Wound Dressings – Types, Management,

Wound Dressings is a post surgical cleaning, progress technique of wound to heal up quickly and regular checkup the surgical parts or remove parts of the body in where the wound is present. The wound is a discontinuity of the epithelial lining of the skin or mucosa due to physical or thermal damage, fracture, surgical incisions and they can be present over different anatomical parts of the body. However, the basic principles of choosing a wound dressing remain the same in every country of the world. In the United States, acute and chronic wounds affect more than six million people, and this will grow in numbers due to our elderly and diabetic populations. Choosing the correct dressing system and taking care will lessen the time of healing, provide cost-effective care, and improve the patient’s quality of life.

The goal is to help the wound heal as soon as possible by using an appropriate dressing material, technique, procedure to maintain the right amount of moisture. When the wound bed is dry, or semi-dry use a dressing to increase moisture, and if too wet and the surrounding skin is macerated, use material that will absorb excess fluid and protect the surrounding healthy skin.

The most important system to consider before choosing a specific wound dressing are cleaning, absorbing, regulating, and the need to add specific medication. It is important to choose a dressing guided by the cost, ease of application, time-consuming, and clinician’s preference.

Wound Assessment

The initial assessment should begin with the following:

  • How: How was the fracture created, and, if chronic, why is it still open? (underlying etiology)
  • Where: Where on the body parts is it located? Is it in an area that is difficult to offload, complicated, or keep clean? Is it in an area of high skin tension? Is it near any vital organ and structures such as a major artery?
  • When: How long has this wound been present? (e.g., chronic less than 1 month or acute, more than 6 months)
  • What: What anatomy and structure does it involve? (e.g., epidermis, dermis, subcutaneous tissue, fascia, muscle, tendon, bone, arteries, nerves)
  • What: What comorbidities, economic or social factors does the patient have which might affect their ability to heal the wound?
  • Is it life-threatening? or not
  • Identify the location of the wound
  • Determine the cause of the wound and fracture
  • Determine the stage of the wound and fracture
  • Superficial tissue, skin involving or not only the epidermal layer or Partial-thickness affects the epidermis and extend into the dermis
  • Full-thickness extends through the dermis and into the adipose tissues or Full-thickness extends through the dermis, and adipose exposes muscle or bone
  • Evaluate and measure the depth, length, and width of the wound
  • Assess for presents of puss, type, and amount of exudate, Serous, serosanguineous, sanguineous, or purulent, Minimal, light, moderate, or heavy
  • Access surrounding skin tissue, Assess wound margins for tunneling, rolled, undermining, fibrotic changes, and if unattached and evaluate for signs and symptoms of infect warm, pain, odor, delayed healing, pain

While there are many excellent biologics systems, skin grafts, and other options available, without the appropriate system of the nature of the wound, the chances of healing declined significantly.

Wound Treatment

  • If too dry, use a hydrogel to hydrate the tissue. Dry eschar may also benefit from enzymatic debridement ointments such as collagenase.
  • If the wound has a minimal drainage system, a hydrocolloid will keep it just right.
  • If there is heavy drainage, absorb the excess amount of fluid using material like alginate, hydrofibers, cellulose, foam, ceramic fiber, or negative pressure wound therapy.
  • If the surrounding skin shows maceration, use zinc oxide, protective films, or a negative pressure wound therapy regularly.
  • If the wound is infected and more time takes to heal and there is a lot of sloughs, which cannot be mechanically debrided, then a chemical debridement can be done with collagenase-based products.
  • If the bioburden type wound needs to be controlled, a silver-based or iodine-based product should be used.
  • If the wound has an excessive odor, topical metronidazole or activated-charcoal dressing material will help.
  • If the wound has healthy granulation tissue and needs to have faster healing and epithelialization, hydrocolloid, foams, collagen, or silver collagen will help to wound healing.
  • If the wound is superficial, occlusive semiocclusive dressings help to heal the wound. Polymeric membrane dressings also are good to treat superficial abrasions wounds.

Management

After following the principles of wound debridement, the wound should be irrigated and itching with a neutral solution like normal saline to wash off any debris. Never use toxic or irritating solutions like hydrogen peroxide which are detrimental to wound healing.

Next chose a dressing material that is easy to replace, soft stays in place with appropriate anchoring, and does not cause harm to the wound bed or normal surrounding skin by shearing force or sticking to the skin. Patients can develop complications like contact or allergic reactions.

The ideal dressing should keep the wound moist but not macerated, limit bacterial overgrowth, keep odor to a minimum position, and be a comfortable dress to wear. Frequent inspection of the wound is necessary to optimize wound dressing selection.

Today there are many types of dressings and even techniques to manage wounds. For the most part, the majority of wounds that require special dressings are chronic wounds or surgical wounds and more.

The overall objective of a wound dressing include the following

  • Decrease the pain
  • Apply compression for hemostasis
  • Protect the wound from the environment
  • Protect the wound from soiling with body fluids or waste
  • Immobilize the injured body part
  • Promote wound healing

Before applying any type of wound dressing, it is important to assess the following

  • Mechanism of injury
  • Risk of contamination
  • Injury to deeper structures
  • Underlying nerve or tissue damage
  • Any perfusion deficits
  • Tetanus status
  • Disability
  • Amount of tissue loss

When there is a nonhealing or chronic wound or a wound caused by trauma, it is important to get an x-ray to ensure that there is no fracture or a foreign body left in the tissues. If the x-rays do not reveal a foreign body, then ultrasound is a useful technique to identify radiolucent foreign bodies like splinters or thorns.

Indications of wound

  • pyodermas, including cellulitis,
  • impetigo,
  • erysipelas,
  • folliculitis,
  • ecthyma gangrenosum,
  • hidradenitis,
  • bite wounds,
  • rabies, tetanus, dermatophytes, toxic shock, unusual skin infections (Orf, trichomycosis),
  • waterborne bacteria, flesh-eating, sporotrichosis.
  • The management of chronic, suturing, instruments, local anesthesia. Basic Wound
  • Care instructions
  • Laceration Irrigation
  • Wound Healing Pearls
  • Dermabond
  • Bite & Puncture Wounds Rabies
  • Skin Infections (Pyoderma) Tetanus
  •  Skin Ulcers
  • Debridement Wound
  • Chronic & Complicated Wounds
  • Chronic Wounds: Maggots rafts, Flaps, microsurgery
  • Wound Dressings Wound Healing
  • Debridement Off-Loading
  • Diabetic Foot Ulcers & Infections  Exudate Management.

Currently Available Dressing Options

  • The semipermeable dressing – It is best for wound dressing that allows for moisture to evaporate and also reduces pain. This dressing also helps as a barrier to prevent environmental infection. The semipermeable dressing does not absorb moisture and requires regular inspection. It also requires a secondary dressing material to hold the semipermeable dressing in a place.
  • Tulle – It is a non-adherent dressing comprised of paraffin. It aids to help to heal but doesn‘t absorb exudate. It requires a secondary dressing to hold it in place. It is good for burns as one can add topical, accidental dressing antibiotics to the dressing. It is known to cause allergies, itching, and skin irritation and this limits its wider use.
  • Plastic film dressings – It is most commonly known to absorb exudate and can be used for wounds with a moderate amount of exudate. They should not be used on dry wounds. They require a secondary dressing to hold the plastic in place.
  • Fixation sheets – It can conform to body contour and provide pain relief quickly and also allow exudate to escape easily. These sheet dressings do need oil application before removal and can be used to manage low-intensity wounds that are not needed for regular check-ups. They should not be applied directly to infected wounds.
  • Calcium alginate dressings – They keep the wound moist, help to reduce pain, and can be used to pack cavities. They also provide hemostasis, hematoma and can absorb excess exudate quickly. They should not be used in the presence of an infection or on dry wounds. Often another dressing is required to hold the alginate in place.
  • Foam dressings –  It helps to keep the wound moist, can absorb fluid, and can also protect the wound. They can be used on wounds with a moderate amount of exudate and should be avoided on dry wounds. They can be painful to remove if they dry out.
  • Hydrocolloid dressings – retain moisture and are painless to remove. They are ideal for small abrasions and not to be used on dry or infected wounds.
  • Paper adhesive tape –  It is useful for just approximating wound edges, laceration and is ideal for small wounds. The tape is not useful on wounds with large exudates.

Wound dressings should provide the most optimum conditions for wound healing while protecting the wound from infection with microorganisms and further trauma. It is important that the dressings be removed atraumatically, to avoid further damage to the wound surface during dressing changes.

Certain special wounds will need more specialized wound dressings, for example, skin substitutes, biological skin products, and other complex wound dressing products. Compression therapy is needed for venous leg ulcers.

References