A Guide To Selecting The Right Dressings For Wounds
- Volume 26 - Issue 7 - July 2013
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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
What kind of antimicrobial dressing do you use?
Dr. Suzuki uses a lot of silver-based dressings, such as Mepilex Ag (Molnlycke) or Aquacel Ag (Convatec). He also frequently uses the Sorbact (BSN Medical) dressing, which is a plastic mesh with antimicrobial coating. Dr. Suzuki says Sorbact is inexpensive in comparison to silver dressings.
Dr. Steinberg uses a variety of antimicrobial dressings. He often uses oxidized regenerated cellulose/collagen/silver topical dressing materials as an adjunct when applying bioengineered alternative tissue grafts in the clinic. Dr. Steinberg also likes to use a silver containing foam dressing, citing its ability to provide a moisture balance in the wound environment
If he does use antimicrobial dressings, Dr. Bell uses one of the following: silver impregnated alginate, cadexomer iodine or antibiotic-saturated alginates. Dr. Suzuki will use the iodine-based antimicrobial Iodosorb gel and Iodoflex pads (Smith & Nephew).
When trying to “clean up” an especially foul smelling or dirty wound, Dr. Bell may moisten or saturate an alginate dressing with Dakin’s solution, which he uses until the situation becomes more stable. He does not use Dakin’s solution to “promote granulation” but to reduce the bacterial burden in an extreme situation.
When trying to manage a wound with persistent biofilm or a heavy bacterial burden/multiple organisms including methicillin resistant Staphylococcus aureus (MRSA), Dr. Bell may use a saturated alginate dressing once daily with a triple antibiotic solution of gentamicin-clindamycin-polymyxin (GCP solution). He has found this to be a great adjunct to concurrent oral or IV antibiotic therapy.
Dr. Suzuki also says medical honey products, such as Medihoney (Derma Sciences) and TheraHoney gel (Medline), have excellent antimicrobial properties. Dr. Steinberg also cites success with the medical honey containing dressings, finding no allergy concerns with this class of dressing even in highly sensitive patient populations.
However, Dr. Suzuki cautions that, although rare, he has had patients with silver and iodine allergies.
Do you have any favorite new dressings at the moment?
Dr. Steinberg is involved in a current multicenter clinical trial that involves a negative pressure wound therapy dressing with the addition of a wound irrigation system. As he notes, this system allows one to treat open surgical wounds with topical agents such as saline, acetic acid and detergents. Dr. Steinberg says this technological advance may prove to decrease biofilm and wound base colonization between surgeries and wound healing phases.