Monday, October 22, 2007

Dressings for Acute and Chronic Wounds

A strong consensus was reached for use of the following combinations: for chronic wounds, (1) debridement stage, hydrogels; (2) granulation stage, foam and low-adherence dressings; and (3) epithelialization stage, hydrocolloid and low-adherence dressings; and for the epithelialization stage of acute wounds, low-adherence dressings," the review authors write. "For specific situations, the following dressings were favored: for fragile skin, low-adherence dressings; for hemorrhagic wounds, alginates; and for malodorous wounds, activated charcoal."

Chronic wounds were defined as those expected to take more than 4 to 6 weeks to heal because of 1 or more factors delaying healing, including venous leg ulcers, pressure ulcers, diabetic foot ulcers, extended burns, and amputation wounds. Acute wounds were defined as those expected to heal in the expected time frame, with no local or general factor delaying healing. These included burns, split-skin donor grafts, skin graft donor site, sacrococcygeal cysts, bites, frostbites, deep dermabrasions, and postoperative-guided tissue regeneration. Summary from the MedScape article by Dr. Laurie Barclay.

So what are these dressings? What is a hydrogel? or an alginate?

HYDROGELS

Hydrogel dressings are composed mainly of water in a complex network that keep the cross-linked polymer gels intact. The water is released to provide and maintain a moist wound environment. By increasing moisture content, hydrogels have the ability to help cleanse and debride necrotic tissue. Hydrogels are non-adherent and can be removed without trauma to the wound. Hydrogel dressings are not very absorptive, and therefore are not the appropriate choice for moderate to highly exudating wounds. Hydrogel dressings often require secondary dressings for this reason. Hydrogel dressings can be shaped into gauze, sheets, or filler material.

SYNTHETIC FOAM DRESSINGS

These dressings were designed to absorb large amounts of exudates and to maintain a moist wound environment. They are not as useful as alginates or hydrocolloids for debridement. They should not be used on low or non-exudating wounds as they will cause dryness and scabbing.

HYDROCOLLOID DRESSINGS

Hydrocolloids are sterile wound dressings, which consist of a hypoallergenic, hydrocolloid adhesive with an outer clear adhesive cover film impermeable to liquids, bacteria and viruses. The inner layer of hydrocolloid adhesive rapidly absorbs exudate. The breathable outer film layer provides for a high rate of moisture vapor transmission. Together, these features ensure an optimal moist wound environment, minimize the chance for damage to healthy skin surrounding the wound and provide extended wear for up to seven days. (photo credit)

LOW ADHERENCE DRESSINGS

The use of low or non-adherence dressing materials will minimize disruption of healthy granulation tissue and re-epithelialized surfaces.

  • Jelonet Paraffin Gauze Dressing (Smith & Nephew) is a low-adherent tulle dressing that allows the wound to drain freely into an absorbent secondary dressing.
  • Tegaderm Non-Adherent Contact Layer is a woven nylon fabric with sealed edges that is a lint-free, non-adherent, non-toxic, non-irritating, and hypoallergenic material. It can be left on the wound for up to 7 days. This contact layer can be used under gauze or other absorbent dressings. It will allow exudates to pass through to an absorbent outer barrier. The non-adherence of this material will minimize disruption of healthy granulation tissue and re-epithelialized surfaces. (photo credit)
  • Paranet "Vernaid" Sterile Paraffin Gauze Dressing BP

ALGINATE DRESSINGS

These dressings are sterile, highly conformable, and absorbent primary wound dressings for use on moderately to heavily exudating wounds. They are composed of calcium alginate which is a seaweed component. When the dressing is in contact with wound, the calcium in the dressing is exchanged with sodium from the wound fluid and this turns dressing into a gel that maintains a moist wound environment. It is a good dressing for exudating wounds and helps in debridement of sloughing wounds. It should not be used on low exudating wounds as this will cause dryness and scabbing. This dressing should be changed daily. (photo credit)

The activated charcoal products are for stoma bags to decrease or elimate the odor from the collected urine or feces. The article at DermNet NZ on skin problems from stomas is very well written.

References

Dressings for Acute and Chronic Wounds--A Systematic Review; Arch Dermatol. 2007;143:1297-1304; Olivier Chosidow, MD & others (can access online if AMA member)

Consensus Statement Describes Dressings for Acute and Chronic Wound Management--MedScape article by Laurie Barclay, MD

Wound Dressings--Family Practice Notebook

Synthetic wound dressings at DermNet NZ

Skin problems from stomas at DermNet NZ

1 comment:

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