DRESSING CHOICE
i
12
WOUND CARE TODAY
2015,Vol 2, No 1
Box 1 cont.
EDGES cont.
Dressing suggestion
Undermining – dressing selected
will be a rope or ribbon that is
suitable for use in cavities
Hydrofibre ribbon/alginate ribbon/honey ribbon,
Dacc ribbon dressing
Epithelial – epithelial tissue within
the wound will require a dressing
that protects this delicate tissue
Wound contact layer/film dressing /foam
ability to absorb. Care should also be
taken when applying or removing
films from fragile skin as the
adherence of the product may cause
skin-stripping (Sussman, 2010).
Examples include: Opsite
®
(Smith
and Nephew); Tegaderm
®
(3M);
Mepore
®
(Mölnlycke Health Care).
Honey dressings
Properties
Honey’s high osmolality and slow
release of hydrogen peroxide has
been shown to inhibit bacterial
growth (Gethin and Cowman, 2008).
When to use
Honey can be used on a wide variety
of wounds due to its antimicrobial
and anti-inflammatory properties.
Honey also facilitates debridement
and can be used on slough or necrotic
wounds. Honey also may deodorise
odourous wounds, promote a moist
wound environment, and stimulate
the formation of granulation tissue.
Considerations
Honey may initially increase exudate
production, which may cause
maceration and require an increase
in dressing-change frequency. There
have also been reports that honey
can increase pain due to its high
osmolality (Coulborn et al, 2009).
Caution should be used on patients
with sensitivity to bee venom.
Honey is available in several
presentations, such as tulle dressings,
alginate dressings, and ointments.
Wound contact layers
Properties
These dressings are simple
inexpensive dressings which are
designed to be in direct contact with
the wound bed. They are primarily
made from knitted viscose or
polyester. Newer versions have been
impregnated with hydrocolloids,
petroleum jelly and silver.
When to use
Wound contact layers are useful
to protect granulation tissue and
preventing adherence. They can be
used under compression (Palfreyman
et al, 2006), as well as in combination
with an absorptive secondary
dressing, allowing exudate to flow
through the weave of the fabric into
the secondary layer.
Considerations
Wound contact layers have no
absorptive properties and are not
recommended for use on highly
exudating wounds. There is some
evidence to show that granulation
tissue may grow through the weave
of the dressing if left in place for too
long, resulting in potentially traumatic
removal (World Union of Wound
Healing Societies [WUWHS], 2007).
Hydrofibres
Properties
Hydrofibre dressings are often
confused with alginates due to
similarities in appearance and
gelling properties. Hydrofibre
dressings consist of sodium
carboxymethyl cellulose and
hollow fibres — this allows for the
hydrophilic action of the dressing,
which absorbs high quantities of
exudate by vertical wicking.
Hydrofibres create a moist
wound-healing environment as well
as promoting autolysis (destruction
of cells through the action of their
own enzymes). There is also some
evidence to indicate that hydrofibres
are able to bind harmful proteases
that may prevent healing, thus
protecting the wound bed.
When to use
Hydrofibres are recommended for
highly exuding wounds with or
without slough. Formulations include
ribbon dressings and a silver version,
making the product suitable for cavity
and infected wounds.
Considerations
Hydrofibres require a secondary
dressing and are not considered
suitable for dry or necrotic wounds.
Examples include: Aquacel
®
(ConvaTec); Durafiber
®
(Smith and
Nephew); Exufiber
®
(Mölnlycke
Health Care).
Antimicrobials
Properties
Antimicrobial dressings are variously
impregnated with non-selective
agents that kill bacteria or inhibit
their growth. There are a wide range
of products that come under the
antimicrobial umbrella, including
those which contain:
i
Iodine
i
Silver
i
Honey
i
Polyhexamethylene biguanide
(PHMB)
i
Dialkylcarbamoyl chloride (DACC
technology).
There is an increased interest
in topical antimicrobials due to
the issues surrounding antibiotic
resistance, and in some cases the
use of topical antimicrobial therapy
negates the need for treatment
with antibiotics. Some areas of
controversy around the use of topical
antimicrobials lie in the cost of the
products (Michaels et al, 2009), and
inappropriate usage (Mahoney, 2014).
