Wound care dressing basics

Overview

Selecting appropriate dressings for wound care can improve lives and save limbs. The choice of appropriate dressings can significantly effect the rate of healing, the strength of the repaired skin, and the cosmetic appearance of the scar. In general, moisture content of the wound is paramount and dressings are selected that are best suited to maintain a balance: moist enough to promote healing while removing excess exudate [1] Occluded wounds heal 40% faster than open wounds. [2]

General Considerations

The ideal wound dressing [3]:

  • has the ability to keep the wound bed moist while absorbing excess fluids
  • protects the wound from further damage
  • addresses bacterial bioburden
  • does not injure viable surrounding peri-wound tissue
  • achieves hemostasis
  • debrides necrotic tissue
  • is appropriate for wound size, depth, and location
  • inexpensive with a long shelf life
  • doesn't cause the patient pain during changes

Dressing Types

Type Benefits Indications Contraindications/Precautions
Hydrocolloid Traps exudate and moisture, washes away during dressing changes and produces a painless mechanical debridement Epithelialization stage, clean, low exudative wound Do not use on necrotic wounds, highly exudative, may macerate viable skin.
Hydrogel Rehydrates wounds, feels cooling to the patient Debridement stage, dry wounds, wounds with low exudate. Do not use on necrotic wounds, highly exudative, may macerate viable skin.
Alginate Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing Highly exudative wounds and cavities Caution with friable tissue
Foams Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing Granulation stage, highly exudative wounds and cavities Do not use on necrotic tissue
Silver-Imgregnated Antimicrobial action Use with critically colonized wounds Can discolor skin, some people are sensitive to it
Silicone Low adherence, protects neighboring viable skin, conforms to wound Use as a contact layer Dries out easily
Collagen Matrix Biologic dressing, accelerates rate of complete wound healing Non-healing Stage 3 and 4 pressure ulcers, when traditional dressings have failed Expensive
Gauze Inexpensive Open dressing Requires more frequent dressing changes

Wound Packing

Although wet-to-wet and wet-to-moist packing has been the standard of care for many years, research indicates that gauze dressings are labor intensive and therefore not optimal. Many superior options are now available. [4]

  • Wet-to-Wet Dressings

Indication: To keep a clean wound clean and prevent the build-up of exudates. Technique: Moisten a piece of gauze with saline and just barely squeeze out the excess fluid so it isn't soaking wet. Unravel the gauze, place it onto the wound, and cover with a dry dressing over the top. The dressing should not be allowed to dry or stick to the wound. Change 2-3 times per day. Moisten with saline if it gets too dry.

  • Wet-to-Moist Dressings

Indication: To clean a dirty or infected wound. Technique: Moisten a piece of gauze with saline and squeeze out the excess fluid so it is damp, not dripping wet. Unravel the gauze, place it onto the wound, and cover with a dry dressing over the top. The dressing is allowed to dry out and when it is removed it pulls off the debris. Ideally, change 3-4 times per day. Change more often on a wound that is in need of more debridement, less often on a cleaner wound. Switch to the wet-to-wet dressing when the wound is clean. Note: The wet-to-moist dressing is not a substitute for mechanical/sharp debridement.

See Also

External Links

National Pressure Ulcer Advisory Panel: http://www.npuap.org/

References

  1. Atiyeh BS, Ioannovich J, Al-Amm CA, El-Musa KA. Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing. Curr Pharm Biotechnol 2002; 3:179.
  2. Svensjö T, Pomahac B, Yao F, et al. Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg 2000; 106:602.
  3. Paddle-Ledinek JE, Nasa Z, Cleland HJ. Effect of different wound dressings on cell viability and proliferation. Plast Reconstr Surg 2006; 117:110S.
  4. Ovington LG. Hanging wet-to-dry dressings out to dry. Home Healthc Nurse 2001; 19:477.