WOUND DRESSINGS
“We can no longer care only for the wound itself; we must step back and look at the
entire human being who happens to have a wound that needs healing”
MOIST WOUND HEALING
Moist wound healing is crucial for effective wound care.
Dr. Winter's discovery in the 1960s emphasized the
importance of a moist wound environment.
Epithelial cells require moisture to migrate for the healing
process.
Traditional dressings evolved from natural coverings like
feathers, lint, and mud, while modern dressings actively
stimulate cell proliferation and encourage epithelial
migration.
EVOLUTION OF WOUND DRESSINGS
Traditional wound dressings primarily aimed at protecting
against infection and absorbing wound fluid.
Contemporary dressings maintain moist conditions, promote
rapid healing, act as barriers, decrease pain, and can be cost
effective.
Despite advancements, some clinicians still prefer traditional
methods like wet-to-dry gauze.
IMPORTANCE OF MOISTURE BALANCE
Maintaining a balanced moist wound environment is critical for cellular growth and
collagen proliferation.
Excess moisture can impede healing, cause skin damage, and lead to periwound
maceration.
New generation moisture balanced dressings come with various characteristics, such
as occlusive, semi-occlusive, absorptive, hydrating, autolytic, débriding, or
hemostatic.
TREATMENT DECISIONS AND ASSESSMENT
Wound treatment decisions should be patient centered and based on a thorough
wound assessment.
The MEASURES Acronym guides wound care principles (Antimicrobials, Edges,
Assess, Support, Underlying health issues, Risk factors, Exudate, Size and shape).
Clinicians need to match wound assessment characteristics with appropriate dressing
choices.
Dressing choices should align with patient goals, wound characteristics, and expected
outcomes.
WOUND CARE
DECISION
ALGORITHM.
DRESSING TYPES AND CHANGES
Primary dressings maintain, absorb, or add moisture to the wound bed
secondary dressings cover or secure primary dressings.
Dressings should be changed based on wound characteristics and patient outcomes.
Weekly reassessment is crucial, and the choice of dressing may evolve as wound
characteristics change over time.
Economic factors, wound etiology, and understanding wound healing biology should
guide dressing selection.
WOUND HEALING BIOLOGY AND ADVANCED TECHNIQUES
Knowledge of cellular biology influences
wound care, such as the use of growth factors
in wound healing.
Growth factors can be derived from a patient's
platelets or used in drug form for application.
Tissue engineered skin equivalents and gene
therapy are emerging options for chronic
wound management.
Ongoing research explores the combination,
quantity, and timing of growth factors for
optimal wound healing.
MOIST WOUND THERAPY AND DRESSING
OPTIONS:
1. TRANSPARENT FILM DRESSINGS
Description: Thin polyurethane membranes with adhesive, providing a see through
covering.
Function: Create a moist environment, imitate outer skin layer, protect against
contaminants.
Indications: Superficial pressure injuries, minor burns, lacerations, catheter sites,
donor sites.
Caution: Accumulated fluid mistaken for infection; change dressing if excess fluid;
potential maceration.
Usage: Absent or low exudate; not recommended for skin tears; excellent as
secondary dressings.
2. HYDROCOLLOID DRESSINGS
Introduction: Mainstay since the 1980s; impermeable, opaque mixtures with
absorbent polymers.
Function: React with wound fluid to form a soft gel; provide a moist environment;
absorb exudate.
Indications: Minimally to moderately heavy exudate, pressure injuries, dermal
wounds.
Caution: Odor during changes is normal; may leave residue; correct sizing crucial;
change every 37 days.
Usage: Not recommended for undermining, tunnels, or sinus tracts; may be cut to fit;
suitable as primary or secondary dressings.
3. HYDROGEL DRESSINGS
Description: Varying water content in amorphous gels, sheets, or impregnated into
mesh type dressings.
Function: Hydrate or donate moisture to dry wound beds; create a moist environment
for autolytic débridement.
Indications: Dry wounds, partial and full thickness wounds, vascular ulcers, skin
tears.
Caution: Maceration risk; can be used with topical medications; daily changes may
be necessary.
Usage: Limited absorptive capacity; various formats available; some contain ionic
silver.
4. HONEY DRESSINGS:
Composition: Medical grade active Leptospermum or Manuka honey.
Mechanisms: Reduce edema, lower wound pH, promote autolytic débridement.
Indications: Infected or highly colonized wounds, slough or necrosis, pressure
injuries.
Caution: Contraindicated for honey allergies; may cause a brief stinging sensation.
Usage: Available in gel, sheets, contact layers; require secondary dressing.
5. FOAM DRESSINGS
Material: Hydrophilic polyurethane base.
Absorption: Highly absorbent; suitable for moderate to heavy exudate.
Indications: Partial and full thickness wounds, granular wounds, skin tears, infected
wounds.
Caution: Thickness affects absorption; available with controlled release ionic silver.
Usage: Left in place for 35 days; suitable for use under compression wraps.
6. CALCIUM ALGINATE DRESSINGS
Material: Non adherent, biodegradable fibers from
brown seaweed.
Absorption: Absorbent, suitable for highly
exudative wounds; form a soluble gel.
Indications: Large draining wounds, pressure
injuries, vascular ulcers.
Caution: Contraindicated for dry wounds, eschar
covered wounds, third degree burns.
Usage: Daily changes; may dry out and adhere;
facilitate autolytic débridement.
7. COMPOSITE DRESSINGS
Composition: Combination of materials for various
functions (bacterial barrier, absorptive layer, foam,
hydrocolloid, hydrogel).
Function: Conformable, available in multiple sizes
and shapes.
Indications: Caution with fragile skin; may require
a secondary dressing; not all provide a moist
environment.
8. COLLAGEN DRESSINGS
Source: Derived from bovine, ovine, porcine, equine, or avian;
100% or combined with alginates.
Function: Support moist wound environment, encourage
collagen deposition, restart wound healing cascade.
Indications: Granulating or necrotic wounds, partial or full
thickness wounds.
Caution: Contraindicated for those sensitive to source; not for
dry wounds or third degree burns.
Usage: Changed every 13 days; require a secondary dressing.
9. CONTACT LAYER DRESSINGS
Composition: Single layer of woven net acting as
low adherence material.
Function: Protective interface between wound and
secondary dressings; allows exudate to pass through.
Caution: Not recommended for dry wounds or third
degree burns.
Usage: Left in place for up to 7 days; used with
ointments, creams, or topical products.
10. ANTIMICROBIAL DRESSINGS
Types: Silver ions, cadexomer iodine, honey,
polyhexamethylene biguanide (PHMB).
Function: Provide antimicrobial effect and moist
environment; adjunct in treating wound infections.
Caution: Silver dressings may cause temporary
staining; remove before xray, MRI, or radiation.
Usage: Various forms available; not a replacement for
systemic antibiotic therapy.
11. ABSORPTIVE DRESSINGS
Classification: Based on absorbency and
occlusion; multilayered with cellulose, cotton, or
rayon.
Function: Manage moderate to heavy draining
wounds; minimize adherence to wound bed.
Caution: Initial monitoring for dressing change
frequency; may form a gel with wound exudate.
