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Authors

  1. Baranoski, Sharon RN, APN, CWOCN, MSN, FAAN, DAPWCA

Article Content

KEEPING ABREAST OF wound dressing choices and application techniques is an ambitious undertaking. In this series, I'll describe common types of wound dressings, when to use them, and what advantages and disadvantages to consider. But first, let's review some general points about wound dressings.

 

Environmental issues

The role of a wound dressing is to provide the right environment to enhance and promote wound healing. A moist healing environment stimulates cell proliferation and encourages epithelial cells to migrate. Moisture-retentive dressings also act as a barrier against bacteria and absorb excess wound fluid, creating opportune conditions for healing. Today's wound dressings can also help decrease or eliminate pain, reduce the need for dressing changes, and provide autolytic debridement. Used appropriately, they're cost-effective.

 

Choosing the right dressing depends on your wound assessment and characteristics of the wound bed. Healing requires moisture in the wound bed, but what kind and how much? This is where your clinical decision skills come into play. Choosing the right dressing to fit the various types of wound bed characteristics is key. Is the wound copiously draining? Is it dry? Does it need added moisture? Does it need debridement? Is it infected? These are important questions to discuss with the physician, so that the right dressing can be chosen to speed healing.

 

With these points in mind, let's look at some popular dressings and when to use them.

 

Gauze

Gauze comes in woven and nonwoven forms, can be impregnated with various products, such as petrolatum, iodides, and antimicrobials. A new product, gauze impregnated with the antimicrobial 0.2% polyhexamethylene biguanide, can be used as a primary dressing for I.V. sites, tracheostomy sites, drain sites, and partial- and full-thickness wounds. This type of gauze inhibits bacterial penetration and may reduce infections in partial- and full-thickness wounds. It's not intended to treat infection, but can be used along with treatment for wound infection.

 

Indications: Although indications vary depending on the product, gauze dressings can generally be used on draining wounds; necrotic wounds; those requiring debridement or packing; wounds with tunnels, tracts, or dead space; surgical incisions; burns; dermal ulcers; and pressure ulcers.

  
Figure. Figuring it ... - Click to enlarge in new windowFigure. Figuring it all out

Advantages: Readily available in many sizes and forms, gauze can be used on infected wounds and can be combined with other topical products. It's effective for packing wounds with tunnels, tracts, or undermining.

 

Disadvantages: Gauze must be held in place by a secondary dressing, and fibers may shed or adhere to the wound bed. Gauze dressings should be changed frequently-if it dries out, it may stick to the wound bed and disrupt wound healing. Gauze isn't recommended for effective moist wound treatment or bacterial barrier. Although research supports moist wound healing, the old standard of wet-to-dry gauze dressings is still being used in some places.

 

Transparent film

Made of polyurethane or copolymer, this type of dressing has a porous adhesive layer that lets oxygen pass through to the wound and moisture vapor escape from the wound.

 

Indications: Partial-thickness wounds, Stage I and II pressure ulcers, superficial burns, and donor sites. It also can be used as a secondary dressing.

 

Advantages: This dressing doesn't have to be removed when you examine the wound. Transparent film also is impermeable to external fluid and bacteria, promotes autolytic debridement, and prevents or reduces friction. Available in numerous sizes, it conforms to the body. Change the dressing every 5 to 7 days, or if it becomes soiled, wet, or starts to leak fluid.

 

Disadvantages: The dressing may stick to some wounds. Most transparent dressings don't absorb moisture and aren't indicated for draining wounds. However, some of the newer transparent films have absorption properties. Fluid retention under the dressing may lead to periwound maceration. This dressing can't be used on third-degree burns.

 

Foam

Nonadherent and nonocclusive, foam is an absorptive dressing consisting of hydrophilic polyurethane or film-coated gel.

 

Indications: Stages II through IV pressure ulcers, partial- and full-thickness wounds with minimal to heavy drainage, surgical wounds, dermal ulcers, and under compression wraps. Check the package insert to determine if the product can be used in infected wounds or those with tunneling or sinus tracts.

 

Advantages: Many sizes, shapes, and forms are available. Foam is conformable, easy to apply, and easy to remove because it's nonadherent. The frequency of dressing changes depends on the amount of wound drainage.

 

Disadvantages: A secondary dressing or tape may be needed to secure some of the first foam dressings. Newer versions have an adhesive border to help keep them in place. Foam isn't recommended for nondraining wounds or dry eschar. Some foams can't be used on infected wounds or those with tunneling or tracts. Always read the package insert to determine if you can use the product for a particular wound type. If not changed appropriately, foam dressings can let excess moisture accumulate, macerating periwound skin.

 

Composites

Manufactured as a single dressing, composites are combinations of two or more different products. Features may include a bacterial barrier, absorptive layer, foam, hydrocolloid, or hydrogel. The dressing may have semi-adherent or nonadherent properties.

 

Indications: Use composites as primary and secondary dressings for partial- and full-thickness wounds, for minimally to heavily draining wounds, dermal ulcers, and surgical incisions. Check the package insert to see if the dressing is suitable for pressure ulcers.

 

Advantages: Composites facilitate autolytic debridement, are conformable, and are available in many sizes and shapes. Most include an adhesive border, so they're easy to apply and remove. Check the package insert for frequency of dressing change.

 

Disadvantages: Some composite dressings are contraindicated for Stage IV pressure ulcers. The adhesive borders of composites may limit their use on fragile skin. Not all composite dressings provide a moist healing environment, so monitor frequently for desiccation.

 

In my next article, I'll describe hydrocolloids, hydrogels, alginates, and other wound therapies and when they're used.

 

Resources

 

Baranoski S. Wound dressings: A myriad of challenging decisions. Home Healthcare Nurse.23(5):307-317, May 2005.

 

Baranoski S, Ayello E. Wound Care Essentials: Practice Principles. Lippincott, Williams & Wilkins, 2003.

 

Hess CT (ed.) Clinical Guide to Wound Care, 6th edition. Lippincott, Williams & Wilkins, 2007.

 

Ovington L. Hanging wet-to-dry dressings out to dry. Advances in Skin & Wound Care. 15(2):79-86, March-April 2002.