Wound Dressings

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Cleansers

Saline Cleanser

Normal Saline

Normal saline is an appropriate cleansing solution. There are many other cleansing solutions on the market and all are excellent aids in cleansing away loose debris. Cleansers do not work as debriding agents.


Gauzes

Nonwoven Gauze

Nonwoven gauze (pictured above) is nonabsorptive so they aid in keeping the wound bed moist. They are also helpful when keeping a wound bed dry and they have a low adherence.

Woven Gauze

Woven Gauze (pictured above) has interstitial elements or small gaps between the threads allowing for absorption and sticking to the wound bed. This gauze is most commonly used for wet to dry dressings.

Kerlix Gauze

Kerlix Gauze (pictured above) is most commonly used to wrap extremity wounds to hold the primary and secondary dressing in place. They should not be wrapped too tightly in arterial ulcer patients as they can cause arterial obstruction and further wound development.


Hydrogels

Hydrogel gauze in sheet form

Hydrogel Impregnated Gauze

Hydrogel Gauze (Pictured above). Hydrogels can be used on many types of wounds. They can debride wounds by activating autolytic debridement; therefore, hydrogels can be used on wounds with slough and necrosis. They are most commonly used for granulating wounds. They give the wound a moist healing environment. They are not recommended for wounds with heavy drainage as they are not highly absorbent, and they are not recommended on dry stable eschars of the lower extremity as they will cause them to open.

Liquid Hydrogel

Hydrogel in liquid form can be added to a wound base followed by a secondary dressing on top. Hydrogels can be used on many types of wounds. They can debride wounds by activating autolytic debridement; therefore, hydrogels can be used on wounds with slough and necrosis. They are most commonly used for granulating wounds. They give the wound a moist healing environment. They are not recommended for wounds with heavy drainage as they are not highly absorbent, and they are not recommended on dry stable eschars of the lower extremity as they will cause them to open.


Hydrocolloids

Duoderm Hydrocolloid dressing

Duoderm (pictured above), perform autolytic debridement and are also protective of the skin. If applying to healthy skin, one must be careful as this can cause moisture related damage to the skin. Hydrocolloids are occlusive and adhesive wafer dressings, which combine absorbent colloidal materials with adhesive elastomers to manage light to moderate amounts of wound exudate. Most hydrocolloids react with wound exudate to form a gel-like covering, which protects the wound bed and maintains a moist wound environment. Hydrocolloid powders and pastes are also available with increased absorptive capacity.  Duoderm is considered a hydrocolloid.


Enzymatic Debriding Agents

Santyl Dressing Ointment

Santyl (pictured above) is an enzymatic debriding agent composed of collagenase. Santyl is most commonly used on wounds with devitalized tissue. Santyl is not harmful to granulating tissue.


Collagens

Collagen Dressing

Puracol Dressing

Colactive Dressing

Collagen Dressings (pictured above) come in many forms including sheet form, foam form, powder, and liquid. There are multiple manufacturers. Collagen is believed to play an important role in Matrix Metalloproteinase (MMP) activity in wounds. MMPs are highly active in chronic wounds and degrade the body's natural collagen. Collagen dressings; however, attract the MMPs in the wound, allowing the body's own collagen to act without interference. Collagen dressings also lay down a scaffolding to allow healthy epithelial cells to move across the wound and lay down epithelium.


Honey Dressings

Honey Dressing

Honey dressings can come in both liquid and gauze forms. Honey dressings are generally produced from Manuka Honey derived from the Leptospermum scoparium species of plant in New Zealand. Honey products have been used since ancient times for wound healing. Honey has anti-inflammatory, anti-bacterial and anti-oxidant properties. The antibacterial properties are due to acidity, hydrogen peroxide activity, osmotic effects, nutritional content, stimulation of immunity and unidentified compounds. Honey used for medicinal purposes is sterilized by gamma radiation. Many of the actions of honey are due to its high sugar content; honey is also used for wound deodorization. The anti-inflammatory properties allow reduction in tissue swelling and exudates. Flavenoids, monophenolics, polyphenolics, and vitamin C are responsible for the anti-oxidant activity of honey (5). Although honey contains many properties that would theoretically assist in wound healing, further research is needed to demonstrate clinical effectiveness (6).


foams

Nonbordered Foam Dressing

Bordered Foam Dressing

Polyurethane foam (pictured above) has a hydrophilic inner core and a hydrophobic outer core. As pictured above they can be non-bordered or bordered. At the present time foams are being used a secondary dressing, but they may play a role in providing a primary dressing role contacting the wound directly. These are absorbent dressings, where the outer surface is bonded to a vapor-permeable polyurethane membrane a barrier to liquid and microorganisms. Foams can be composed of various materials to control sticking to the wounds surface, adhesion, and absorption.


calcium alginates

Calcium Alginate Rope

Calcium Alginate rope (shown above) is excellent for packing wounds with moderate to heavy drainage. Calcium alginates are an excellent dressing for draining wounds as they are highly absorptive. When packing wounds with rope make sure to have a portion extend from the wound to identify during removal.

Calcium Alginate nonwoven rope

Calcium Alginate Sheet form

Calcium Alginate in sheet or gauze form as pictured above can be used on wounds that do not need packing into tunnelled areas. Calcium alginates are excellent for absorption of moderate to heavy drainage in wounds. Calcium alginate dressings are derived from seaweed, and they have a hydrophilic nature which attracts water. As these dressing attract drainage from the wound, they form gelatinous type material. Once in contact with an exuding wound, an ion-exchange reaction takes place between the calcium ions in the dressing and sodium ions in serum or wound fluid. When a significant proportion of the calcium ions on the fibre have been replaced by sodium, the fibre swells and partially dissolves forming a gel-like mass. If Calcium Alginate dressings are lost in the wound, they are biodegradable, but they should be found. Sometimes individuals will mistake the drainage captured in these materials as infection but may not be.


Silver Impregnated Products

Calcium Alginate with Silver

Pictured above is silver impregnated Calcium Alginate rope dressing. Silver has been used since ancient times for its anti-microbial properties. Silver dressings have definitively not shown to be effective in preventing infection over non-silver impregnated dressings. These dressings are most commonly used in infected wounds.


Other Dressings

Allevyn Dressing

Calmoseptibe

Xenaderm Dressing

BCT Combinations (Balsam Peru, Castor Oil, and Trypsin)

Granulex Dressing

Granulex (pictured above) is a BCT combination. The Balsam peru is known to increase blood flow to an area, and prevent bacterial growth. Castor oil: prevents skin cells from breaking down, which aids in wound healing. Trypsin helps shed damaged skin cells. Other BCT Combinations include xenaderm which is in ointment form, and Vasolex. In addition Proderm contains Balsam Peru and Castor Oil but not Trypsin. These BCT Combinations can be used to treat dry vascular wounds, Stage 1 ulcers, and Deep Tissue Injury.

Vaseline Impregnated Dressing

Vaseline impregnated gauze (pictured above) is a fine mesh, absorbent gauze impregnated with white petrolatum. This is a non-adherent material; however, it may dessicate or dry out and should not be left on for more than 3 days.

Xeroform dressing

Xeroform pictured above is a  sterile, fine mesh gauze impregnated with a blend of 3% Bismuth Tribromophenate (Xeroform) and USP Petrolatum. It is non-adherent to the wound, and it helps maintain a moist wound environment. The Bismuth Tribromophenate (Xeroform) provides  a deodorizing action. This is a primary dressing that is most commonly used in the setting of skin grafts, donor sites, and burn settings.


References

  1. National Pressure Ulcer Advisory Panel, Support Surface Standards Initiative Terms and Definitions. Ver. 01/29/2007
  2. Ferrel et al. A randomized trial of low-air-loss beds for treatment of pressure ulcers. JAMA.  1993; 269(4):494-7
  3. Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 1962; 193: 293-294.
  4. Jude EB, et al. Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med. 2007 Mar; 24(3):280-8
  5. R. Yaghoobi, A. Kazerouni, O Kazerouni Evidence for Clinical Use of Honey as an Anti-bacterial, Anti-inflammatory, Anti-oxidant, and Antiviral Agent: A Review. Jundishapur Journal of Natural Pharmaceutical Products. 2013 August; 8(3):100-4.
  6. Jull AB1, Walker N, Deshpande S. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2013 Feb 28;2:CD005083. doi: 10.1002/14651858.CD005083.pub3.
  7. Zou SB, et al. Cytotoxicity of silver dressings on diabetic fibroblasts. Int Wound J. 2012 Apr 26.
  8. Gregor S, et al. Negative Pressure Wound Therapy, A Vacuum of Evidence. Arch Surg. 2008;143(2):189-196.
  9. http://www.dressings.org/Dressings/mepilex.html
  10. Murphy, et al. Advances in Wound Healing: A Review of Current Wound Healing Products. Plastic Surgery International Volume 2012 (2012), Article ID 190436, 8 pagesdoi:10.1155/2012/190436.
  11. Leyden J, et al. Comparison of topical antibiotic ointments, a wound protectant, and antiseptics for the treatment of human blister wounds contaminated with Staphylococcus aureus. J Fam Pract. 1987 Jun;24(6):601-4.
  12. Diehr et al. Clinical inquiries. Do topical antibiotics improve wound healing? J Fam Pract. 2007 Feb;56(2):140-4.
  13. Brett, et al. A Review of Collagen and Collagen-based Wound Dressings. Wounds.
  14. Thomas S., Alginate dressings in surgery and wound management--Part 1. J Wound Care. 2000 Feb;9(2):56-60.