A Guide To Selecting The Right Dressings For Wounds

Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

The proper selection of a wound dressing can greatly facilitate wound healing. Accordingly, the panelists share their thoughts on dressing selection, antimicrobial dressings and emerging dressings in wound care.

Q:

How do you select your dressing in your practice setting?

A:

John Steinberg, DPM, FACFAS, uses “a very practical approach” to dressings. He stresses the importance of realizing that the dressing is not likely the factor that will “heal the wound” or not.

   “Your debridement, offloading and other medical/surgical management will likely be the source of healing while the role of the dressing is to provide an appropriate environment for that healing to take place,” notes Dr. Steinberg.

   “First and foremost, the condition of the wound will determine the type of dressing best suited for achieving the immediate goal, whether (it is) exudate management, autolytic debridement, promotion of granulation, etc.,” concurs Desmond Bell, DPM, CWS.

   In his wound care center, Kazu Suzuki, DPM, CWS, stocks about 50 different kinds of dressings (including various sizes). He and his colleagues try to keep the dressings organized and minimize the inventory as most dressings have a few years of shelf life listed in the expiration dates on their sterile packages. He selects the wound dressings mainly based on two factors: to match the amount of wound drainage and whether he wants to use the antimicrobial dressings.

   Dr. Bell notes that one must consider the cost of the dressing. If one is treating a hospitalized patient, the choices may be limited to what is on the formulary or contract, adds Dr. Bell. Seeing patients in multiple settings and facilities can present a challenge as he points out that one may have to change dressing orders if a patient gets transferred in the middle of treatment. Patients who are in home health situations are often limited further by access to dressings, according to Dr. Bell. He acknowledges that home health agencies in general have become very stringent when it comes to the types of dressings they will provide.

Q:

Do you favor antimicrobial dressings or regular sterile dressings?

A:

When Dr. Suzuki was in residency training over 10 years ago, he learned that, “If the wound is clean, all you need to use is a sterile dressing and you don’t necessarily have to use antimicrobial dressings.” Nonetheless, he expresses doubt in that conventional belief, citing more and more data on biofilm impeding the healing of chronic wounds.

   Therefore, Dr. Suzuki says it may be beneficial to use an antimicrobial dressing on most wounds to hasten the healing process even if wounds are not clinically infected. As Dr. Suzuki notes, it appears that to break down the biofilm over the chronic wound, one would have to combine debridement along with a topical antimicrobial (biocide) agent or dressings.1 The conventional belief is that antimicrobial dressings may reduce wound infection although he says he has not seen any real-life data supporting the claim.

   More often than not, Dr. Bell will use use sterile rather than antimicrobial dressings.

   “We are always concerned with the potential for bacterial resistance, not to mention the cost, especially if a wound is clinically improving or is without signs of infection,” explains Dr. Bell.

   Likewise, while he will certainly utilize some antimicrobial dressings, Dr. Steinberg has greatly reduced this practice recently. He emphasizes the importance of assessing the individual wound and determining if surface infection/contamination is a concern. If so, Dr. Steinberg recommends a short course of a topical antimicrobial dressing. If there is no infection concern, Dr. Steinberg would follow the N.I.C.E. data out of the United Kingdom that basically found a low level of evidence for the effectiveness of antimicrobial dressings.2

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