Wounds 4 - Dressings

What dressings should be used for wounds healing by primary intention?

Protective dressings that absorb exudate - waterproof, padded, soft, non-stick

What is the traditional method for wound healing?

Leave it open to the air to dry out so it will form a scab

What are the roles of scabs in wound healing?

Protects healing wound from ingress of dirt and microorganisms

What is the issue with dry wounds?

Migrating polymorphonuclear leucocytes such as macrophages can’t get through dry tissue and increases scarring

What do moist conditions allow for healing?

Epidermal cells will migrate to the surface of the wound and reduce scarring

What are the 3 key conditions for optimum wound healing?

Warm, sterile and moist

What are ideal properties of dressing?

• Moist with exudate, no maceration

• Free of clinical infection and excessive slough

• Free of toxic chemicals, particles or fibres released by the dressing

• At optimum temperature for healing to take place

• Undisturbed by frequent or unnecessary dressing charges

• At optimum pH

What are the different types of dressing?

Hydrocolloid, foam, alginates, hydrogel, tulle, absorbent

What type of dressing is a microgranular suspension of natural or synthetic polymers in an adhesive matrix?

Hydrocolloid

What are the characteristics of a Hydrocolloid dressing?

Has granules that are semi-hydrate and hydrophilic, adhesive matrix that is hydrophobic

What does the hydrophobic adhesive matrix and hydrophilic granules allow for hydrocolloids?

Allows granules to absorb to wound but can’t leave - gases escape but moisture can’t

What type of wounds are hydrocolloids and hydrogels not good for?

Wet wounds as they slowly absorb fluid from the wound

What is the type of dressing that is absorbent polyurethane with other components?

Foams

What other components are present in foams?

Hydrocellular, hydropolymer, soft silicone foams

What type of wounds are foams good for?

Painful wounds e.g., burns where nerves are exposed

Why is silver incorporated into foam dressings?

Antibacterial

Why is charcoal incorporated into charcoal?

For fungi and dead tissue as it absorbs odour

What are characteristics of wounds?

Very flexible to nooks, can cut to fit the wound, can be bordered

How should you figure out what size is needed for a dressing?

Oversize the centre as adhesion must be on healthy tissue

What is the type of dressing that is seaweed based?

Alginate

What are the 2 different forms of alginate dressing?

Mannuronic acid, Guluronic acid

What gels do mannuronic rich alginates form?

Soft flexible gels

What are the properties of soft flexible gels?

Can be rinsed away, absorb exudate, good 4 packing wounds, can rinse away

What gels do guluronic acid alginates form?

Firm gels

What are the properties of guluronic rich alginates?

Can be removed in 1 piece, highly absorbent

What type of dressing has a high water content, is kind and cooling to the skin and donates moisture to dry wounds?

Hydrogels

What forms can hydrogel dressings come in?

Flat gels/sheets and tubes/containers that are squirted into the wound

What is needed on top of hydrogel dressings?

Secondary dressing to hold in place

What are the 2 types of tulle dressing?

Medicated or non-medicated

What type of dressing is made from knitted polyester and is only used as a secondary dressing?

Tulle

What are the properties of tulle dressings?

Soaked in paraffin and placed on top of the wound, floats on top and is hydrophobic, open weave and allows wounds to dry out, no occlusion

What type of wounds are tulles good for?

Burns and skin grafts

What type of dressing is a primary dressing, allowing gas exchange out and comes into the contact with wound to retain moisture?

Vapour permeable films

What can vapour permeable films be used for?

Newly healed wounds

What are properties of vapour permeable films?

Sterile, thin, conformable, hypoallergenic, vapour-permeable, adhesive coated, can have absorbent backing

What dressing is made of viscose/rayon and is an absorbent pad with an adhesive border?

Low adherence primary dressing e.g., Mepore, primapore

What properties do plastic film faced dressings have?

Perforated polyester film contact layer, absorbent cotton pad, hydrophobic backing e.g., melolin

When are surgical absorbent dressings used?

To clean wet wounds/wet before using e.g., absorbent cotton BP, gauze, lint

What wounds are surgical absorbent dressings used on?

Dry wounds as otherwise can shed fibres and be painful to remove