11/13/24, 7\:28 PM Guide | Wound dressings

Wound dressings

Table of contents

Introduction

This guide provides a general overview of wound dressing types including the advantages and disadvantages of each. Please
follow local guidelines and consult the wound management formulary in your organisation. Further advice may be obtained
from the tissue viability team.

Background

Wound healing

Wound healing is a complex process that involves multiple stages. The principal stages of wound healing include\:
Haemostasis\: vasoconstriction and activation of the coagulation cascade to prevent further bleeding
In
attract other cell types
Cell proliferation\: granulation tissue provides a sca
Epithelialisation\: epithelial cells migrate from the wound edges to cover the wound defect
Tissue remodelling\: iterative breakdown and rebuilding of the wound’s extracellular matrix resulting in gradual improvement
in the tensile strength of the wound
It's important to understand the wound healing process as this can inform the choice of an appropriate dressing (e.g. a moist
environment is essential for cell proliferation and epithelialisation in particular).
See our wound healing overview for more details.

Assessing a wound

Inspection of a wound can provide clues as to the current stage of healing and the presence of additional factors which may
impair the healing process such as infection\:
Pink (epithelialisation phase)
Red (granulation/proliferation phase)
Yellow (sloughy/granulation phase)
Black (necrotic tissue/eschar)
Wounds with signs of infection (e.g. o

Assessing a dressing type

There are a few things you should consider when assessing a wound dressing\:
What is the action of the dressing?
When should it be used?
Are there any contra-indications to its use?
What is the method of application and removal?
Is a secondary dressing required and if so, what type?

Characteristics of an ideal wound dressing

An ideal wound dressing\:
promotes moist wound healing
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manages excess exudate
provides thermal insulation
is impermeable to micro-organisms
causes minimal trauma on removal
is cost-e
is easily available

Types of wound dressing

A primary dressing refers to the dressing in direct contact with the wound surface.
A secondary dressing refers to a dressing which
the absorption of wound exudate.
The use of a primary and secondary dressing together is often referred to as a combined dressing.

Simple island dressings

Simple island dressings consist of a basic absorbent wound pad with an adhesive backing.
These types of dressing are only appropriate for wounds in which the edges are closely re-approximated (i.e. close
together/healing by primary intention). These dressings are typically used to cover a wound that has been closed by sutures.
Simple island dressings should not be used in the context of open wounds.
It is important to clarify if the patient has any allergies before applying a simple island dressing due to the presence of
adhesive (this is true for all dressings that contain adhesive).
Advantages
Useful for wounds in which the edges are closely re-approximated such as post-operative incisions
Can absorb small amounts of wound exudate
Provide a covering for the wound
Disadvantages
Not appropriate for open wounds or those with excessive exudate
Appropriate wound types
Closely approximated wounds (e.g. surgical incisions with sutures or skin tears) healing via primary intention
Examples
Some examples of simple island dressings include\:
Alldress®
Primapore®

Non-adherent wound contact layer dressings

Non-adherent wound contact layer dressings (sometimes referred to as 'non-adherent dressings') are designed to minimise
sticking to the drying exudate of the wound, resulting in less trauma and pain when the dressing is removed.
Non-adherent dressings are typically used to directly cover the wound bed with a secondary absorbent dressing placed over
the non-adherent dressing to absorb exudate and
Non-adherent dressings are most suitable for clean, granulating, lightly exuding wounds without necrosis.
Advantages
Protect the wound bed from direct contact with secondary dressings.
Disadvantages
Limited ability to absorb exudate and require a secondary dressing
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Appropriate wound types
Super
Burns
Leg ulcers
Examples
Some examples of low-adherence dressings include\:
Mepitel®
Atrauman®

Films & membranes

Film and membrane dressings allow the passage of water vapour and oxygen through them, which can help reduce the risk
of maceration of tissue due to excessive moisture and provide oxygen to assist with the wound healing process.
These types of dressings also provide visibility of the wound, without the need to remove the dressing, which can be useful for
monitoring the healing process and early recognition of problems such as infection.
Their ability to absorb exudate is typically limited, and removal can result in tissue damage due to adherence.
Advantages
Allow passage of water vapour reducing the risk of maceration
Allow passage of oxygen to facilitate the healing process
Provide visibility of the wound
Disadvantages
Limited ability to absorb exudate
Appropriate wound types
Epithelialising wounds
Super
Examples
Some examples of
Mepore® Film
Hydro
Tegaderm®

Moist dressings

Moist dressings work by either preventing the loss of moisture from the wound or donating moisture to the area directly.
The two primary subtypes of moist dressings are\:
Hydrocolloid dressings
Hydrogel dressings
Both hydrocolloid and hydrogel dressings work by stimulating autolytic debridement which involves the breakdown of
damaged proteins, see
our guide).
Hydrocolloid dressings
When a hydrocolloid dressing comes into contact with wound exudate, the hydrocolloid component of the dressing becomes
a gel. This gel then creates a waterproof seal that prevents moisture loss from the wound through evaporation.
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Dressings should be large enough to fully cover the wound with some additional margin (at least 2cm) to ensure an
adequate seal is established.
Hydrocolloid dressings can be left in place for up to 7 days.
Advantages
Maintain wound hydration by preventing the loss of moisture
Create an optimum healing environment (warm and moist)
Disadvantages
Can lead to skin maceration due to excessive moisture
Appropriate wound types
Super
Examples
Some examples of hydrocolloid dressings include\:
Granu
Tegaderm Hydrocolloid®
Hydrogel dressings
Hydrogel dressings contain water in a gel form.
The amount of water contained within the dressing varies but is typically 60-70%.
Hydrogel dressings are ideal for wounds that contain necrotic tissue, as this is often desiccated. The water from the hydrogel
is absorbed by the necrotic tissue which then softens and is easier for the body to break down through the previously
described process of autolytic debridement.
A hydrogel dressing should be large enough to cover the wound with a minimum of a 3cm margin.
A secondary dressing such as a
wound bed.
Hydrogel dressings need to be changed every 2-3 days on average.
Advantages
Facilitate the breakdown of necrotic tissue through rehydration and subsequent softening.
Disadvantages
Excessive use of hydrogel dressings can cause skin maceration.
Appropriate wound types
Wounds with desiccated necrotic tissue (if the aim is to debride)
Examples
Some examples of hydrogel dressings include\:
Kerralite Cool®
Intrasite Gel®

Absorbent dressings

Absorbent dressings function to absorb and contain wound exudate.
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If wound exudate is not managed appropriately, it can result in skin maceration, poor dressing adherence and leaking.
There is a wide range of absorbent dressings available which vary in shape, size and absorbancy.
Absorbent dressings should be applied to a dry wound bed, meaning excess exudate should ideally be cleaned away prior to
the application where appropriate.
Hydro
Hydro
dressings are an evolution of the hydrocolloid dressings mentioned above, with the di
entirely of hydrocolloid and thus have a much greater ability to absorb wound exudate.
When Hydro
Hydro
Hydro
Advantages
E
Aids moist wound healing and autolytic debridement
Haemostatic
Creates a warm, moist environment
Disadvantages
Can sometimes stick to the edges of a wound causing tissue damage on removal if used inappropriately
Appropriate wound types
Wounds with medium to high levels of exudate
Dehisced surgical wounds
Abscess cavities
Examples
Some examples of Hydro
Aquacel®
Alginate dressings
Alginic acid, also called algin, is a naturally occurring polysaccharide that is re
Alginate dressings absorb wound exudate and form a gel-like covering over the wound to facilitate the healing process,
similar to Hydro
There are a variety of alginate dressing subtypes, some of which form a gel layer which can later be removed in one piece and
others that disintegrate and need to be irrigated to remove them from the wound.
Alginate dressings need to be used in combination with a secondary dressing to hold the alginate dressing close to the
wound bed.
Advantages
Helps to debride wound via stimulation of macrophages
Absorbs and retains
Easy to apply and remove
Haemostatic
Disadvantages
Can dry out the wound
Fibres can stick to the wound bed
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Can result in skin maceration
May sting on contact with the wound
Has an odour when it becomes wet
Appropriate wound types
Pressure ulcers
Venous ulcers
Bleeding wounds
Excessively exudative wounds
Examples
Some examples of alginate dressings include\:
Tegaderm® Alginate
Algisite M®
ActivHeal® Alginate
Foam dressings
Foam dressings absorb exudate and either transform it into a gel-like foam or absorb the exudate into the core of the
dressing, e
Foam dressings need to be changed when they become saturated or show up to 75% strikethrough.
Advantages
Do not stick to the wound surface
Manage excess exudate e
Creates a warm, moist environment
Disadvantages
Do not hold large amounts of exudate
May cause odour when wet
Adhesive dressing can cause skin stripping to fragile skin
Appropriate wound types
Wounds with medium to high levels of exudate
Examples
Some examples of foam dressings include\:
ActivHeal® Foam Adhesive
PolyMem®
Allevyn gentle®

Antimicrobial dressings

For local wound infection, a topical antimicrobial dressing can be used to reduce the level of bacteria at the wound surface
but will not eliminate a spreading infection.
Some dressings are designed to release the antimicrobial into the wound, others act upon the bacteria after absorption from
the wound.
The amount of exudate present and the level of infection should be taken into account when selecting an antimicrobial
dressing.
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Medical-grade honey has antimicrobial and anti-in
treat clinically infected wounds. Dressings containing silver should be used only when clinical signs or symptoms of infection
are present.
Silver, honey and iodine may come impregnated in hydrocolloids, hydro
absorbency. Antimicrobials should only be used in the short term (up to 2 weeks) and be regularly reviewed.
Advantages
Inhibit bacterial growth and kill surface bacteria
Can reduce odours if caused by bacteria
Disadvantages
Risk of an allergic reaction
Potential for antimicrobial resistance developing
Limited ability to absorb exudate
Appropriate wound types
Wounds with local infection/bacterial colonisation
Examples
Some examples of antimicrobial dressings include\:
Inadine®
Activon Tulle®
Aquacel Ag®

Odour absorbent dressings

Odour absorbent dressings, as the name suggests, are typically used in cases where wound odour is causing signi
distress to the patient. They are more e
the outside of secondary dressings.
These types of dressings typically stop functioning if they become wet.
Advantages
Can reduce wound odours
Disadvantages
Stop functioning when they become wet
Appropriate wound types
Severely malodorous wounds
Examples
Some examples of odour absorbent dressings include\:
CarboFLEX®
CliniSorb® Odour Control Dressings

References

1. British National Formulary (BNF). Wound Management. Available from\: [LINK].
2. Jones V, Grey JE, Harding KG. Wound dressings. BMJ. 2006 Apr 1;332(7544)\:777-80. DOI\: 10.1136/bmj.332.7544.777.
3. Pauline Beldon (Tissue Viability Nurse Consultant). How To Choose The Appropriate Dressing for Each Wound Type. Wound
Essentials Volume 5. Published 2010.
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Source\: geekymedics.com
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