Keys To Effective Wound Dressing Selection

Nancy Slone Rivera, MS, ANP-C, CWON, CFCN, and Stephanie C. Wu, DPM, MSc

How Dressings Enhance Healing

Wound dressings, for the most part, facilitate preparation and advancement of the wound bed.10 The ideal dressing should provide a moist healing environment, infection control, pain relief, and be easy and safe to use.11 Dressings for diabetic foot ulcers should be able to withstand shear forces, absorb exudates, allow for drainage and not be too bulky in the shoe.12 Dressings can assist with debridement, trauma protection, reduction of hypergranular tissue, inflammation and bacterial load. Dressings can also facilitate neovascularization, granulation and epithelial growth.13 Treatment goals may progress through autolytic debridement, subsequent granulation formation and drainage absorption, and finally the enhancement of reepithelialization. Repeated assessment is essential since the initial dressing protocol may not be appropriate to closure.

   Wound dressings can be passive, active or interactive. Passive dressings mainly serve as a wound covering to protect the wound. Active dressings deliver topical treatments to the site and create a moist environment. Interactive dressings not only create a moist wound environment but also interact with the wound bed components to further promote wound healing.14

A Guide To Indications And Contraindications For Gauze Dressings

Plain gauze is a passive dressing, which clinicians may use as primary or secondary cover dressings or as packing material. Gauze comes in woven and non-woven sponges and rolls. Non-woven dressings have longer strands than woven dressings and create a stronger pad with improved fluid wicking properties.

   When cut, woven gauze can leave fibers in the wound, acting as a foreign body and perpetuating inflammation.15 Rolled gauze does not have high retentive qualities unless thickly layered. While these dressings are inexpensive, they require frequent changing and ultimately incur higher cost due to care time and the volume of product used.16

   The “wet to dry saline gauze dressing” is no longer recommended because of its properties of non-selective debridement, disruption of newly formed tissue and pain upon dressing removal.17

What You Should Know About Hydrogel Dressings

Hydrogel dressings can hydrate and maintain a moist wound bed as well as liquefy necrotic tissue. Hydrogels are cross-linked polymer gels that are comprised of up to 80 percent water and may contain other materials depending on the manufacturer. Hydrogels are non-adherent so they do not harm the wound bed or surrounding skin. Selection of a specific hydrogel dressing depends on the amount of moisture required by the wound, frequency of dressing changes, depth of the wound, bacterial load and the amount of necrotic tissue. Keep in mind that the frequency of dressing changes with hydrogels must be able to sustain a moist wound bed status.

   Hydrogel dressings come in gel, sheet, impregnated gauze and gelatinous fibers. The gel form and impregnated gauze donate the most moisture and are indicated for wounds that have a drier base.18 If hydrogel impregnated gauze is unavailable, one can use plain non-woven gauze impregnated with the gel.

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