TABLE 55-1 Common Wound Dressings by Category (Listed Alphabetically) | ||||||||||||||||||||||||||||
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Wound Dressings
Wound Dressings
Emily Bahram-ahi
Dressings are generally described as either primary or secondary. The primary dressing is applied directly adjacent to the wound bed to achieve functions such as tissue debridement, infection or inflammation control, or moisture balance. The secondary dressing is then placed against the primary dressing in order to secure and enhance the primary dressing, add absorbency or padding, relieve or add pressure, protect the wound, or provide additional therapeutic effects.
Table 55-1 lists advantages, disadvantages, and examples of common wound dressings by category. In addition, each major category of wound dressings is discussed individually in the text below—grouped according to wound moisture content (Fig. 55-1). In a wet wound environment, with moderate-to-heavy exudate, alginates, foams, hydrofibers, and gauze would be suitable choices, given that they are capable of absorbing excess fluid. These dressings would also be appropriate if the wound is infected. In a wound with appropriate moisture content without any signs of infection, films and hydrocolloids would likely be effective dressing choices. And lastly, for a dry wound without any signs of infection, a dressing that donates moisture, such as hydrogels, would be helpful to soften and debride dry necrotic tissue and support granulation. Additional types of hydrogels, such as hydrogel with silver (i.e., Silvasorb® gel), can be used to donate moisture as well as prevent infection.
DRESSING SELECTION
I. WET WOUNDS
A. Alginates. Alginates are highly absorbent, nonocclusive, biocompatible dressing derived from seaweed. They are sold as nonadhesive sheets, ropes, and alginate-tipped applicators. Alginates absorb sodium from the exudate or serum and release calcium into the wound, creating a beneficial hemostatic effect. The alginate gel helps maintain a moist wound environment after exudate has been absorbed, similar to the gel formed by hydrocolloids. The remaining gel, along with any exudate, debris, or bacteria that were absorbed by the gel, can be irrigated with saline at each dressing change. Alginates are an effective choice for moderate to highly exudating wounds that are either infected or noninfected. The hemostatic properties also make alginates an ideal choice for heavily bleeding wounds. Alginates help maintain moisture balance in the wound and promote autolytic debridement. Thus, the alginates are commonly utilized for partial- and full-thickness wounds, venous stasis ulcers, diabetic ulcers, and other wounds with heavy exudate. The rope form of alginate is often used as packing for deep wounds, and the alginate-tipped applicators can be used in place of cotton-tipped applicators for probing a wound, because they are less likely to induce an inflammatory response in the wound if fibers are left behind.
If the wound is not very exudative, alginates could potentially cause a harmful desiccation; in this case, a dressing more suitable for lower amounts of exudate should be selected. For this reason, alginates should not be used on tendons, bones, or joint capsules, or on wounds with minimal or no exudate. As nonadherent dressings, alginates require a secondary dressing. In a noninfected wound, they can be left in place for several days or changed as necessary depending on the amount of exudate; however, in an infected wound, they must be changed daily. Dressing changes require saline irrigation to remove the residual gel.
B. Foams. Foam dressings are moderately absorbent, semiocclusive polymer dressings, typically made of polyurethane or silicone. Foams are available as pads of various thicknesses, rolls, or foam packings for deep cavity wounds. Most foams are nonadherent; however, some contain an adhesive border. Foams contain two layers: the absorbent layer adjacent to the wound and the outer, semipermeable, barrier layer. The outer layer is similar to film dressings in that it is permeable to gas and water vapor, but impermeable to bacteria and fluids, thereby retaining moisture in the wound bed and preventing bacterial contamination.
