Wound Care: Wound Dressings

General Considerations

Moisture Level

  • Moisture Control is the Most Important Factors in Choosing Dressings
    • Other Factors are Secondary (Antimicrobial, Odor Control, Debridement, etc.)
  • Moisture Promotes Healing
    • Prevents Tissue Dehydration & Cell Death
    • Accelerates Angiogenesis
    • Increases Breakdown of Necrotic Tissue & Fibrin
    • Easier Migration of Epidermal Cells
    • Increased Exposure to an Acute Wound’s Own Growth Factors
  • Excessive Moisture (Wet Environment) Causes Maceration

Tissue Damage by Inappropriate Moisture Levels

  • Maceration: Softening & Break Down of Tissue Due to Excessively Wet Environment
  • Desiccation: Dehydration & Cell Death Due to Excessively Dry Environment

Dressing Types (Based on Moisture Levels)

  • Open (Permeable) Dressings
    • Definition: Both Air & Liquid Can Penetrate
    • Primarily Describes Gauze Dressings (Rolls or 4×4 Inch Squares)
    • Includes:
      • Wet-to-Dry Dressings
      • Wet-to-Moist Dressings
    • Generally Not Used for Chronic Wounds
  • Semi-Occlusive (Semi-Permeable) Dressings
    • Definition: Air Can Penetrate but Not Liquid
    • Includes:
      • Hydrogels
      • Hydrocolloids
      • Foams
      • Alginates
      • Films
  • Occlusive (Non-Permeable) Dressings
    • Definition: No Air or Moisture Can Penetrate
    • Many Semi-Occlusive Dressings Can Be Made Occlusive Depending on a Secondary Adhesive Dressing

Negative Pressure Wound Therapy (NPWT)

General Approach for Chronic Wounds

  • Wound Management:
    • Necrosis or Slough: Debride as Appropriate
    • Granulation: General Cleansing & May Consider NPWT
  • Wound Dressing:
    • Dry-Low Exudate: Hydrogel
    • Moderate-High Exudate: Foam or Alginate

Types of Dressings

Dressing Supplies

Open (Permeable) Dressings

  • Primarily Describes Gauze Dressings (Rolls or 4×4 Inch Squares)
    • Loosely Packed into the Wound
    • Covered with Thicker Absorbent Pads (ABDs)
  • Wet-to-Dry: Uses Dry Gauze
    • Appropriate Only for Mechanical Debridement to Remove Drainage & Necrotic Tissue
    • Should Be Changed Every 4-8 Hours
    • Can Cause Significant Pain with Changes
  • Wet-to-Moist: Uses Gauze Moistened with Saline (Excess Wrung Out)
    • Some Mistakenly Interchange the Term with “Wet-to-Dry”
    • Used to Keep Wounds Moist & Remove Drainage/Dead Tissue
    • Should Be Changed Daily

Semi-Occlusive (Semi-Permeable) Dressings

  • Hydrogels: Synthetic Polymer with High Water Content (> 90-95%)
    • Minimally Absorbent & Mostly Moisten Wound Beds
    • Most Useful for Dry Wounds with Minimal Exudate
    • Can Provide Some Cooling Effect in Burns or Painful Wounds
    • Also Promotes Some Autolytic Debridement
    • Forms: Sheets, Gels & Foams
    • Ex: Skintegrity, AquaDerm, IntraSite Gel, Derma-Gel, etc.
  • Hydrocolloids: Two-Layered with Inner Hydrocolloid
    • Two-Layer Dressing
      • Inner Layer – Hydrocolloid Adhesive Moistens the Wound Bed
      • Outer Layer – Film/Foam Protects the Wound
    • Not Appropriate for Either Dry/Necrotic Wounds or Wounds with High Exudate
    • Best for Low-Moderate Exuding Wounds
    • Ex: DuoDerm, DermaFilm, Tegasorb, etc.
  • Foams: Semipermeable Nonadherent Polyurethane Foam
    • High Absorptive Capacity
    • Not Appropriate for Dry or Minimally Exudative Wounds – Can Cause Desiccation
    • Best for Moderate-High Exuding Wounds
    • Can Be Impregnated with Various Substances/Antibacterial Agents (Silver, Honey, Iodine, etc.)
    • Can Have a Second Hydrophobic Layer to Inhibit Bacterial Contamination
    • Requires Another Adhesive Dressing Above
    • Ex: Mepilex, CuraFoam, DermaFoam, etc.
  • Alginates: Complex Polysaccharides Formed by Algae
    • Insoluble to Water but Exchange Calcium for Sodium
      • Exchange in Sodium-Rich Wound Fluid Creates an Amorphous Gel Over the Wound Bed
      • Gel Can Be Washed with Saline to Clean with Changes
    • Not Appropriate for Dry or Minimally Exudative Wounds – Can Cause Desiccation
    • Best for Moderate-High Exuding Wounds
    • Omits an Unpleasant Odor
    • Forms: Pads, Ribbons & Beads
  • Films: Thin Clear Adhesive Dressings
    • Allow Visualization of the Underlying Wound
    • Maintains Moisture with Minimal Absorptive Capacity
    • Most Often Used for IV Lines & Catheters
    • Ex: Tegaderm, Cutfilm, etc.