Wound dressings
Background
The four stages of wound healing and various wound dressings will be defined and summarised in order to equip the ED staff with some of the knowledge base required for safe and effective wound management. For more details on wound healing please visit http://intranet/tissue/
Time occurance |
Phase |
Signs |
| Initial response, < 60 minutes | Haemorrhage / Haemostasis | Bleeding/Vasoconstriction then Coagulation |
| 10 mins - 5 adys | Inflammatory | Vasodilation & redness, Swelling & wound exudate Pain |
| 3 days - 1 month | Proliferation | Growth and reproduction of tissue |
| 3 weeks - 1 year | Maturation | Remodelling of collagen, Gradual fading of scar |
Dressings used
Mepitel
- non-adherent silicone dressing
- 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.
- careless removal of dried-out Jelonet risks destroying fragile new granulation tissue.
- 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 (an 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.
Sorbsan ribbon
- highly comfortable calcium alginate non-woven primary dressing
- 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 wounds - change dressing according to clinical condition of wound and amount of exudate produced
Comfeel Plus
- 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, first and second degree 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 |
Conclusion
All types of wounds commonly present at Emergency Departments. As this paper has highlighted, there are a variety of wound dressings and it is imperative for both ED doctors and nurses to understand their application. Only then, can safe, informed and competent wound care be delivered. As a result of this teaching resource, it is hoped that the knowledge gained will equip ED doctors and nurses with the ability and skill to treat wounds both appropriately and effectively.
