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Calcium alginate fibers have a novel gel-forming capability in that, upon the ion exchange between
sodium ions in the contact solution and calcium ions in the fiber, the fiber slowly transforms into a
fibrous gel. This paper reviews the principles of the gel-forming process for alginate fibers and
analyzed the gelling behavior of various types of alginate fibers. The absorption characteristics of
alginate wound dressings were analyzed and it was found that alginate wound dressings absorb a
large quantity of liquid into the fiber structure, in addition to those held between the fibers in the
textile structure. This gives rise to the unique gel blocking properties of alginate wound dressings. In
addition, alginate wound dressings also have novel hemostatic and antimicrobial properties as well
as the ability to promote wound healing. They are now widely used in the management of highly
exuding wounds such as leg ulcers, pressure sores, and surgical wounds. Copyright # 2007 John
Wiley & Sons, Ltd.
INTRODUCTION moist, and epithelial cells from the edge of the wound can
migrate across the wound surface. Second, alginate fibers
Alginate fibers are made from sodium alginate, which is a have a unique gel-forming characteristic whereby on contact
natural polymer extracted from brown seaweeds. As a textile with wound exudates, the sodium ions in the wound
fiber, alginate fiber has a limited use since it is relatively exudates can exchange with the calcium ions in the fiber, and
expensive, and tends to dissolve in the alkali conditions of as more and more sodium ions enter the fiber structure, the
many textile processes such as bleaching, dyeing, and fiber absorbs more and more water and becomes a gel. For
finishing. In the early stages of its development, alginate the alginate wound dressings, as water enters the fiber
fiber was used in the textile industry principally in the structure, the entire textile structure is transformed into a
production of water soluble yarns that would dissolve in a sheet of moist gel, thus providing an ideal moist healing
scouring process.1,2 These yarns were used as a support environment for the wound. Many clinical trials have shown
during the manufacture of fine lace, or as draw threads in the that alginate wound dressings not only have the high
production of hosiery. Fabrics from alginate fibers were once absorption capacities, but also the ability to promote wound
produced commercially for their fire-resistant property, healing.7–16
because of the high content of metal ions in the fiber. Alginate This paper reviews the unique gel-forming properties of
fibers were also used for the manufacture of bags used for the alginate fibers and their application in the production of high
transportation of soiled hospital linen that were designed to performance wound dressings.
dissolve in the wash. However, by the 1970s, they were
replaced for these applications by cheaper synthetic fibers.
Since the 1980s, alginate fibers have been widely used in THE PRINCIPLES OF GEL FORMATION
the manufacture of high-tech wound dressings.1–4 This can FOR ALGINATE FIBERS
be attributed to two reasons. First, it has been shown in recent
years that the ideal environment for wound healing is a moist As can be seen in Fig. 1, alginate is a linear polymeric acid
but not wet condition.5,6 In order to create this environment composed of 1,4-linked b-D-mannuronic acid (M) and
on the wound surface, many products were developed with a a-L-guluronic acid (G) residues. During the fiber making
feature to hold moisture in its structure, so that the interface process, sodium alginate is dissolved in water to form a
between the wound surface and the dressing can be kept viscous solution, which is then extruded through spinneret
Table 2. The calcium release and gel swelling properties of three types of alginate fibers17
High G fiber Mid-G fiber High M fiber
Copyright # 2007 John Wiley & Sons, Ltd. Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
Alginate fibers 9
Table 3. The gel swelling properties of three types of alginate fibers containing different levels of sodium ions17
Sample High calcium fiber Mid-calcium fiber High sodium fiber
Copyright # 2007 John Wiley & Sons, Ltd. Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
10 Y. Qin
Figure 7. The nonwoven structure of a piece of calcium Figure 8. Photomicrograph of a piece of alginate nonwoven
alginate wound dressing. dressing wet in normal saline, 200.
In the above mentioned experiment (W1 W)/W lateral spreading of the liquid. This so-called ‘gel blocking’
represents the standard absorption capacity of a dressing property is clinically an important feature of an alginate
defined in the British Pharmacopeia for alginate wound wound dressing. As Fig. 9 clearly shows, wound covered by
dressings. (W1 W2) represents the liquid held between the an alginate wound dressing has a clean edge, with the wound
fibers, while (W2 W3) represents that held inside the fiber. exudate absorbed into the dressings immediately on top of
When the fiber is highly hydrophobic, such as glass fibers, the wound surface.
the absorption of fluid would be held mainly between fibers
by capillary forces. On the other hand, in the case of some
ALGINATE WOUND DRESSINGS
superabsorbent fibers, most of the absorption takes place
inside the fibers. Alginate has a long history of applications in wound
Table 4 shows the absorption behavior of two types of management. It is reported that early sailors used seaweeds
alginate dressings and other non-alginate materials. Because to treat wounds, burns and eczema, and during the World
of the ion-exchange properties, alginate fibers absorb much Wars, because of shortage of cotton, dried sea moss dressings
more liquid into the fibers than other non-alginate dressings. were sent to field hospitals to treat wounded soldiers.9
It should be pointed out that in the case of a wound dressing, During World War II, Blaine25 investigated tissue reactions to
the fact that fluid can be absorbed into the fiber structure is alginate fibers and reported the use of alginate fibers for
important in several respects. First, when the fluid is hemostasis and as a bone wax substitute.26 In 1951, Blaine
absorbed into the fibers, they swell as a result. As the fiber used alginate fibers as absorbable hemostats in surgery and
expands upon swelling, the free spaces between the fibers are noted that 10 days after the implantation, the alginate became
closed, and bacteria in the textile structure or in the wound almost entirely absorbed. Blaine27 also reported that
exudates are then immobilized. This can help prevent the alginates did not lessen the antibiotic activity, could be heat
proliferation of bacteria, and reduce wound infection and sterilized, and did not promote bacterial growth.
cross infection in hospital wards. Second, if the fluid is held The first modern alginate wound dressing was brand
between the fibers by capillary forces, it can easily migrate named Sorbsan, which was launched in 1983.28 It consisted of
along the textile structure. Clinically, this would mean the a loose fibrous fleece made from calcium alginate fibers with
spreading of wound exudates from the wounded area to the a high mannuronic acid content. This was followed by other
surrounding healthy skins under the dressing, causing skin products that differed both in their chemical composition
maceration. Ideally, wound dressings should be able to and textile structures. For example, Kaltostat, a fibrous high
absorb a large amount of exudates, and contain the fluid G calcium alginate, was introduced into the market in 1986.
within the fiber structure. Later, Kaltostat was further modified to consist of a mixture
Figure 8 shows the photomicrograph of a piece of alginate of calcium and sodium alginate. The sodium alginate was
nonwoven dressing wet in normal saline. Compared to Fig. 7, introduced to improve the gel-forming ability of the fibers.
it can be seen that the fibers within the dressing are highly Alginate wound dressings are produced either as flat
swollen, blocking the capillary structure, hence limiting the sheets, which are used to cover superficial wounds, or as
Table 4. Absorption behavior of two types of commercial alginate and some non-alginate wound dressings24
Product (W1 W)/W (W1 W2)/W3 (W2 W3)/W3 (W1 W2)/(W2 W3) W3
TM
Sorbsan 11.98 73.7 15.2 4.83 0.139
KaltostatTM 16.30 47.1 14.8 3.18 0.198
Knitted fabric of viscose filament yarn 1.88 4.64 2.72 1.71 0.379
Woven cotton gauze 4.83 11.5 6.45 1.78 0.059
Polyester nonwoven fabric 18.35 67.6 3.97 17.01 0.494
Copyright # 2007 John Wiley & Sons, Ltd. Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
Alginate fibers 11
Table 5. Key structural features of seven commercially available alginate wound dressings29
Ratio between guluronate Ratio between calcium Nonwoven
and mannuronate contents and sodium content structure
Copyright # 2007 John Wiley & Sons, Ltd. Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
12 Y. Qin
apparent lack of toxicity following a series of animal studies acceptability of the dressing. A total of 155 donor sites were
in which fibers were implanted into animal tissues, and gels examined, among these, 130 were treated with alginate and
made from alginates were used to treat experimentally 25 with paraffin gauze. Sites treated with the alginate healed
produced burns. Successful use of alginate-derived materials in 7.0 0.71 days, whilst the paraffin gauze dressed wounds
in aural surgery and neurosurgery was reported by Passe took an average time of 10.75 1.6 days to heal. Patient
and Blaine40 and Oliver and Blaine,26 respectively. Bray comfort and the quality of healing with the alginate were
et al.41 described the results of a 3-month trial on the use of significantly better than that achieved with gauze.
alginate in the casualty department of Croydon Hospital.
Alginates in the form of films, wool, gauzes, and clots formed Pressure ulcers
in situ by mixing sterile solutions of calcium chloride and Sayag et al.12 compared the efficacy of an alginate (Algosteril)
sodium alginate, were applied to a wide range of wounds, with that of dextranomer paste, an established local
including burns, lacerations, ulcers, and amputations. In all treatment, in a prospective, randomized, controlled trial of
cases, healing was rapid and uneventful. By the late 1940s 92 patients with full-thickness pressure ulcers. A minimum
and early 1950s, alginates were being used in some 70 40% reduction in wound area was obtained in 74% of patients
hospitals in the UK over a range of surgical specialties.27 in the alginate group and 42% in the dextranomer group. The
More recently, the first clinical report regarding a fibrous median time to achieve this reduction was 4 weeks for the
alginate wound dressing was published in 1983 when Fraser alginate and more than 8 weeks for the dextranomer. Mean
and Gilchrist8 and Gilchrist and Martin42 described their surface area reduction per week was 2.39 3.54 cm2 and
experiences with the Sorbsan alginate dressing in the 0.27 3.21 cm2 in the alginate and dextranomer groups,
management of foot disorders and a variety of skin lesions, respectively. The authors concluded that the striking efficacy
following a clinical evaluation in a group of hospitals in the of the alginate dressings suggested that they may have
Sunderland area. The results of these studies were very pharmacological properties to wound healing.
positive and supported the findings of Blaine some 40 years
earlier. Further papers described the use of Sorbsan in the
NOVEL USES OF THE GEL-FORMING
management of problem wounds including infected trau-
ABILITIES OF ALGINATE FIBERS
matic wounds and leg ulcers.43,44
Alginate wound dressings are used on many types of In addition to nonwoven wound dressings, alginate fibers
wounds with medium to high levels of exudates. Some of can be used to make a number of novel composite materials
these wounds are described below. for wound management and other biomedical applications.
Qin and Gilding made fiber reinforced alginate gel by
Leg ulcers dispersing chopped calcium alginate fibers in a solution of
Thomas and Tucker carried out a controlled trial of an sodium alginate. During drying, the calcium ions released
alginate dressing involving 64 community patients with leg from the alginate fibers crosslinked the sodium alginate, and
ulcers.45 The patients were allocated to treatment with either a fiber reinforced sheet of alginate was formed. When in
an alginate dressing (Sorbsan) or paraffin gauze (tulle) as a contact with water, the sodium alginate component in the gel
control. Only 4% of the ulcers treated with tulle healed absorbs water into the sheet and a hydrogel is formed. If the
during the study, while 31% of those treated with the alginate mixture of calcium alginate fiber and sodium alginate
healed completely. The average healing rate achieved with solution is placed in a freezer to form a sheet of solid ice,
the alginate was over four times of that with tulle. Overall, and then taken immediately to a freeze drying machine, a
73% of alginate patients showed improvement during the freeze-dried pad can be prepared over a period of about
trial, compared with 43% in the control group. 20 hr. The resultant product is a porous dehydrated hydrogel
capable of absorbing more than 20 g of normal saline for a
Burns and donor sites gram of the sheet material.46
Alginate wound dressings are ideal for the treatment of In order to donate moisture to dry wounds, the calcium
burns and donor sites, where their hemostatic and absorbent alginate fibers can be mixed with sodium alginate solution to
properties are most useful. Groves and Lawrence10 com- form amorphous hydrogels.47,48 By mixing 1 kg of calcium
pared Sorbsan with a standard gauze pad. In a laboratory test alginate fibers with a length of about 10 mm, 1.2 kg of sodium
the alginate absorbed nearly three times as much citrated alginate and 50 g of sodium citrate in 40 l of water and 8.5 kg
blood as the gauze; when applied to fresh, split-thickness of propylene glycol, a viscous fibrous gel can be formed, with
donor sites for 5 min after excision, blood loss from the sites a viscosity of about 800,000 mPa s. This type of gel can be
treated with the alginate was almost half than from those applied on dry wounds to donate water to the devitalized
treated with gauze. tissue, allowing them to separate from the wound, so that a
The effect of long-term application of alginates to donor clean wound surface can be developed.
sites was investigated by Attwood.11 In an initial study, 15 It is also possible to produce sheet hydrogel by impre-
patients with split skin grafts had half of their wound ganating a nonwoven alginate felt with a sodium alginate
dressed with an alginate (Kaltostat), and the other with solution.49 For example, a nonwoven calcium alginate felt
paraffin gauze. Every area dressed with the alginate showed with a weight/unit area of about 60 g m2 was treated with a
significantly better healing than the corresponding ‘control’ 2% sodium alginate solution dissolved in a 80/20 mixture of
area. The second phase of the study assessed the time to water and propylene glycol, with the ratio between solution
complete healing of alginate-dressed areas and patient to felt at 40 to 1. The fibers in the nonwoven felt interacted
Copyright # 2007 John Wiley & Sons, Ltd. Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
14 Y. Qin
with the sodium alginate in the solution to form a sheet 19. Bonnema J, Ligtenstein DA, Wiggers T, van Geel AN. The
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Renn et al.50 developed a method of producing an antibacterial analysis of human wound and blister fluid. Eur.
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24. Qin Y. Absorption characteristics of alginate wound dres-
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DOI: 10.1002/pat