Page updated 30 April 2007
Guide to Wound Care Preparations
Optimum wound dressings allow:
- A moist environment at the wound-dressing interface
- Non-adherence to the wound surface
- Thermal insulation
- Vapour permeability
- Impermeability to micro-organisms
- Freedom from particulate matter
Points to consider when choosing a wound dressing include:
- Type: passive, interactive,or occlusive
- Accessibility of wound
- Range of size available
- Conformation to the wound
- Acceptibility to the patient
Notes on non/low adherent dressings (e.g. Melolin, N.A. Ultra, Release, Mepitel)
- Most are low adherent rather than non-adherent
- Can be used on their own on dry, lightly exuding wounds
- Do not absorb excessive exudate
- May require a secondary dressing
- Require securing with adhesive tapes, bandages or top dressing
- Some dressing products can stay in place for up to 7 days
Notes on semi-permeable films (e.g. Opsite, Tegaderm)
- Can be used in conjunction with hydrogels to rehydrate eschar
- Suitable for shallow wounds
- Films have no absorbent properties
- May cause adhesive trauma on fragile skin when removed
- Some dressing products can stay in place for up to seven days
- Valuable for covering intravenous line inserion sites
Notes on barrier film (e.g. Cavilon)
- A no sting protective transparent barrier film
- Indicated as a protective interface between the skin and bodily wastes, fluids and adhesive dressings and tapes
- Provides pain free protection on broken skin
- Is non cytotoxic and will not interfere with wound healing
Notes on hydrogels (e.g. Nu-Gel, Ultrasite)
- High water content transmits moisture vapour and oxygen
- Donate water molecules to the wound surface - rehydrate non-viable tissue
- Do not damage underlying fibroblasts
- Absorb excess amounts of exudate
- Maintains a moist wound environment
- Indicated for use in sloughy and necrotic wounds
- Debrides the wound by rehydration and promoting autolysis
- Can be used at all stages of wound healing
- Easy to remove and atraumatic for the patient
- Cover with non-adherent/occlusive dressing
Notes on hydrocolloids (e.g. Granuflex, Duoderm)
- Consists of a self adhesive base which forms a gel on contact with exudate
- Allow gaseous exchange to take place at the wound surface
- Absorb light to moderate exudate
- Can be used on dry, necrotic or granulating wounds
- Enhance the growth of new blood vessels
- Require infrequent dressing changes
- Although bacteria grow nwithin the colloid, this is not a disadvantage
Notes on alginates (e.g. Kaltostat, Sorbsan)
- Main role is to absorb exudate so they should not be moistened before application to the wound
- Greatest use in heavily exuding wounds, even when infection is present
- Do not damage underlying fibroblasts
- Require a secondary dressing
- Possess haemostatic properties
- Can be left in place for 3-5 days, depending on the amount of exudate
- Available as a wound or cavity dressing
Notes on sugar paste
- Applicable for deep infected wounds
- Bactericidal due to osmotic effect
- Consistency can be tailored to the size of a wound
- Does not damage underlying tissue healing
- Held in pace with a secondary superficial dressing
Notes on hydrofibre dressings (e.g. Aquacel)
- Consist of a soft non-woven fibre of sodium carboxymethylcellulose
- Directly absorbs fluid into the fibres which increase the fluid handling capacity of the dressing
- On absorption of fluid the dressing forms a soft cohesive mass of gel which can be removed in one piece from the wound bed
- Minimises excoriation and maceration of the skin at the edges of heavily exuding wounds
- Promotes moist wound healing
- Can be used under compression bandaging or hosiery
Notes on enzymatic dressings (e.g. Varidase)
- Used for cleaning/debriding necrotic wounds
- Requires changing at least once daily
- Expensive
- Short shelf life
- Must be kept in a refrigerator
- May be covered by a film dressing
- Rarely indicated
Notes on iodine based polysaccharide bead dressings (e.g. Iodosorb, Iodoflex)
- Absorb exudate
- Can be used on sloughy wounds
- Indicated for use in infected wounds and for medium to heavily exuding wounds
- Rapidly inactivated in presence of pus
- Dressing changes colour when it requires removal
- Contra-indicated for use in patients with thyroid disorders
Notes on paraffin gauze / tulle gras (non-medicated) (e.g. Jolonet, Paratulle, Paranet)
- Requires frequent changing to avoid drying out
- Can adhere to granulation tissue, so should be applied in three layers
- May cause trauma to the wound bed when removed
- Requires a secondary dressing
- Only recommended for use on clean superficial wounds
Notes on deodorising dressings (e.g. Actisorb Silver 220)
- Indicated for use on malodorous, infected wounds
- Can be used on infected wounds
- Can be applied directly to the wound surface
- May be used over a non/low adherent dressing if adherence to the wound bed occurs
- Absorbs bacteria, eliminates offensive odour and reduces excessive exudate
Notes on topical antibiotics (e.g. Metronidazole gel)
- Can be used on malodorous or fungating wounds
- Requires frequent application
- Requires a secondary dressing
- Consider the use of systemic metronidazole
Notes on foam dressing / hydropolymers (e.g. Lyofoam, Tielle Lite Classic or Plus)
- Provides a moist healing environment
- Suitable for exuding wounds of medium to high exudate
- Can be left in place for 4-7 days depending on the amount of wound exudate
- Use water or saline to aid removal
- Lyofoam has been proven to be effective in treating overgranulation tissue (Harris and Roistad, 1992)
- Shaped dressings are available
- Does not require a secondary dressing
Notes on Cavi-Care (silastic foam)
- A two component dressing in which the base and catalyst are mixed together immediately prior to use
- Used for deep, clean wounds but not contra-indicated on dirty wounds
- Must not be used on narrow sinuses as the stent cannot be removed
- Remove and clean regularly depending on the level of exudate. On removal the dressing should be washed with tap water and soaked in 0.5% Chlorhexidine solution. This is rinsed off with water or saline (Williams, 1995)
Notes on vaccum assisted closure (Vac therapy)
- VAC is a therapy that applies a universal negative force to a wound drawing the edges together and assisting closure
- Works by positioning a special foam dressing in the wound cavity under a vacuum
- Helps to remove fluids from the wound and increases localised blood flow. Reduces localised oedema
- Enhances epithelial migration
- Reduces bacterial colonisation
- Promotes granulation tissue
- Promotes moist wound healing
- Cost effective
- Has a positive effect on patient quality of life
- No controlled trials of use
Notes on topical antibiotics and antiseptics
Antiseptics (e.g. Chlorhexidine, povidone iodine, Inadine)
Antibiotics (e.g. Metronidazole gel, silver sulphadiazine cream (Flamazine), mupirocin (Bactroban), fusidic acid (Fucidin)
- Recommended in only a few circumstances e.g. MRSA, infected wounds and burns
- Rarely indicated in hospital practice
- Select for resistance
- Antiseptics have been shown to damage healthy tissue and may not reduce bacteria to safe levels
- Many antiseptics are deactivated by organic material (e.g.) slough
- Sensitivity reactions can often occur with repeated use
Notes on growth factors (e.g. Regranex)
- Promotes recruitment and proliferation of the cells involved in wound repair
- Enhances the formulation of granulation tissue
- Used for full thickness, neuropathic, chronic, diabetic ulcers
- Requires changing daily
- Not suitable for individuals below 18 years old
- Expensive
Notes on silicone dressings (e.g. Cica-Care, Mepiform)
- Promotes hydration of the scar
- Used to reduce hypertrophic and keloid scarring
- Used to flatten scar tissue, increase elasticity and reduce discolouration
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