POLYMERS FOR ADVANCED TECHNOLOGIES

Polym. Adv. Technol. 2008; 19: 6–14

Published online 29 June 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pat.960

The gel swelling properties of alginate fibers

and their applications in wound management
Yimin Qin*
The Biochemical Materials Research and Development Center, Jiaxing College, Jiaxing 314001, Zhejiang Province, People’s Republic of China
Received 20 March 2007; Accepted 14 April 2007

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.

KEYWORDS: alginate fiber; wound dressing; ion exchange; hydrogel; antimicrobial

INTRODUCTION
Alginate fibers are made from sodium alginate, which is a
natural polymer extracted from brown seaweeds. As a textile
fiber, alginate fiber has a limited use since it is relatively
expensive, and tends to dissolve in the alkali conditions of
many textile processes such as bleaching, dyeing, and
finishing. In the early stages of its development, alginate
fiber was used in the textile industry principally in the
production of water soluble yarns that would dissolve in a
scouring process.1,2 These yarns were used as a support
during the manufacture of fine lace, or as draw threads in the
production of hosiery. Fabrics from alginate fibers were once
produced commercially for their fire-resistant property,
because of the high content of metal ions in the fiber. Alginate
fibers were also used for the manufacture of bags used for the
transportation of soiled hospital linen that were designed to
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 manufacture of high-tech wound dressings.1–4 This can
be attributed to two reasons. First, it has been shown in recent
years that the ideal environment for wound healing is a moist
but not wet condition.5,6 In order to create this environment
on the wound surface, many products were developed with a
feature to hold moisture in its structure, so that the interface
between the wound surface and the dressing can be kept
moist, and epithelial cells from the edge of the wound can
migrate across the wound surface. Second, alginate fibers
have a unique gel-forming characteristic whereby on contact
with wound exudates, the sodium ions in the wound
exudates can exchange with the calcium ions in the fiber, and
as more and more sodium ions enter the fiber structure, the
fiber absorbs more and more water and becomes a gel. For
the alginate wound dressings, as water enters the fiber
structure, the entire textile structure is transformed into a
sheet of moist gel, thus providing an ideal moist healing
environment for the wound. Many clinical trials have shown
that alginate wound dressings not only have the high
absorption capacities, but also the ability to promote wound
healing.7–16
This paper reviews the unique gel-forming properties of
alginate fibers and their application in the production of high
performance wound dressings.
THE PRINCIPLES OF GEL FORMATION
FOR ALGINATE FIBERS
As can be seen in Fig. 1, alginate is a linear polymeric acid
composed of 1,4-linked b-D-mannuronic acid (M) and
a-L-guluronic acid (G) residues. During the fiber making
process, sodium alginate is dissolved in water to form a
viscous solution, which is then extruded through spinneret

*Correspondence to: Y. Qin, The Biochemical Materials Research

and Development Center, Jiaxing College, Jiaxing 314001,
Zhejiang Province, People’s Republic of China.
E-mail: yiminqin1965@126.com
Contract/grant sponsor: Natural Science Fund of Zhejiang Pro-
vince, China; contract/grant number: Y405030.

Copyright # 2007 John Wiley & Sons, Ltd.


Figure 1. The chemical structure of alginic acid.
holes into an aqueous calcium chloride bath, where upon the
ion exchange between calcium ions in the bath and sodium
ions in the as-spun filament, a swollen calcium alginate
filament is formed. Upon further stretching, washing, and
drying, calcium alginate fibers can be produced.
Figure 2 shows the structural changes during the
production and application of calcium alginate fibers as a
wound dressing material. During the production process,
sodium alginate is converted into calcium alginate when the
sodium alginate filament emerging from a spinneret is
coagulated by calcium ions in the calcium chloride solution.
On contact with wound fluid, which contains among other
components, sodium ions, the calcium ions in the calcium
alginate fiber exchange with the sodium ions, slowly
converting the fiber into sodium alginate. Since sodium
alginate is water soluble, water is drawn into the fiber,
turning it into a fibrous gel.17
The gel formation process depends on the formation of the
water soluble sodium alginate within the alginate fiber,
which is again dependent on the ability of sodium ions to
replace calcium ions in the fiber. In a study on the binding
abilities of alginate for divalent metal ions during the gel
formation of sodium alginate solution, Haug and Smidsrod18
had noted that the ability for alginate to bind divalent metal
ions is related to the ion-exchange coefficient between the
divalent metal ion and the sodium ion:
½Metal ion concentration in the gel
½Sodium ion concentration in the solution
2
K¼
½Sodium ion concentration in the gel
2 ½Metal ion concentration in solution

Figure 2. Structural changes during the production and
application of calcium alginate fibers as a wound dressing
material.
Copyright # 2007 John Wiley & Sons, Ltd.
Alginate fibers 7
Table 1. The ion-exchange coefficients of alginate extracted
from two different types of seaweeds18
Type of seaweeds and the M/G ratio of alginate
Laminaria Laminaria hyperborea
Metal ions digitata, M/G ¼ 1.60 stems, M/G ¼ 0.45
Cu2þ–Naþ 230 340
Ba2þ–Naþ 21 52
Ca2þ–Naþ 7.5 20
Co2þ–Naþ 3.5 4
After studying various metal ions, Haug and Smidsrod18
found that the binding abilities for alginate are in the order
of:
Pb2þ > Cu2þ > Cd2þ > Ba2þ > Sr2þ > Ca2þ > Co2þ ¼ Ni2þ
¼ Zn2þ > Mn2þ
It should be pointed out that since they have significantly
different stereochemical structures, guluronic acid and
mannuronic acid have significantly different binding abil-
ities to metal ions. Table 1 shows the ion-exchange
coefficients of alginate extracted from two different types
of seaweeds.18 It can be seen that the ion-exchange
coefficients differ greatly both in terms of the different metal
ions against the same variety of alginate, and also for the
same metal ions against alginate with different guluronic
acid and mannuronic acid contents. For the calcium alginate,
the ion-exchange coefficients between calcium and sodium
are 7.5 and 20, respectively for the alginate with high M and
high G contents.
It is clear that among different metal ions, calcium ion has a
relatively weak binding with alginate. The choice of calcium
as the divalent metal ion used for the production of alginate
fibers for wound management is therefore a right choice from
the point of view of the subsequent gelation of the fiber when
it is in contact with wound exudate. Should other metal ions
such as barium are used, the absorption and gel-forming
abilities of the alginate wound dressings would be poorer.
The differences in the ion-exchange coefficients also
explain the differences in the gel-forming abilities of the
high M and high G calcium alginate fibers. As can be seen in
Figs. 3 and 4, when a high G calcium alginate fiber is placed
in contact with normal saline solution, because the calcium
ions bind firmly with alginate, ion-exchange is difficult, and
the fiber swelling is limited. On the other hand, for the high
M calcium alginate fiber, because the binding between
calcium ion and the alginate is relatively weak, ion exchange
between calcium ions in the fiber and sodium ions in the
solution is easy, hence the fiber quickly turns into a mixed
calcium and sodium alginate when in contact with normal
saline solution. A fibrous gel is formed as a result.
It is important to point out that body fluid has a complex
composition and in addition to the ion exchange between
Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat
8 Y. Qin
Figure 3. Photomicrographs showing the swelling of high G
calcium alginate fiber when wet in normal saline, 200.
Figure 4. Photomicrographs showing the swelling of high M
calcium alginate fiber when wet in normal saline, 200.
sodium and calcium ions, the protein component in the
wound exudate can also bind calcium ions, hence increasing
the gel-forming abilities of the calcium alginate fibers. In a
study of the composition of serous fluid formed after axillary
dissection, Bonnema et al.19 found that on the first post-
operative day, the drainage fluid contained blood contents
and a high concentration of creatine phosphokinase. After
day one, it changed to a peripheral lymph-like fluid that
Table 2. The calcium release and gel swelling properties of three types of alginate fibers17
High G fiber
Ratio of M/G About 0.4
Ca(II) content in contact solution, ppm 317.5
Gel swelling ratio in water, g/g 2.69  0.27
Gel swelling ratio in 0.9% saline, g/g 8.49  0.62
Copyright # 2007 John Wiley & Sons, Ltd.
contained different cells and more protein. Frohm et al.20
analyzes the fluid from a post-operative wound, six leg
ulcers, and a large blister. They found that wound fluid con-
tains fragments of peptides. Trengrove et al.21 found that wound
fluid collected from leg ulcers contained 0.6–5.9 mmol l1
glucose and 26–51 g l1 protein. James and Taylor22 showed
that a typical wound fluid contained 2.9% protein.
THE GELLING ABILITIES OF ALGINATE
FIBERS
Table 2 shows the gelling abilities of three types of alginate
fibers with different M/G contents. The high G alginate fiber
contains about 70% G and 30% M acids, while the high M
alginate has about 65% M and 35% G acids. After being in
contact with solution A (defined in the British Pharmacopeia
as an aqueous solution containing 142 mmol of sodium
chloride and 2.5 mmol of calcium chloride) for 30 min at
378C, the solution of the high G alginate fiber contains about
317.5 ppm calcium ions, while the solution of the high M
alginate fiber contains 560 ppm calcium ions, almost twice as
much as the figure for the high G alginate fiber. This clearly
demonstrates that the high M alginate fiber exchanges ions
more readily with the sodium-containing solution, and its
gelling ability is much better than the high G alginate fiber.17
Figure 5 shows the photomicrographs of a piece of high G
calcium alginate fiber when wet in water.23 It can be seen that
apart from a slight degree of swelling, the fiber showed a
minimum level of change before and after wetting. This is
understandable as in a high G calcium alginate fiber, the
polymeric chains are firmly bound together through the ‘egg
boxes’ formed between GG blocks in neighboring polymer
chains. It is difficult for water to penetrate into the firm
polymer structure, hence the fiber has a good wet stability.
Figure 6 shows the photomicrographs of a piece of high M
calcium alginate fiber when wet in normal saline solution. It
is clear that the wet sample has absorbed a large amount of
water into the fiber structure during the wetting process,
effectively turning itself into a piece of hydrogel. In clinical
applications, when high M alginate fibers are placed in
contact with wound exudate, the exchange of sodium and
calcium ions gradually transforms calcium alginate fiber into
sodium alginate fiber, resulting in the formation of a fibrous
gel, and in the process, the absorption of a large quantities of
exudate by the dressing.
The gel swelling abilities of the alginate fibers can be
measured quantitatively by placing 0.2 g of fiber in 100 ml of
either distilled water, or 0.9% wt/wt aqueous sodium
chloride solution (normal saline). After 1 hr, the fibers are
separated with the contacting solution and placed in a
centrifuge tube with the bottom half filled with knitted
Mid-G fiber High M fiber
About 1.6 About 1.8
450 560
6.0  0.87 5.69  0.39
14.51  0.74 15.89  0.65
Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat

Figure 5. Photomicrographs of a piece of high G calcium
alginate fiber when wet in water, 200.
Figure 6. Photomicrographs of a piece of high M calcium
alginate fiber when wet in normal saline solution, 200.
viscose rayon fabric to contain the spin off solution. The
centrifuge is carried out at 1200 rev/min for 15 min. After
that the fiber (W1) is dried at 1058C to constant weight (W2).
The gel swelling ratio is expressed as the ratio between the
weight of the wet sample and that of the dry sample, i.e., W1/
W2.24
As can be seen in Table 2, when wet in water, high G
calcium alginate fiber had a limited extent of swelling, with
the gel swelling ratio of 2.69, similar to the value obtained
from cotton and viscose rayon fibers. High M alginate fibers
swell better than high G alginate fibers, however, this
Table 3. The gel swelling properties of three types of alginate fibers containing different levels of sodium ions17
Sample High calcium fiber
Calcium alginate content 98.3%
Sodium alginate content 1.7%
Gel swelling ratio in water, g/g 2.69  0.27
Gel swelling ratio 0.9% saline, g/g 8.49  0.62
Copyright # 2007 John Wiley & Sons, Ltd.
Alginate fibers 9
difference widens when saline is used as the contacting
media. The gel swelling ratio for a high M calcium alginate
fiber in saline is 15.89, as compared to that of 8.49 for a high G
calcium alginate fiber.
Since sodium alginate is responsible for the swelling of
alginate fibers in aqueous media, during the production
process, calcium alginate fibers were converted into a mixed
calcium and sodium alginate in order to make the product
more absorbent. It can be seen from Table 3 that as the
contents of sodium ions increase, there is a corresponding
increase in the absorption capacities of the dressings. The gel
swelling ratio in 0.9% saline increased from 8.49 g/g for the
high calcium fiber to 18.58 g/g for the high sodium fiber. This
result suggests that one way of improving the absorption and
gelling properties of the alginate wound dressing is to
introduce sodium ions into the fiber.
THE GEL BLOCKING PROPERTIES OF
ALGINATE WOUND DRESSINGS
Figure 7 shows the nonwoven structure of a piece of calcium
alginate wound dressing. When the dressing is in contact
with wound exudate, absorption takes place in two ways.
First, some of the wound fluid is held by capillary forces
between the fibers in the nonwoven textile structure. This
action is rapid and the liquid is held by physical forces.
Second, as the fibers are wet, water is drawn into the fiber
structure by chemical forces. In the case of alginate wound
dressings, a large amount of water is absorbed into the fiber
structure as the fiber transforms into a mixed salt of calcium
and sodium alginate.
In view of the above analysis, the absorption of liquid by a
wound dressing can be divided into three categories, i.e. the
overall absorption of the dressing, liquid absorbed between
the fibers, and liquid absorbed into the fiber. In order to
quantify these three forms of absorption capacity, samples of
alginate dressings are cut into 5 cm  5 cm sizes and
conditioned at 208C, 65% relative humidity overnight. The
dressings are then weighed (W) before being placed in plastic
Petri dishes (90 mm in diameter) and wetted with 40 times
their own weight of solution A. The dish is then placed in a
378C oven for 30 min. After that, the dressing is lifted out of
the solution by holding it with a forcep at one corner. The
solution is left to drip for 30 sec and the wet dressing is
weighed (W1). The sample is then placed in a centrifuge tube
half filled with knitted gauze to contain the spin-off liquid.
After centrifuging at 1200 rpm for 15 min, the dressing is
taken out and weighed again (W2). Finally, the dressing
is dried to a constant weight at 1058C for 4 hr and the weight
is weighed (W3).24
Mid-calcium fiber High sodium fiber
76.5% 54.1%
23.5% 45.9%
24.05  0.85 20.60  2.66
13.42  1.03 18.58  0.94
Polym. Adv. Technol. 2008; 19: 6–14
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10 Y. Qin
Figure 7. The nonwoven structure of a piece of calcium
alginate wound dressing.
In the above mentioned experiment (W1  W)/W
represents the standard absorption capacity of a dressing
defined in the British Pharmacopeia for alginate wound
dressings. (W1  W2) represents the liquid held between the
fibers, while (W2  W3) represents that held inside the fiber.
When the fiber is highly hydrophobic, such as glass fibers,
the absorption of fluid would be held mainly between fibers
by capillary forces. On the other hand, in the case of some
superabsorbent fibers, most of the absorption takes place
inside the fibers.
Table 4 shows the absorption behavior of two types of
alginate dressings and other non-alginate materials. Because
of the ion-exchange properties, alginate fibers absorb much
more liquid into the fibers than other non-alginate dressings.
It should be pointed out that in the case of a wound dressing,
the fact that fluid can be absorbed into the fiber structure is
important in several respects. First, when the fluid is
absorbed into the fibers, they swell as a result. As the fiber
expands upon swelling, the free spaces between the fibers are
closed, and bacteria in the textile structure or in the wound
exudates are then immobilized. This can help prevent the
proliferation of bacteria, and reduce wound infection and
cross infection in hospital wards. Second, if the fluid is held
between the fibers by capillary forces, it can easily migrate
along the textile structure. Clinically, this would mean the
spreading of wound exudates from the wounded area to the
surrounding healthy skins under the dressing, causing skin
maceration. Ideally, wound dressings should be able to
absorb a large amount of exudates, and contain the fluid
within the fiber structure.
Figure 8 shows the photomicrograph of a piece of alginate
nonwoven dressing wet in normal saline. Compared to Fig. 7,
it can be seen that the fibers within the dressing are highly
swollen, blocking the capillary structure, hence limiting the
Table 4. Absorption behavior of two types of commercial alginate and some non-alginate wound dressings24
Product (W1  W)/W (W1  W2)/W3
TM
Sorbsan 11.98
KaltostatTM 16.30
Knitted fabric of viscose filament yarn 1.88
Woven cotton gauze 4.83
Polyester nonwoven fabric 18.35
Copyright # 2007 John Wiley & Sons, Ltd.
Figure 8. Photomicrograph of a piece of alginate nonwoven
dressing wet in normal saline, 200.
lateral spreading of the liquid. This so-called ‘gel blocking’
property is clinically an important feature of an alginate
wound dressing. As Fig. 9 clearly shows, wound covered by
an alginate wound dressing has a clean edge, with the wound
exudate absorbed into the dressings immediately on top of
the wound surface.
ALGINATE WOUND DRESSINGS
Alginate has a long history of applications in wound
management. It is reported that early sailors used seaweeds
to treat wounds, burns and eczema, and during the World
Wars, because of shortage of cotton, dried sea moss dressings
were sent to field hospitals to treat wounded soldiers.9
During World War II, Blaine25 investigated tissue reactions to
alginate fibers and reported the use of alginate fibers for
hemostasis and as a bone wax substitute.26 In 1951, Blaine
used alginate fibers as absorbable hemostats in surgery and
noted that 10 days after the implantation, the alginate became
almost entirely absorbed. Blaine27 also reported that
alginates did not lessen the antibiotic activity, could be heat
sterilized, and did not promote bacterial growth.
The first modern alginate wound dressing was brand
named Sorbsan, which was launched in 1983.28 It consisted of
a loose fibrous fleece made from calcium alginate fibers with
a high mannuronic acid content. This was followed by other
products that differed both in their chemical composition
and textile structures. For example, Kaltostat, a fibrous high
G calcium alginate, was introduced into the market in 1986.
Later, Kaltostat was further modified to consist of a mixture
of calcium and sodium alginate. The sodium alginate was
introduced to improve the gel-forming ability of the fibers.
Alginate wound dressings are produced either as flat
sheets, which are used to cover superficial wounds, or as
(W2  W3)/W3 (W1  W2)/(W2  W3) W3
73.7 15.2 4.83 0.139
47.1 14.8 3.18 0.198
4.64 2.72 1.71 0.379
11.5 6.45 1.78 0.059
67.6 3.97 17.01 0.494
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Figure 9. A leg wound covered by a piece of alginate wound
dressing.
cavity fillers, usually in the form of ribbon or rope. The flat
dressings are normally made in a nonwoven fabric process in
which the fibers are carded to form a web that is then
cross-lapped to form a felt. In some products, the felt is then
needled or entangled by means of high-pressure water jets to
give the dressing a coherent structure.1
After more than two decades of development, alginate
wound dressings have now become one of the most versatile
wound dressing materials. They have unique gel-forming
properties and high absorption capacities. It is now generally
accepted that the wound heals better in a moist condition,
and the ability to form a moist gel has given the alginate
dressings their unique characteristics. They are gaining
widespread use in the management of exuding wounds such
as pressure sores and leg ulcers.
Table 5 outlines the key structural features for several
types of commercial alginate wound dressings. It is
important to point out that for an alginate wound dressing,
there are three structural levels to differentiate different
products, i.e. molecular, fibrous, and textile structures.
Alginate is a copolymer and its molecules differ on the
relative proportions of a-L-guluronic acid and b-D-mannuronic
acid monomers. During the wet spinning process, sodium
alginate is converted into calcium alginate. In some cases,
part of the alginic acid in the fiber can form salt with sodium
ions, resulting in a mixture of calcium/sodium alginate.
Different fibers can differ in the metal ion composition as
well as the various types of additives that are blended into
the fiber during the production process, for example, CMC is
added into the fiber to increase the absorption capacity.
During the production process for wound dressings, the
Table 5. Key structural features of seven commercially available alginate wound dressings29
Ratio between guluronate
and mannuronate contents
SorbsanTM 39/61
TegagelTM 39/61
AlgosterilTM 68/32
KaltostatTM 68/32
Tegagen HGTM 38/62
CurasorbTM 68/32
UrgosorbTM
Alginate/CMC ratio  85/15 68/32
Copyright # 2007 John Wiley & Sons, Ltd.
Alginate fibers 11
carding and needling process also differ for different
products, for example, Sorbsan is presented as a loose
unneedled fleece, while Kaltostat is presented as a needle
punched integral felt.29
PROPERTIES AND APPLICATIONS OF
ALGINATE WOUND DRESSINGS
The hemostatic properties of alginate wound
dressings
In 1951 Blaine27 performed a comparative evaluation of
absorbable hemostatic agents, including alginates. He found
that after 12 weeks, calcium alginate fibers were absorbed in
the body, while sodium alginates were generally absorbed
within 10 days. Blair et al.30 compared the hemostatic effect of
oxidized cellulose (Surgicel), porcine collagen (Medistat),
calcium alginate (Kaltostat), and surgical gauze in liver
lacerations in the rabbit. Their results showed that calcium
alginate stopped bleeding in less than 3 min compared with a
mean of 5.7  0.75 min for porcine collagen, 12.5  0.9 min for
oxidized cellulose, and >15 min with gauze.
Sirimanna31 investigated the use of calcium alginate fiber
for packing nasal cavity following surgical trimming of the
inferior turbinates. Thirty-two nostrils were packed with
Kaltostat for 36–48 hr to achieve hemostasis. There was no
bleeding while the packs were in place or after removal.
These results were compared retrospectively with two other
treatments, i.e. trousered paraffin gauze and glove finger
packs, both of which had been associated with bleeding in
over 50% of cases either while in situ or after removal. In a
second study, the three types of packings were compared
prospectively.32 All three were similarly effective in
preventing bleeding while in situ, but the alginate caused
significantly less bleeding on removal.
The hemostatic effect of the alginate fibers was attributed
to the calcium ions released from the fibers, which can
activate platelet coagulation. In this respect, products made
from high M alginates are more effective than their high G
equivalent. Evidence for the hemostatic activity of one high
M alginate dressing, Sorbsan, was produced in a study in
which the dressing was applied to experimental, full, and
partial thickness wound models for up to 14 days to assess its
effects on healing. Histological evaluation showed the
dressing to be an effective hemostat, generally well tolerated
by body tissues.33
In a detailed study on the hemostatic properties of various
alginate wound dressings, it was shown that high M type
dressings generally have better hemostatic properties than
Ratio between calcium Nonwoven
and sodium content structure
96.6/3.4 Unneedled
96.6/3.4 Hydro-entangled
99.6/0.4 Needled
80/20 Needled
65/35 Needled
99.2/0.8 Needled
95.2/4.8 Needled
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12 Y. Qin
high G alginate dressings. In addition, after comparing the
effects of calcium and zinc containing alginates and
non-alginate dressings on blood coagulation and platelet
activation, it was found that alginate materials activated
coagulation more than non-alginate materials, with zinc
alginate being more effective than calcium alginate.34
The antimicrobial functions of alginate
wound dressings
For alginate fibers, it is well known that when they are in
contact with wound exudate, the calcium ions in the fibers
exchange with sodium ions in the fluid, and the fibers are
transformed from water insoluble calcium alginate into
water soluble sodium alginate, resulting in the absorption of
a large amount of water by the fibers. In a wound dressing,
typically with a nonwoven structure, as the fibers absorb
water and swell, the spaces between the fibers are closed and
any bacteria that are carried in the wound exudate are
trapped in the wound dressing. This can help reduce the
spreading of bacteria, giving the alginate wound dressings
bacteria static properties.35
The development of silver containing alginate fibers has
enhanced the antimicrobial activities of alginate wound
dressings by the sustained release of the broad spectrum
antimicrobial silver ions.36 Figure 10 shows the antimicrobial
mechanism for the silver containing alginate wound
dressings. As the dressing absorbs exudates, the fibers
absorb liquid into the fiber structure and swell as a result,
reducing the interfiber spaces and effectively trap bacteria in
the nonwoven structure. The release of silver ions from the
fibers then kills the bacteria that are trapped in the alginate
wound dressing, thus making the dressings highly anti-
microbial.
Figure 11 shows the antimicrobial action of silver
containing alginate fibers against Escherichia Coli. There
was 100% reduction in bacteria count within 5 hr after the
fibers were placed in contact with solutions containing the
bacteria. Interestingly, although the Sorbsan alginate fibers
showed some antimicrobial activity, in the solution contain-
ing the other alginate fiber and AquacelTM (made of
carboxymethyl cellulose), antimicrobial effect was not noted
Figure 10. The antimicrobial mechanism of the silver con-
taining alginate wound dressings.
Copyright # 2007 John Wiley & Sons, Ltd.
Figure 11. The antimicrobial action of silver containing algi-
nate fibers against E. Coli.
and there was increased rate of bacteria growth in some
cases.
The wound healing properties of alginate
wound dressings
On contact with wound, alginate wound dressings can
stimulate macrophage activities. The interaction between the
alginate molecule and macrophage cells plays a key role in
many physiological and pathophysiological processes
during the wound healing process by synthesizing various
biologically active molecules called cytokines. Tumor
necrosis factor-a (TNF-a) is an important cytokine, having
cytotoxic properties against both tumor cells and normal
cells infected with intracellular pathogens. It is also a very
important inflammatory mediator, which modulates many
physiological and immunological functions and has been
implicated in inflammatory conditions. Otterlei et al.37
compared the ability of different alginates to stimulate
macrophage cells to produce TNF-a, interleukin-1, and
interleukin-6. They reported that high M alginates were
approximately 10 times more potent in inducing cytokine
production than high G alginates and therefore proposed
that mannuronic acid residues are the active cytoki-
ne-inducers in alginates. Other authors have also produced
evidence to suggest that it is MM blocks rather than GG that
is responsible for cytokine stimulation and antitumor
activity. A treatment of high M alginate with C-5 epimerase,
which converts b-D-mannuronic acid into a-L-guluronic acid,
results in a loss of TNF-inducing ability.38
In another study, it was found that a low concentration of
an extract of an alginate dressing stimulated human
fibroblasts on extended contact,13 indicating that alginate
wound dressings can promote wound healing.
Clinical uses of alginate wound dressings
The first person in modern times to recognize the potential
value of alginate in surgery and wound management was
George Blaine, a major in the Royal Army Medical Corps. He
showed them to be absorbable in tissue, sterilizable by heat,
and compatible with penicillin.39 He also described how he
had used alginate films clotted in situ for the treatment of
wounds and burns in troop ship hospitals in the Far East and
described the use of alginate, sometimes in combination with
plasma as an alginate–plasma film, as ‘puncture patches’
over scleral defects.
During a subsequent assessment of the use of alginate as
hemostats and wound dressings, Blaine25 reported the
Polym. Adv. Technol. 2008; 19: 6–14
DOI: 10.1002/pat

apparent lack of toxicity following a series of animal studies
in which fibers were implanted into animal tissues, and gels
made from alginates were used to treat experimentally
produced burns. Successful use of alginate-derived materials
in aural surgery and neurosurgery was reported by Passe
and Blaine40 and Oliver and Blaine,26 respectively. Bray
et al.41 described the results of a 3-month trial on the use of
alginate in the casualty department of Croydon Hospital.
Alginates in the form of films, wool, gauzes, and clots formed
in situ by mixing sterile solutions of calcium chloride and
sodium alginate, were applied to a wide range of wounds,
including burns, lacerations, ulcers, and amputations. In all
cases, healing was rapid and uneventful. By the late 1940s
and early 1950s, alginates were being used in some 70
hospitals in the UK over a range of surgical specialties.27
More recently, the first clinical report regarding a fibrous
alginate wound dressing was published in 1983 when Fraser
and Gilchrist8 and Gilchrist and Martin42 described their
experiences with the Sorbsan alginate dressing in the
management of foot disorders and a variety of skin lesions,
following a clinical evaluation in a group of hospitals in the
Sunderland area. The results of these studies were very
positive and supported the findings of Blaine some 40 years
earlier. Further papers described the use of Sorbsan in the
management of problem wounds including infected trau-
matic wounds and leg ulcers.43,44
Alginate wound dressings are used on many types of
wounds with medium to high levels of exudates. Some of
these wounds are described below.
Leg ulcers
Thomas and Tucker carried out a controlled trial of an
alginate dressing involving 64 community patients with leg
ulcers.45 The patients were allocated to treatment with either
an alginate dressing (Sorbsan) or paraffin gauze (tulle) as a
control. Only 4% of the ulcers treated with tulle healed
during the study, while 31% of those treated with the alginate
healed completely. The average healing rate achieved with
the alginate was over four times of that with tulle. Overall,
73% of alginate patients showed improvement during the
trial, compared with 43% in the control group.
Burns and donor sites
Alginate wound dressings are ideal for the treatment of
burns and donor sites, where their hemostatic and absorbent
properties are most useful. Groves and Lawrence10 com-
pared Sorbsan with a standard gauze pad. In a laboratory test
the alginate absorbed nearly three times as much citrated
blood as the gauze; when applied to fresh, split-thickness
donor sites for 5 min after excision, blood loss from the sites
treated with the alginate was almost half than from those
treated with gauze.
The effect of long-term application of alginates to donor
sites was investigated by Attwood.11 In an initial study, 15
patients with split skin grafts had half of their wound
dressed with an alginate (Kaltostat), and the other with
paraffin gauze. Every area dressed with the alginate showed
significantly better healing than the corresponding ‘control’
area. The second phase of the study assessed the time to
complete healing of alginate-dressed areas and patient
Copyright # 2007 John Wiley & Sons, Ltd.
Alginate fibers 13
acceptability of the dressing. A total of 155 donor sites were
examined, among these, 130 were treated with alginate and
25 with paraffin gauze. Sites treated with the alginate healed
in 7.0  0.71 days, whilst the paraffin gauze dressed wounds
took an average time of 10.75  1.6 days to heal. Patient
comfort and the quality of healing with the alginate were
significantly better than that achieved with gauze.
Pressure ulcers
Sayag et al.12 compared the efficacy of an alginate (Algosteril)
with that of dextranomer paste, an established local
treatment, in a prospective, randomized, controlled trial of
92 patients with full-thickness pressure ulcers. A minimum
40% reduction in wound area was obtained in 74% of patients
in the alginate group and 42% in the dextranomer group. The
median time to achieve this reduction was 4 weeks for the
alginate and more than 8 weeks for the dextranomer. Mean
surface area reduction per week was 2.39  3.54 cm2 and
0.27  3.21 cm2 in the alginate and dextranomer groups,
respectively. The authors concluded that the striking efficacy
of the alginate dressings suggested that they may have
pharmacological properties to wound healing.
NOVEL USES OF THE GEL-FORMING
ABILITIES OF ALGINATE FIBERS
In addition to nonwoven wound dressings, alginate fibers
can be used to make a number of novel composite materials
for wound management and other biomedical applications.
Qin and Gilding made fiber reinforced alginate gel by
dispersing chopped calcium alginate fibers in a solution of
sodium alginate. During drying, the calcium ions released
from the alginate fibers crosslinked the sodium alginate, and
a fiber reinforced sheet of alginate was formed. When in
contact with water, the sodium alginate component in the gel
absorbs water into the sheet and a hydrogel is formed. If the
mixture of calcium alginate fiber and sodium alginate
solution is placed in a freezer to form a sheet of solid ice,
and then taken immediately to a freeze drying machine, a
freeze-dried pad can be prepared over a period of about
20 hr. The resultant product is a porous dehydrated hydrogel
capable of absorbing more than 20 g of normal saline for a
gram of the sheet material.46
In order to donate moisture to dry wounds, the calcium
alginate fibers can be mixed with sodium alginate solution to
form amorphous hydrogels.47,48 By mixing 1 kg of calcium
alginate fibers with a length of about 10 mm, 1.2 kg of sodium
alginate and 50 g of sodium citrate in 40 l of water and 8.5 kg
of propylene glycol, a viscous fibrous gel can be formed, with
a viscosity of about 800,000 mPa s. This type of gel can be
applied on dry wounds to donate water to the devitalized
tissue, allowing them to separate from the wound, so that a
clean wound surface can be developed.
It is also possible to produce sheet hydrogel by impre-
ganating a nonwoven alginate felt with a sodium alginate
solution.49 For example, a nonwoven calcium alginate felt
with a weight/unit area of about 60 g m2 was treated with a
2% sodium alginate solution dissolved in a 80/20 mixture of
water and propylene glycol, with the ratio between solution
to felt at 40 to 1. The fibers in the nonwoven felt interacted
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
hydrogel. The resultant gel could be autoclaved to provide a
hydrated sheet hydrogel for the treatment of superficial
wounds with low to medium level of exudate.
Renn et al.50 developed a method of producing an
absorbent foam material from calcium alginate fibers and
sodium alginate solution. They dispersed surfactants in the
sodium alginate solution to create a foamy mixture. When
short calcium alginate fibers are mixed into this foam, the
calcium ions released from the fibers crosslink the sodium
alginate, and the foam structure is immobilized. After
drying, a porous alginate foam can be produced.
SUMMARY
Because of the ion exchange between the calcium ions in the
fiber and sodium ions in the wound exudate, alginate fibers
can form gel when applied to exuding wounds. The gelling
process is accompanied by the absorption of wound exudate
into the fiber structure and as the fibers swell, the capillary
structure in the nonwoven wound dressing is closed, thereby
blocking the lateral spreading of liquid. This unique ‘gel
blocking’ property of alginate wound dressings helps reduce
wound maceration. In addition, since alginate wound
dressings have novel hemostatic and antimicrobial proper-
ties, especially with the addition of silver ions, they are
ideally suited for the management of chronic wounds where
a high level of exudates is common.
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