Dressings

Benefits of dressings:

-        Occlusion. Moist, warm environment is better for healing than open wounds.

-        Maintaining correct fluid balance – either dealing with exudates, or adding hydration to wound.

-        Debriding unwanted slough or necrotic tissue.

-        Protection – from water or other contamination.

-        Haemostasis – either compression or direct contact.

-        Antimicrobial activity.

Dressing type	Advantages	Disadvantages	Examples	Typical usage
Gauze	Mechanical debridement Good for filling dead space Cheap Absorptive	Sometimes painful to remove Can peel off granulation tissue on removal Requires daily dressing changes Permeable to fluid and bacteria	Gauze Saline-soaked gauze (absorbs blood, gently debrides) Betadine-soaked gauze (for grossly infected wounds)	Early post-op open wounds Infected wounds
Films	Semipermeable Retains moisture Waterproof Allows wound visualisation	Can tear skin Reactions common with repeated usage Not good for infected wounds	Tegaderm Opsite	Closed clean wounds
Hydrocolloid	Protects – impermeable to bacteria Waterproof/resistant	Not very absorptive – not good with exudates Not good on infected wounds Gets ratty after a week or so	Duoderm Comfeel	Laparotomy wounds post-op Low-exudative pressure ulcers
Foam	Highly absorptive Non-adherent Conformable Good under a compression dressing	Will macerate wound edges if it stays on long enough to become soaked	Allevyn Mepilex foam Mepilex border – minimally adherent and absorbent	Under pressure dressings Dead space Highly exudative wounds
Alginate	Highly absorptive Some haemostatic properties Fills dead space	Falls apart in the wound – annoying fibres, hard to remove later, sometimes unclear if whole dressing has been removed Useless in dry wounds Can dehydrate wound bed Dries rock hard in 48 hours.	Kaltostat Algisite Aquacel (similar use, but not really alginate)	Initial dressing in slowly oozing operative open wounds Chronic highly exudative wounds
VAC (vacuum assisted closure)	Reduces number of dressing changes required Easier to tailor to wound Controls exudate well Moist and warm environment, ideal for healing	Have to carry pump Expensive (although mostly compensated by less dressing changes)	VAC SNAP PREVENA PICO	Acute or chronic open wounds with good arterial supply and no infection.
Hydrogels	Rehydrate wound Can fill dead space	Can cause periwound maceration Minimal absorption	Solosite Prontosan (removes slough and biofilm – chemical debridement) Sorbact gel
Antimicrobial dressings	Some antibacterial activity	Doesn’t make much difference Expensive	Aquacel Ag Mepilex Ag Acticoat (very expensive!!!) Allevyn Ag Sorbact	Can be useful in wounds with suspected chronic low-grade infection Generally over-used, apart from Sorbact, which is fairly cheap and good for diabetic ulcers.
Non-adherent	Less pain to remove and won’t peel off grafts/granulation tissue	Usually doesn’t do much else to the wound other than not stick to it	Mepitel – can be left on for 1+ weeks Adaptic Jelonet (paraffin gauze) – non-adherent for 2-3 days at most	Burns Large areas of early granulation tissue Desquamation After skin grafts