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DRESSING
BY SN EDITH JAMES
FEMALE/MALE
MULTIDISCIPLINE
SURGICAL WARD, QEH II.
TYPE OF WOUND
Necrosis
Slough
Epithelialization
Granulation
NECROSI
S
Wound contains dead
(necrotic) tissue, its
a sign that the wound
is not healing normally.
Necrotic tissue is
often black or yellow
and may be soft, or
form a scab (eschar).
Necrotic tissue must
be removed to get
wound healing back on
track
SLOUGH
To deal with
local infection
(infection in this
wound is
indicated by;
pain at wound
site, reddened
periwound skin,
green/yellow
exudate with
odour, thick
yellow slough
EPITHELIALIZA
TION
Epithelialization
is the natural act of
healing dermal and
epidermal tissue in
which epithelium
grows over a
wound. Epithelium
is a membranous
tissue made up of
one or more layers
of cells that
contains very little
GRANULAT
ION
Granulation
tissue - light
red or dark
pink in color,
being perfused
(permeated)
with new
capillary loops
or "buds"; soft
to the touch;
moist; and
bumpy
TYPE OF
DRESSING
Hydrocolloid
Alginate Dressing
Foam Dressing
Amorphous hydrogels
Transparent Films
Impregnated Gauze
Hydro Fiber
Hydrocolloid Dressing
Characteristics
Absorptive
Occlusive or semipermeable
Adhesive
Moisture retentive
Indications
Light to moderately edudative wounds
Autolytic Debridement
Type 2 to 4 Pressure Sores (some dressings may be
used in Type I sores)
Dry necrotic eschar debridement
Wounds with slough or necrosis
Hydrocolloid Dressing
Contraindications: Relative
Wound infection (especially anaerobic)
Exposed tendon or bone
Diabetes Mellitus (may worsen necrotic Foot Ulcers)
Technique
Change dressing every 3-5 days
Consider stoma adhesive over top under film or
tape
May be used under compression dressing
Hydrocolloid Dressing
Advantages
Requires less care than other dressing types
Become absorbent gels on contact with exudate
Conformable
Adheres to both wet and dry sites
Water resistant
Excellent microbial barrier (prevents infection)
Assists with Autolytic Debridement
Can be used under compression (e.g. Unna Boot)
Hydrocolloid Dressing
Disadvantages
Expensive material
Cost effective when compared with saline dressing
Alginate Dressing
Characteristics
Absorptive
Nonocclusive
Nonadhesive
Moisture-retentive
Indication
Moderate to heavily exudative and wounds
Wounds with undermining or tunneling
Type 2 to 4 Pressure Sores
Autolytic Debridement
Contraindications
Avoid in non-exudative, dry wounds
Avoid in sinus tracts
Alginate Dressing
Technique
Rinse wound residue with each bandage change
Change dressing daily to every 3 days
Advantages
Requires less care than other dressings
Designed to be occlusive
Designed to absorb large exudates (up to 20
times its own weight)
Fills dead space
Conforms to wound shape
Alginate Dressing
Efficacy
Improves Pressure Ulcer healing time
Used before Hydrocolloid Dressing
See Wound Dressing for sample protocol
Belmin (2002) J Am Geriatr Soc 50:269
Disadvantages
No trial data on effectiveness in Pressure Sores
Avoided in light exudate or dry wounds
Risk of dehydrating wound bed and delaying
Wound Healing (risk of scab formation)
Foam Dressing
Technique
Rinse wound residue with each
bandage change
Change dressing daily to every 3 days
Efficacy
Improves Pressure Ulcer healing time
Used before Hydrocolloid Dressing
See Wound Dressing for sample protocol
Belmin (2002) J Am Geriatr Soc 50:269
Foam Dressing
Disadvantages
No trial data on effectiveness in Pressure Sores
Avoided in light exudate or dry wounds
Risk of dehydrating wound bed and delaying
Wound Healing (risk of scab formation)
Advantages
Conformable
Can be used for absorption or wound insulation
Minimize maceration of peri-wound edges (can
be used in areas of fragile skin)
Can be used under compression (e.g.
Unna Boot)
Hydrogel Dressing
Characteristics
Absorptive
Adhesive or non-adhesive
Moisture retentive
Indications
Light to moderately exudative wounds
Autolytic Debridement
Thin, stringy yellow eschar
Dry necrotic eschar
Infected wound (amorphous hydrogels such as Intrasite)
Monitor wound daily if infected
Filler for deep or extensive wounds
Carrier for topical medications
Type 2 to 4 Pressure Sores
Hydrogel Dressing
Technique
Change dressing every 5 to 7 days
Apply gel
Tongue blade
Syringe (20 to 50 cc) filled with gel
Secure
Transparent Film Dressing (e.g. Tegaderm)
Paper tape
Hydrogel Dressing
Advantages
Conformable
Fills ulcer cavity to maintain moist healing environ
Cooling, soothing sensation and analgesia
Assists Autolytic Debridement
Disadvantages
Requires moderate level of care
Maceration of peri-wound edges
Requires fixatives and dressings to hold in place
Avoided in wounds with heavy exudate
No trial data supporting use
Secondary hypergranulation tissue may delay healing
Leafy, friable beefy red tissue
Remove with silver nitrate or Sharp Debridement
Relative
Infected Wounds (especially anaerobic)
Wounds with excessive exudate
Unless combined with foam, gauze, or hydrogel
Technique
Change dressing every 3 to 7 days
Check dressing daily (transparent)
Consider protecting skin edge from maceration
Stomal adhesive wafer
Vaseline
Zinc oxide
Advantages
Transparent Film
Dressing
Disadvantages
Expensive
Maceration of peri-wound edges (wound border must be intact)
Too frequent dressing changes may strip skin
No absorptive capacity (can only use in non-exudative wounds)
Difficult to apply
No data showing efficacy in Pressure Ulcers
Contraindicated in infected wounds
Separates from skin in high friction areas
IMPREGNATED GAUZE
Types: Hypertonic Saline Gauze
(Mesalt)
Indicated for exudate absorption for
cleaning wounds
Change gauze daily
May result in some tissue destruction
Switch to Hydrogel Dressing once
exudate reduced
IMPREGNATED GAUZE
Types: Iodoform Gauze (Iodine
impregnated gauze)
Indicated for tunneling wound with foul
discharge
Change gauze daily
May cause tissue destruction (limit to
<5 days)
Switch to less toxic alternative once
discharge reduced
IMPREGNATED GAUZE
Types: Vaseline Gauze (Petrolatum
impregnated gauze)
Indicated for wound protection and
wound hydration
Change every 2 to 4 days
Particularly effective in extremity skin
tears
Apply vaseline gauze to affected area
Secure gauze with Kerlix wrapped around
extremity
Technique
Disadvantages
Requires more intense wound care (due to repeated
moistening, reapplication)
Consider Hydrocolloid Dressing as simpler alternative