As wound care professionals, wound care dressings are an important tool.
Keeping up to date on the types of wound care dressings available to treat patients in our care is our duty.
Wound care dressings come in various shapes, sizes and have indications for their use.
Professionals who treat wounds must remain aware of the types of wound care dressings they can use, as well as their contraindications. Here’s a list.
Transparent Film Dressings
Transparent wound care dressings are thin, transparent sheets of polyurethane coated with an adhesive and are available in a variety of shapes and sizes. They are semi-permeable, allowing the one-way passage of oxygen and moisture vapor, but are waterproof and impermeable to bacteria.
They act to provide a moist wound healing environment, promote autolysis, and protect wounds from mechanical trauma and bacterial invasion. They allow visualization of the wound bed and can be used as a blister roof.
When to use them
- Partial-thickness wounds with no or minimal drainage
- Non-infected wounds
- Full-thickness wounds covered with dry, necrotic tissue
- Primary or secondary dressing
- To protect from shear and friction over bony prominences
- To protect intact blisters
- Secure tubing and intravenous devices
Contraindications of transparent dressings include full-thickness burns, fragile peri wound skin or thin skin, and moderate to heavy exudate. Do not use on wounds with known or suspected infection, fungal infection, or active herpetic lesions.
Advantages of transparent wound care dressings include that they allow for visualization of the wound bed. They also provide a bacterial barrier, are water-resistant, provide a moist environment, and promote selective debridement via autolysis.
Disadvantages of transparent dressings that they are non-absorptive and they do not adhere well in moist areas. The adhesive may cause stripping of surrounding skin and the dressing may dislodge in high-friction areas.
Reminders:
- You need about a 2-inch border of intact skin.
- Skin must be clean and dry, and some manufacturers recommend defatting skin with alcohol and then using a sealant before application.
- Apply without tension or stretching.
- Buildup of exudate is indicative of autolytic debridement and is a normal occurrence.
Hydrocolloids
Hydrocolloid wound care dressings are wafer dressings containing gel-forming agents in an adhesive compound laminated onto a flexible water-resistant outer layer. Moisture from the wound causes the wafer to form a gel over the wound. Available in various sizes, shapes, thickness, and absorption capabilities. There are precut shapes for areas like the sacrum, elbows, and heels.
Hydrocolloid dressings are occlusive wafer dressings that cover the wound and prevent oxygen, bacteria, or fluids from passing through the dressing. They promote a moist wound environment and autolytic debridement and provide an insulating effect. The thin hydrocolloids are considered to be semi-permeable.
Use hydrocolloid dressings on intact skin or newly healed wounds as prevention. They also can be used on non-infected wounds with scant to moderate drainage, partial or full thickness wounds, dry or moist wound beds, and as secondary dressing over filler materials.
Contraindications of hydrocolloid dressings include full thickness burns; wounds with heavy drainage; fragile peri-wound skin; infected wounds; exposed tendon or bone; fungal or herpetic lesions; and wounds with deep tunnels, tracts and undermining.
The advantages of hydrocolloid dressings are that they are adhesive and moldable, reduce pain, provide moisture barrier, provide moist wound healing, autolytic debridement, and are easy to apply. They are effective at promoting granulation and epithelialization. Good bacterial and environmental barrier.
The disadvantages of hydrocolloid dressings are that the dressing may dislodge with shearing, friction, or due to heavy drainage. Also, they are not recommended for infected wounds. There may be an odor when removed, and they may injure fragile skin.
Reminders for using hydrocolloid wound care dressings:
- Change every 3-7 days as needed.
- Apply wafer 1-2 inches larger than wound.
- Monitor for peri-wound maceration.
- Upon removal, dressing residue may be noted on wound. (It is not necessary to remove residual.)
- Distinct odor may be noted upon dressing removal. Clean wound before assessment.
- Use extreme caution if used on diabetic feet.
- May secure edges with tape, if necessary.
- Daily dressing changes are not appropriate.
- Warm hydrocolloid sheets (e.g. between the hands) prior to application as this aids with effective adhesion and makes the dressing more pliable.
Foam Dressings
Foam wound care dressings are composed of polymers that contain small open cells capable of pulling fluids away from the wound and holding them. They are semi-permeable with a non-adherent or semi-adherent contact layer and hydrophobic or waterproof outer layer. These dressings come in various shapes and sizes.
Foam dressings provide moist wound environment and thermal insulation, are non-adherent, absorptive capabilities vary depending on type and manufacturer, and can be used for reduction of hyper-granulation tissue. Impermeable to bacteria and other contaminants.
Use foam dressings on partial or full thickness wounds; minimal to heavy exudative wounds (varies by manufacturer); red, granular wounds; softened necrotic tissue; partial or full thickness wounds; and shallow draining wounds. You can also use foam dressings to fill dead space (cavity dressing) or under compression.
Contraindications of foam wound care dressings include dry wounds, third degree or full thickness burns, and sinus tracts.
The advantages of foam dressings include that they provide moist wound healing and thermal insulation, and they come in a variety of shapes and sizes.
The disadvantages include that the dressing is expensive if a daily dressing is required, and the wound may desiccate if there is no exudate from the wound.
Reminders:
- Dressing should be 1-2 inches larger than wound.
- Change every 3-7 days or as necessary.
- May require a secondary or cover dressing to hold in place.
Alginates
Alginates are made of highly absorbent, non-woven fibers made from brown seaweed available as ropes, ribbons, or pads. The high absorption is achieved via strong hydrophilic gel formation which limits wound secretion and minimizes bacterial contamination.
Alginates form a gel in the wound base when they come in contact with exudate and can absorb up to 20x their weight in fluid. They promote moist wound healing, autolytic debridement and can promote coagulation and assist with hemostasis.
Use alginates on partial thickness and full thickness wounds with moderate to heavy exudates and bleeding wounds.
Contraindications of alginates include third degree/full thickness burns, eschar covered wound, and minimal exudate or dry wounds,
The advantages of alginates include they are moldable, absorbent, and non-adhesive. They provide a moist wound healing environment and absorb excessive drainage.
The disadvantages of alginates include if the wound bed is dry the dressing will not form gel and may adhere to tissue, causing trauma. They can dehydrate a wound.
Reminders:
- Irrigate wound with normal saline or pH balanced surfactant cleanser between dressing changes.
- Utilize in moderate to heavily draining wounds, not for use in a dry wound.
- Do not moisten before use or use with hydrogels.
- Be careful not to overpack which can delay healing.
- Cover with secondary dressing.
- Change as needed, usually 1-3 days depending upon drainage.
It is inappropriate to moisten this product before using or to use with hydrogel.
Hydrogel Dressings
Hydrogels are three-dimensional networks of hydrophilic polymers containing varying percentages of water, that bind great volumes of liquid due to the presence of hydrophilic residues. Hydrophilic properties enable them to absorb excess exudate while producing a moist wound environment.
Formulations may vary, but hydrogels are often either glycerin based or contain 90% water in a gel base. They are available in sheets, gel, sprays, impregnated gauze, or packing strips.
Hydrogels provide for moist wound healing, autolytic debridement and are able to absorb a minimal amount of fluid. They also add moisture to the wound bed, are non-adherent and assist with pain relief when applied cold.
Hydrogels can be used on partial and full thickness wounds that are dry or moist, on granulating wounds, abrasions, partial thickness burns, skin reactions to radiation, necrotic wounds and wounds covered with eschar.
Contraindications include full thickness burns and moderate to highly draining wounds.
The advantages to using hydrogels include that they are cooling and soothing and may be used on infected wounds. Hydrogels provide hydration of eschar and nonviable tissue to promote debridement. They also facilitate wound repair and epithelialization.
Disadvantages include that gel sheets must be cut to exact size of wound to prevent maceration of surrounding tissue. Hydrogels also require a secondary dressing cover and the gel can dehydrate if it’s not covered.
Reminders:
- Care must be taken to avoid macerating surrounding skin.
- Utilize for light to moderate absorption.
- Clean wound between dressing changes with normal saline or per manufacturers recommendations.
- Dressing changes every 1-4 days as needed.
- For radiation burns, dressing may be stored in refrigerator and applied to wound cold to provide soothing and pain reduction.
Collagen Dressings
Collagen wound care dressings are freeze-dried sheets of collagen, particles, pastes, or gels that are usually derived from cow hides. They encourage the deposition and organization of newly formed collagen fibers and granulation tissue in the wound bed.
Use collagen dressings as the primary dressing for chronic non-healing wounds, partial and full thickness wounds, granulating or necrotic wounds, infected and non-infected wounds, tunneling wounds, and wounds with minimal to heavy exudate.
The advantages of collagen dressings include that they are absorbent, non-adherent, conform well to wounds, maintain moist wound environment, and are easy to use.
The disadvantages include they are not recommended for wounds with heavy eschar, require secondary dressing, and are contraindicated for third degree burns and sensitivity to bovine (cattle) products.
Examples of collagen dressings include Fibracol, BGC Matrix, CellerateRX, Stimulen, and Promogran Matrix.
Reminders:
- Frequency of change will vary according to product used and exudate level of the wound.
- Follow manufacturer’s guidelines
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