How to select the appropriate wound dressing?

Wound dressings are an indispensable and crucial aspect of wound management. With the constant innovation in wound dressings, their variety has become extensive, making it challenging for healthcare providers to select the appropriate dressing.

This article will combine clinical cases to share information on the main components, mechanisms of action, as well as their applicable range, advantages, and disadvantages of commonly used dressings.

Main components: Cotton or synthetic fibers such as gauze, cotton pads, and bandages. They are categorized into coarse-mesh and fine-mesh gauze.

Mechanism of action: These dressings do not have a significant effect on wound healing, so it is also called inert dressing.

Applicable range:

1.   Used for various types of wounds and are often used as the outermost layer of dressings.

2.   Dry gauze can be directly applied to protect the wound, while saline-soaked gauze helps maintain a moist environment for the wound.

3.   Used in combination with drugs to effectively deliver drugs to the wound.

Advantages:

1.   Provide wound protection

2.   Can absorb small amounts of exudate

3.   Easily obtainable, cost-effective

4.   Physical debridement can be used to effectively remove necrotic tissue

Disadvantages:

1.   Dry healing, which leads to quick drying and scab formation, hindering epithelial tissue growth and prolonging the wound healing process.

2.   Require secondary fixation and can cause re-injury during dressing changes, affecting limb function and aesthetics.

3.   The granulation on the wound surface is easy to grow into the mesh of the dressing, and the pathogen can easily pass through the gauze mesh.

Case study: Sterile gauze for postoperative incision of huge abdominal scar



2. Hydrogel Dressing

Main Components: Hydrogel dressings are primarily composed of pure water (70% to 90%), carboxymethyl cellulose, and other supplementary ingredients.

Mechanism of Action: In a moist environment, hydrogel dressings utilize collagenase enzymes present in the wound exudate to degrade necrotic material, promoting autolytic debridement.

Applicable Range: Hydrogel dressings are suitable for autolytic debridement of wounds with yellow slough and black necrotic tissue, as well as wounds with low to moderate exudate. They are also effective for burn wounds, radiation wounds, and wounds with exposed bone membranes or tendons.

Advantages:

1.   Hydrogel dressings maintain a moist environment, which facilitates cell proliferation.

2.   Promote autolytic debridement in wounds with black eschar.

3.   Support epithelialization and granulation tissue growth.

4.   Hydrogel dressings do not adhere to the wound, minimizing damage during dressing changes. They can fill deep cavities within the wound effectively. Additionally, they provide pain relief.

Disadvantages:

1.   Hydrogel dressings lack a bacterial barrier.

2.   They have the potential to saturate the surrounding skin.

3.   A secondary dressing is required.

4.   They are not suitable for highly exuding wounds.

5.   The color of the dressing may turn green, leading to potential confusion with Pseudomonas aeruginosa infection.

Case Study:
 

3. Alginate Dressing

Main Components: Alginate dressings primarily consist of sodium carboxymethyl cellulose and calcium alginate, natural fiber dressings extracted from seaweed plants.

Mechanism of Action:

1. Sodium ions and water from the wound exudate come into contact with calcium ions in the dressing, resulting in ion exchange. This interaction converts calcium alginate into a gel, providing a moist healing environment that promotes wound cell proliferation and accelerates wound healing.

2. Macrophages are activated by the gel and fiber of calcium alginate, facilitating the removal of infected tissues and scabs.

3. Alginate dressings promote the release of growth factors, stimulating the proliferation of fibroblast/keratinocyte cells and expediting healing.

4. When in contact with exudate, sodium ions exchange with calcium ions, releasing calcium ions that have hemostatic and biofilm-stabilizing effects. This stimulates platelet adhesion/aggregation and activates intrinsic coagulation factors, achieved in hemostasis.

Applicable Range:
Alginate dressings are suitable for wounds with moderate to heavy exudate, wounds with cavities or sinus tracts, infected wounds, wounds with necrotic tissue, and malignant wounds. They are particularly effective for highly exuding chronic wounds, such as pressure ulcers and various ulcers.

Advantages:

Alginate dressings exhibit high absorbency. They conform to the contours of the wound and can be used for shallow or deep wounds. They provide a moist healing environment that promotes wound cell proliferation. They keep nerve endings moist, reducing pain. Alginate dressings form hydrogels with necrotic tissue, aiding in autolytic debridement. They are easy to apply and remove, non-toxic, and non-allergenic.

Disadvantages:

Alginate dressings require a secondary dressing for fixation. They are not suitable for dry, small amount of exudate, or wounds with dry scabs. In wounds with deep sinuses and high exudate, it can be challenging to remove residual dressings. Alginate dressings may have an odor and appear purulent-like, which can be mistaken for wound infection. Additionally, they are relatively higher in cost and should not be used by individuals allergic to alginates.

Case Study:

4. Hydrocolloid Dressing

Main Components: Hydrocolloid dressings are made of elastic polymer hydrogels, synthetic rubber, and adhesive substances. The most common gel in the dressing is hydroxypropyl cellulose, which sticks firmly to the skin around wound edges and can swell up to 12 times as it absorbs exudate.

Mechanism of Action: Hydrocolloid dressings contain endogenous enzymes that promote the dissolution of fibrin and necrotic tissue. They activate polymorphonuclear leukocytes and macrophages, effectively facilitating wound debridement. The dressings contain hydrophilic particles that interact with water, forming a gel film that provides a moist environment, reduces pain, and does not harm newly formed tissue.

Applicable Range: Hydrocolloid dressings are suitable for superficial wounds with partial epidermal loss, wounds with low to moderate exudate levels, such as surface wounds、 burns and superficial soft tissue injuries.

Advantages:

1.   Hydrocolloid dressings maintain wound moisture, creating a low-oxygen, slightly acidic environment that accelerates wound healing.

2.   Soften yellow slough and support autolytic debridement.

3.   The dressings absorb low to moderate levels of exudate, reducing dressing change frequency.

4.   Adhesive, can seal the wound surface, no need for a second layer of dressing, waterproof, anti-bacterial and heat preservation

5.   Absorb exudate then forming a gel that keeps peripheral nerves moist. When removed, they do not adhere to the wound, minimizing pain and facilitating epithelialization and granulation tissue growth.

6.    Good conformity, allows for easy customization to fit the wound shape, convenient to use.

Disadvantages:

1.   Hydrocolloid dressings should not be used on infected wounds or wounds with exposed tendons or bones.

2.   They are not recommended for heavily exuding wounds due to their highly occlusive nature, which can lead to excessive moisture and maceration of the surrounding skin.

3.   When tearing off, it is easy to damage the surrounding fragile skin, and it is easy to soften or deform when exposed to heat and friction.

Case Study:  

5. Foam Dressing

Main Components: Foam dressings are composed of polyurethane and polyvinyl alcohol foam.

Mechanism of Action: The material is porous and can absorb a significant amount of exudate, providing a moist, warm, and sealed environment for wound healing. It allows for almost complete permeability to oxygen and carbon dioxide and can serve as a carrier for medications.

Applicable Range: Foam dressings are suitable for wounds with moderate to heavy exudate, such as stage II and stage III pressure ulcers.

Advantages:

1.   Provide a moist, warm, and sealed healing environment that supports autolytic debridement.

2.   Absorb a moderate to large amount of exudate, reducing the impact of exudate and maceration on the wound.

3.   Easy to use, have good conformity, are easily removable without causing skin damage, and can be used on various body parts.

4.   The semi-transparent surface film prevents the entry of dust, microorganisms, and other contaminants, while the foam pad provides cushioning against external pressure, offering a comfortable sensation.

Disadvantages:

Due to their opacity, foam dressings hinder wound observation. And, its not suitable for dry wounds, wounds with black necrotic tissue, or eschar.

Case Study:

6. Silver Ion Dressing

Main Components: Silver ion dressings are a new type of broad-spectrum antimicrobial dressing composed of polyurethane foam, sodium carboxymethyl cellulose, silver, etc. They can rapidly kill microorganisms and continuously release low concentrations of silver ions.

Mechanism of Action:

1.   The positively charged silver ions exhibit high toxicity to microorganisms, fungi, and certain viruses, inhibiting their growth and exerting bacteriostatic effects.

2.   Silver ions impede the synthesis of bacterial cell wall proteins, hinder the division of bacterial cell nucleus DNA, and disrupt the synthesis of bacterial respiratory energy chains, leading to bacterial cell wall rupture and death. The bactericidal effect can last for 3 to 7 days.

Applicable Range: Severely contaminated wounds, infected wounds, graft sites, central venous puncture sites, diabetic foot ulcers, pressure ulcers, etc.

Advantages:

Broad-spectrum antimicrobial activity with strong anti-infective efficacy, capable of rapidly releasing silver ions for quick bactericidal action. It absorbs a significant amount of exudate, reducing skin saturation. It maintains a moist wound environment, accelerates wound healing, and reduces scar formation.

Disadvantages:

1.   Not suitable for individuals allergic to silver.

2.   Not suitable for those undergoing magnetic resonance imaging (MRI).

3.   Relatively expensive.

Case Study:

7. Silicone Foam Dressing

Main Components: A sterile polyurethane foam dressing with a silicone adhesive that is absorbent and self-adhesive

Mechanism of Action:

1. The unique 3D tree-like foam structure of the foam layer absorbs vertically and fits closely with the wound bed;

2. Excellent exudate management ability, SAP three-dimensional liquid locking technology, firmly locks exudate;

3. The surface of the silicone layer, gentle and skin-friendly, safe fit;

Applicable Range:

1. Suitable for a variety of exudative wounds

2. Thin silicone foam dressing is suitable for a variety of non-exudative/low-exudative wounds

3. Especially suitable for joints and other wounds that need to increase mobility

Advantages:

1. Super absorbent, to prevent impregnation and leakage to the greatest extent

2. Provide an ideal moist wound healing environment

3. Provide better prote

Disadvantages: Relatively expensive

Case Study:

Conclusion:

After reviewing the characteristics and case studies of the above dressings, it is worth noting that in the selection and application of wound dressings, we should be aware of the principle that no single dressing can be suitable for all wounds. Different dressings are needed for different stages of wound healing. When choosing dressings, the following ten factors should be considered comprehensively to select the most appropriate dressing for the best outcome:

- Stage of wound healing

- Amount of exudate

- Presence of infection

- Odor and adhesiveness of the dressing

- Skin irritation and absorbency

- Frequency of dressing changes

- Ease of use

- Pain caused during dressing changes

- Protection of the surrounding skin

- Patient preference

In clinical practice, the selection of dressings should be individualized. Dynamic selection and combination of dressings should be employed to choose the safest, most effective, easy-to-use, and cost-effective dressings. This approach will help patients achieve the best treatment outcomes. For further guidance, please contact our experts on www.trummed.com