IN MY PREVIOUS ARTICLE (January 2008), I described basics of choosing a wound dressing, and when to use gauze, foam, and composite dressings. In this article, I'll look at several more types of dressings and when they're used.
This dressing consists of hydrophilic colloid particles bound to polyurethane foam that's impermeable to bacteria and other contaminants.
Indications: Stages I through IV pressure ulcers, partial- and full-thickness wounds, dermal ulcers, and necrotic wounds. Hydrocolloids also can be used under compression wraps or stockings, as a secondary dressing, or as a preventive dressing for areas at high risk for friction.
Advantages: Hydrocolloids come in numerous sizes, shapes, forms, and thicknesses. They're minimally to moderately absorptive, reduce pain, and facilitate autolytic debridement. The dressing also is self-adherent, conformable, and provides thermal insulation. Because hydrocolloids can be worn for 3 to 5 days, fewer dressing changes are needed.
Disadvantages: Some of these dressings may adhere to the wound bed or be difficult to remove. The odor they produce can be mistaken for infection, and some dressings may leave a residue in the wound bed. Hydrocolloids aren't recommended for heavily draining wounds, sinus tracts, or fragile skin. Some are contraindicated for full-thickness wounds or infected wounds-check the package insert.
Water- or glycerin-based, this dressing can consist of 80% to 99% water on a nonadherent, cross-linked polymer. The dressing has variable absorptive properties.
Indications: Stages II through IV pressure ulcers, partial- and full-thickness wounds, dermabrasion, painful wounds, dermal ulcers, radiation burns, donor sites, and necrotic wounds.
Advantages: Hydrogels rehydrate the wound bed and reduce wound pain. They can be used on infected wounds and with topical medications. These dressings also promote autolytic debridement. Nonadherent, they're easy to remove, and usually are changed daily.
Disadvantages: Because hydrogels are nonadherent, they may need to be secured by a secondary dressing. They aren't recommended for heavily draining wounds, and their absorptive properties mean they may macerate periwound skin.
A nonwoven composite of cellulose-like fibers, alginate dressings are made from brown seaweed. The dressing material forms a soft gel when mixed with wound fluid.
Indications: Moderate to heavily draining wounds, partial- and full-thickness wounds, pressure ulcers (Stages III and IV), dermal wounds, surgical incisions or dehisced wounds, sinus tracts, tunnels, cavity wounds, and infected wounds. Alginates also can be used for hemostasis on postoperative wounds.
Advantages: Alginates are highly absorptive and nonocclusive, and have hemostatic properties for minor bleeding. Removal is trauma-free, and the frequency of dressing changes often is reduced. When beginning treatment, change alginates daily; thereafter, they can be changed every other day or when saturated. Available in sheets, ropes, and in other composite dressings, alginates can be used on infected wounds.
Disadvantages: A secondary dressing may be needed to secure an alginate, and the dressing tends to have a distinctive odor noticeable during dressing changes. Alginates are contraindicated for dry eschar, third-degree burns, surgical implantation, and heavy bleeding.
Similar to an alginate, a hydrofiber consists of sodium carbomethylcellulose that interacts with wound exudate to form a gel.
Indications: Moderate to heavily draining wounds, partial- and full-thickness wounds, pressure ulcers (Stages III and IV), surgical wounds, donor sites, dehisced wounds, cavity wounds, and wounds with sinus tracts or tunnels.
Advantages: Highly absorptive, hydrofibers don't need to be changed frequently, and are available in sheets and ribbons. Removal is trauma-free.
Disadvantages: Because the dressing is nonadherent, you'll need a secondary dressing to secure it. Hydrofibers are contraindicated for dry eschar, nonexudating wounds, third-degree burns, and heavy bleeding.
These dressings are impregnated with cadexomer iodine for immediate and controlled release, and protect against bacteria or reduce bacterial load in a wound.
Indications: Any type of infected wound, including colonized chronic nonhealing wounds.
Advantages: Antimicrobial dressings reduce the risk of infection.
Disadvantages: Because they're nonadherent, a secondary dressing is needed. Also, these dressings can't be used in patients sensitive to iodine.
These dressings contain ionic silver for immediate and controlled release. Transparent film, hydrocolloids, hydrogels, foams, alginates, hydrofibers, and composites all are available with silver.
Indications: Infected or highly colonized wounds. Some silver dressings can be used under compression wraps or stockings. Contraindicated for Stage I pressure ulcers, third-degree burns, and nonexudating wounds. See the specific product information for details.
Advantages: Inhibits pathogen growth, especially of antibiotic-resistant strains. Cost-effective antimicrobial action for up to 7 days.
Disadvantages: A secondary dressing is needed to secure silver dressings in place. These dressings can't be used in patients sensitive to silver and must be removed (and the wound cleaned) before the patient has magnetic resonance imaging. Silver dressings aren't recommended for use together with topical medications. Because silver turns black when it oxidizes, it may stain or discolor periwound tissue.
By knowing about the major types of wound dressings and how to select the right one, you can help your patient heal faster.
Baranoski S. Wound dressings: A myriad of challenging decisions. Home Healthcare Nurse. 23(5):307-317, May 2005.
Baranoski S, Ayello E. Wound Care Essentials: Practice Principles. Lippincott Williams & Wilkins, 2003.
Hess CT (ed). Clinical Guide to Wound Care, 6th edition. Lippincott Williams & Wilkins, 2007.
Ovington L. Wound dressings, form, function, feasibility, and facts. In Krasner D, et al. (eds), Chronic Wound Care, 3rd edition. HMP Communications, 2001.