The four stages of wound healing and various wound dressings will be defined and summarised. For more details on wound healing please visit http://intranet/tissue/.
If placed directly over the wound surface or on top of adhesive (steri-) strips, prevents traumatic wound adherence by the secondary dressing
Ideal for fingertip wounds
Expensive
Possesses little absorbency
Tip
Wet own fingers in normal saline prior to handling and applying Mepitel. Otherwise, the dressing may stick to protective gloves and cause further wound trauma when attempting to detach dressing from rubber
Kaltostat
Calcium sodium alginate dressing
Protective and interactive
Absorbs exudate/saline and converts to a firm gel/fibre mat
Forms a moist, warm healing environment
Trauma-free removal due to the gel
Can remain in situ for up to seven days
Ideal on actively bleeding wounds, i.e., complete or partial digit loss. Promotes haemostasis through gel formation
Ideal for cavity packing and heavily-exuding wounds, i.e. pressure sores, venous stasis/arterial/diabetic ulcers, donor sites, abrasions, lacerations, superficial burns, post-surgical wounds and other external traumatic wounds
Tip
Not for use on dry wounds, necrotic tissue, third-degree burns or as a surgical swab
Change Kaltostat regularly if infection is present
If the Kaltostat dressing has formed a gel, but has been allowed to dry out, never attempt to pull off. Moisten the dry dressing with normal saline to prevent tissue trauma
Inadine
Topical wound dressing impregnated with an ointment containing 10% Povidone iodine
Provides a prolonged antiseptic effect thereby preventing bacterial, protozoal and fungal infections
Relatively inexpensive
Ideal for the prevention of infection in minor burns, superficial traumatic skin loss injuries and in conjunction with other therapies for ulcerative wounds
Ideal for dog and human bites
Can soften crusts and exudate
Ineffective on deep wounds
Should not be used where there is known hypersensitivity to iodine
Tip
Observe for fading of colour of Inadine. Indicates loss of its antiseptic properties
Inadine can be changed up to two times daily in the event of highly infected/heavily secreting wounds
Jelonet
Paraffin gauze mesh dressing
Ideal for minor burns and wounds with superficial skin loss
Possesses no absorbency capacity
Moist healing environment cannot be maintained without a secondary dressing
Dries out very quickly causing it to stick
Granulating tissue often grows into the mesh. This tissue can be damaged upon dressing removal
Tip
For effective wound healing, apply four layers of Jelonet
Leave in situ for two to three days only
Apply Bactroban (antibacterial ointment) to the surfaces of minor burns first, then the Jelonet. This reduces the risk of Jelonet sticking to the wound and drying out
No adhesive trauma at dressing changes to the delicate skin surrounding wound
Economical in that a large margin of dressing is not required around the wound
Hydrophilic, so wound exudate is drawn into the dressing as is any contaminating bacteria. A gel is then formed through swelling of the Sorbsan fibres
The gel promotes effective gaseous exchange and creates a warm, moist healing environment
The gel can be washed away producing minimal wound trauma and pain free dressing changes
Reduces bacterial count at wound site thereby minimising wound odour
Ideal for deep open wounds, i.e., leg ulcers
Perfect for treating large wound sinuses
Great in tending to abcesses
However,
Not to be used on dry wounds or necrotic tissue
Intrasite
Clear amorphous hydrogel
Promotes natural debridement of wounds by gently rehydrating necrotic tissue
Loosens and absorbs slough and exudate
Creates a moist healing environment
Non adherent therefore does not harm viable tissue or skin surrounding wounds
Ideal for treating shallow and deep open wounds, i.e. pressure sores, leg ulcers, surgical/malignant wounds, partial thickness wounds, scalds, lacerations, grazes and infected wounds
Tip
Necrotic/sloughy wounds - change dressing at least every three days
Clean, granulating ounds - change dressing according to clinical condition of wound and amount of exudate produced
Comfeel Plus Granuflex
Where healing is by granulation, this hydrocolloid dressing is useful
Absorbs a moderate amount of exudate
Creates a moist wound environment through rehydrating necrotic tissue thereby promoting debridement
Stimulates formation of vascular tissue and speeds wound healing
Permits non-traumatic dressing removal without sustaining damage to newly formed tissue
Ideal for pressure ulcers, leg ulcers, minor abrasions and lacerations, 1st & 2nd burns, dermatological excisions, post-operative wounds and donor sites
However
Granuflex has a tendency to lose wound contact if sited over joints or within the sacral cleft. If possible, it should be appropriately supported and observed closely for misplacement. Otherwise damage to new tissue may occur
Through absorption of exudate, a distinctive, yet inoffensive, odour may be produced. Patients should be advised of this to reduce concern
Tip
Be vigilant of the fact that due to the autolytic properties of Granuflex, the wound may appear larger after several dressing changes
Not to be used in the event of known hypersensitivity to the dressing
Leave in situ for a maximum of seven days
Bordered granuflex
This dressing has the same properties as Granuflex
Ideal for dermal ulcers, pressure ulcers, leg ulcers, superficial wounds, second degree burns and donor sites
It is more supportive than Granuflex and more likely to remain in position
Duoderm extra thin
Hydrocolloid dressing which interacts with wound exudate forming a soft mass which is easily removed without causing damage to newly formed tissue
Highly flexible and ideal for awkwardly sited pressure sores
Ideal for managing minor burns, abrasions, lacerations, post-operative wounds, pressure sores (stages I - II) and leg ulcers
Waterproof and bacteria-proof
Tip
Ensure 2cm margin all around the wound
Change dressing in event of leakage or the softened area reaching the dressing edge
Leave in situ for no longer than seven days
Tegaderm
Gas-permeable film, ideal for epithelialising wounds, primary closed wounds and minor burns
Useful in securing central/arterial lines
However
Useless in treating infected and moderate to heavily exuding wounds
Summary of Wound Dressings
Classification
Dressing
Indications
Non-adherent
Mepitel, Telfa
Dry wounds, for protection
Medicated low-adherent
Inadine
Superficial infected wounds
Alginates
Kaltostat
Deep cavity wounds. Heavily exuding wounds
Hydrocolloids
Intrasite gel, Granuflex, Duoderm
Granulating wounds with light to moderate exudate
Gas-permeable
Tegaderm
Epithelialising or Primary closure wounds. Minor burns
Paraffin gauze
Jelonet
Superficial skin loss wounds/burns
Content by Annie E Owen RN, Dr Íomhar O Sullivan, Michaela Arrowsmith RN 11/03/2004. Last review Dr ÍOS 5/04/23.