How to choose wound dressings? (Wounds, wound healing, wound dressings)

Dear doctor,

I read your article on ‘Wound Healing’, however you have not described anything on Wound dressings. I am often confused when different doctors advise different dressings for the same wound. Can you tell me how wound dressings are decided?

Nancy A,

Medical student,

Illinois, USA

Dear Nancy,

Thank you very much for your letter. Wound healing is a complex process and was exhaustively described in

1. Wound healing, scars, mature scars, hypertrophic scars, keloids
http://asktheburnsurgeon.blogspot.com/2010/03/wound-healing-scars-mature-scars.html

2. Part II: Wound healing: why wounds fail to heal, factors affecting wound healing, chronic wounds, non healing wounds.

http://asktheburnsurgeon.blogspot.com/2010/04/part-ii-wound-healing-why-wounds-fail.html

Wound dressings must be selected according to the nature of the wound. A wide variety of wound dressings are available and choosing the ideal one is critical to the healing of the wound.

An optimal wound dressing:

1)Must promote normal wound healing process (epithelisation)

2) Must absorb the discharge or exudate from the wound

 3)must help the wound clear away the dead tissue in the wound (autolytic debridement)

4) Must not damage the normal surrounding skin.

5)Must destroy the bacteria in the wound.

 A wound in general must be kept moist, since drying will lead to cell and tissue death. If a wound is producing a lot of exudate (discharge), a dressing which is highly absorptive will help to prevent the wound from being soggy and wet. It will also avoid maceration of the skin. If a wound is showing local signs of infection, then a wound dressing which has antibacterial incorporated into it will be helpful.

Some wounds may have dead tissue in them that may appear pale, grey, black or white in colour. The presence of dead tissue hampers the normal wound healing process and such a wound will never heal unless this dead tissue is removed by the use of dressing with enzymatic preparations or by the surgeons knife (a process called debridement)

If a wound is dry then a dressing which will prevent moisture to pass through and provide a moist environment will help the normal wound healing process and epithelialisation.

A wound that is clean and showing signs of healing like good epithelisation (growth of skin cells) will need less frequent dressings since changing the dressing frequently will damage the delicate new epithelial cells.

If a wound is badly contaminated or infected and producing a lot of discharge then it is important that frequent dressing changes be made to keep the wound clean and promote healing.

Infected wounds must have culture study to know the organisms or germ causing the infection and appropriate antibiotics must be give for the same.

Some wounds are small and may heal spontaneously. Some wound are large and will need new skin to applied over them (Skin grafting) to heal, otherwise they will remain as non-healing wounds. To make the wound ideal for skin grafting and promote good granulation tissue (new blood vessels and cells) - dressing which have hypertonic saline impregnated in them can be used.

Some wounds are not dry or exudative (producing too much discharge). A polyvinyl film dressing which in impermeable to bacteria but allows oxygen and moisture to pass through partially can be used. However one must be cautious as polyvinyl film dressing can cause skin maceration especially in those who sweat a lot or live in humid areas.

Some wounds are large and cannot heal spontaneously. These wounds may need the help of dressings supported by negative pressure suction (Vac therapy) which will help to decrease the bacteria, increase the blood supply, increase the granulation tissue, reduce the size of the wound and prepare the wound for skin grafting.

Types Of Wounds

Dry wounds

Exudative wounds

Neither dry nor wet wounds

Infected wounds

Sloughy wounds

Hyper granulating wounds

Poorly granulating wounds

Different dressing materials that are presently available in the market for different wounds will be described in detail in a future article.

Asktheburnsurgeon+