4 of the patients reached SAR40 at 4 weeks and 75.4 at 8 weeks, proportions significantly larger than in the control group (22.6 and 58.5, respectively, P< .0001). Dressing tolerance was good in both strategies.

Conclusions: In grade III or IV PUs, treatment using first calcium alginate dressings and then hydrocolloid dressings promotes faster healing than treatment with hydrocolloid dressings alone.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alginates*
  • Analysis of Variance
  • Bandages, Hydrocolloid
  • Biocompatible Materials*
  • Colloids*
  • Female
  • Glucuronic Acid
  • Hexuronic Acids
  • Humans
  • Male
  • Occlusive Dressings*
  • Pressure Ulcer / pathology
  • Pressure Ulcer / therapy*
  • Statistics, Nonparametric
  • Wound Healing


  • Alginates
  • Biocompatible Materials
  • Colloids
  • Hexuronic Acids
  • Glucuronic Acid