Wound care dressing basics
Overview
Selecting appropriate dressings for wound care can improve lives and save limbs. The choice of topical treatment, debridement, the selection of appropriate dressings, and type of closure depends on the type of wound being treated.
General Considerations
The ideal wound dressing:
- 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
Topical Therapy
| 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 | 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 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 |
Closure
Complications
Chronic wounds which are physiologically impaired may require special considerations.