A Guide To Selecting The Right Dressings For Wounds

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

   Dr. Suzuki and his colleagues have been using the latest iteration of Allevyn foam dressing, the Allevyn Life series (Smith & Nephew) “and we are very impressed by it.” He notes the dressing stays on the skin very well because it has very wide adhesive borders in comparison to most bordered dressings. Dr. Suzuki says Allevyn also features silicone adhesive (leaving no iatrogenic skin tears when removing the dressings) and a contoured foam pad. He notes this dressing doesn’t leave a skin mark and folds around the body part well. Dr. Bell notes that silicone materials have reduced trauma during dressing removal, can facilitate overall comfort and help decrease shearing in pressure ulcers.

   Dr. Suzuki has also tried Drawtex dressing (SteadMed Medical), a hydroconductive dressing that actively “draws” wound drainage and absorbs it very well. He notes one can layer the Drawtex dressings on top of another to increase the fluid absorption. Dr. Suzuki says one cannot replicate this feature with conventional foam dressings.

   In contrast, Dr. Bell notes the lack of any real recent technological breakthroughs when it comes to dressings.

   “The existing technology gets tweaked and marketed, but honestly, I haven’t seen anything exceptional,” asserts Dr. Bell.

Q:

What is your approach when you encounter new dressings?

A:

Noting that he is always curious about new dressings, Dr. Suzuki will put dressings on himself for a few days. “If the dressing is comfortable to me, I would be more willing to use it on my patients,” he says.

   Even though wound dressings have been around for many years, Dr. Suzuki thinks there are many areas in which dressings can improve in terms of wear time and comfort. He also acknowledges cost considerations, especially the daily cost of the dressing. For example, he says the Cutisorb (BSN Medical) super absorbent dressing may appear expensive at first but it may be cost-effective as the dressings’ wear time is long (up to seven days) in comparison to conventional dressings that may need daily changes, which require costs for material and labor.

   “If a manufacturer’s representative tells you about the wonderful and amazing results of the company’s latest and greatest dressing, ask for the data. Let’s see some evidence before we get too excited,” cautions Dr. Bell.

   If a new dressing has merit, Dr. Bell will further examine the construct and features of the product. Emphasizing the importance of critical thinking, Dr. Bell will ask himself questions and try to play devil’s advocate while remaining skeptical. He will ask why is one dressing better than what is already available and has proven to be efficacious and safe. Dr. Bell also recommends further reading on the new products, citing Cochrane Reviews and PubMed as great starting points.

   Dr. Steinberg also tries to think critically about dressing use and tries to avoid duplication/unnecessary expense. He argues that each clinic and provider needs to have a dressing list that can meet the needs of the patient population. There is very little human trial data on any of the dressings that he uses or proposes to use so requiring randomized, double-blinded trials in order to include a dressing wound be impractical. However, Dr. Steinberg will look at the clinical data on the dressing and then weigh that with the practical features that the materials will bring to his patients.

   Dr. Bell is a board-certified wound specialist of the American Academy of Wound Management and a Fellow of the American College of Certified Wound Specialists. He is the founder of the “Save a Leg, Save a Life” Foundation, a multidisciplinary, non-profit organization dedicated to the reduction of lower extremity amputations and improving wound healing outcomes through evidence-based methodology and community outreach.

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