DRESSING CHOICE
i
WOUND CARE TODAY
2015,Vol 2, No 1
11
Box 1
Choosing the right dressing
TISSUE TYPE
Exudate
level
Dressing suggestion
Slough: requires a dressing to
debride the wound bed
Low to
moderate
Hydrogel/hydrofibre/hydrocolloid/honey
Low to
moderate
Hydrofibre/honey
Necrosis: requires a dressing to
debride the wound bed
Low
Hydrogel/hydrocolloid/honey
Surgical debridement may be required
Granulation: needs to be protected Low
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INFECTION/INFLAMMATION
Exudate
level
Dressing suggestion
Infected wounds may require
systemic antibiotics
Dressings should only be used for
short periods
Low
Iodine /silver wound contact layer/silver foam/
PHMB contact layer or PHMB gel/honey
High
Silver alginate/silver hydrofibre/dacc dressings/
Honey
MOISTURE
Dressing suggestion
If a wound is too wet, maceration
and skin damage may occur
Dressing selection should assist in
exudate management
Hydrofibres/alginates/superabsorbants
Underlying cause of exudate should be identified during
holistic assessment
If wounds are to dry it may prevent
the migration of fibroblasts.
Dressings that donate moisture
are required
EDGES
Dressing suggestion
Non-advancing
A non-advancing wound indicates non healing and referral to
specialist wound teams may be appropriate
natural material functions alongside
living tissue, in this case the wound
bed). The main function of hydrogels
is to donate moisture to the wound
and facilitate autolytic debridement
of slough and necrosis. Hydrogels
are available in a gel or sheet
formulation.
When to use
Hydrogels are useful for dry, sloughy
or necrotic wounds. There is some
evidence that hydrogel sheets may
assist in the management of painful
wounds (Young and Hampton, 2005).
Considerations
Maceration of the surrounding
skin may occur with hydrogels
and dressing changes may need
to be more frequent. For this
reason, hydrogels are not usually
recommended for use on highly
exuding wounds. If larval therapy is
to be used, any trace of the hydrogel
will need to be fully irrigated from
the wound, as the propylene glycol
contained in most hydrogels (with
the exception of Purilon
®
[ConvaTec])
is toxic to larvae.
Examples include: Intrasite
®
Gel
(Smith and Nephew); Purilon
®
(ConvaTec); Actiform Cool
®
(Activa
Healthcare).
Films
Properties
Film dressings are composed of a
thin non-absorbent polyurethane
material. They are semi-permeable
to oxygen and water vapour, but
impermeable to bacteria, therefore
creating an ideal wound-healing
environment (Sussman, 2010).
When to use
Film dressings are useful for low-
exuding superficial wounds and
because they are transparent they
allow the nurse to view the wound
bed and monitor the wound’s
progress. Films are also helpful as
secondary dressings, however they are
not recommended for use over foam
dressings as this may affect the overall
ability of the foam to handle exudate.
Considerations
Films are not suitable for highly
exuding wounds as they have no
