TYPE OF WOUND

DRESSING
BY SN EDITH JAMES
FEMALE/MALE
MULTIDISCIPLINE
SURGICAL WARD, QEH II.

TYPE OF WOUND

Necrosis
Slough
Epithelialization
Granulation

NECROSI
S
Wound contains dead
(necrotic) tissue, its
a sign that the wound
is not healing normally.

Necrotic tissue is
often black or yellow
and may be soft, or
form a scab (eschar).
Necrotic tissue must
be removed to get
wound healing back on
track

SLOUGH
To deal with
local infection
(infection in this
wound is
indicated by;
pain at wound
site, reddened
periwound skin,
green/yellow
exudate with
odour, thick
yellow slough

EPITHELIALIZA
TION
Epithelialization
is the natural act of
healing dermal and
epidermal tissue in
which epithelium
grows over a
wound. Epithelium
is a membranous
tissue made up of
one or more layers
of cells that
contains very little

GRANULAT
ION

Granulation
tissue - light
red or dark
pink in color,
being perfused
(permeated)
with new
capillary loops
or "buds"; soft
to the touch;
moist; and
bumpy

TYPE OF
DRESSING

Hydrocolloid
Alginate Dressing
Foam Dressing
Amorphous hydrogels
Transparent Films
Impregnated Gauze
Hydro Fiber

Hydrocolloid Dressing
Characteristics
Absorptive
Occlusive or semipermeable
Adhesive
Moisture retentive

Indications
Light to moderately edudative wounds
Autolytic Debridement
Type 2 to 4 Pressure Sores (some dressings may be
used in Type I sores)
Dry necrotic eschar debridement
Wounds with slough or necrosis

Hydrocolloid Dressing
Contraindications: Relative
Wound infection (especially anaerobic)
Exposed tendon or bone
Diabetes Mellitus (may worsen necrotic Foot Ulcers)

Technique
Change dressing every 3-5 days
Consider stoma adhesive over top under film or
tape
May be used under compression dressing

May be applied over an Alginate Dressing

Hydrocolloid Dressing
Advantages
Requires less care than other dressing types
Become absorbent gels on contact with exudate
Conformable
Adheres to both wet and dry sites
Water resistant
Excellent microbial barrier (prevents infection)
Assists with Autolytic Debridement
Can be used under compression (e.g. Unna Boot)

Hydrocolloid Dressing
Disadvantages
Expensive material
Cost effective when compared with saline dressing

Maceration of peri-wound margins

May produce foul, sour odor
Too frequent dressing changes may strip skin
Limits wound visability, monitoring
Secondary hypergranulation tissue may delay healing
Leafy, friable beefy red tissue
Remove with silver nitrate or Sharp Debridement

Alginate Dressing
Characteristics
Absorptive
Nonocclusive
Nonadhesive
Moisture-retentive

Indication
Moderate to heavily exudative and wounds
Wounds with undermining or tunneling
Type 2 to 4 Pressure Sores

Autolytic Debridement

Contraindications
Avoid in non-exudative, dry wounds
Avoid in sinus tracts

Alginate Dressing
Technique
Rinse wound residue with each bandage change
Change dressing daily to every 3 days

Advantages
Requires less care than other dressings
Designed to be occlusive
Designed to absorb large exudates (up to 20
times its own weight)
Fills dead space
Conforms to wound shape

Alginate Dressing
Efficacy
Improves Pressure Ulcer healing time
Used before Hydrocolloid Dressing
See Wound Dressing for sample protocol
Belmin (2002) J Am Geriatr Soc 50:269

Disadvantages
No trial data on effectiveness in Pressure Sores
Avoided in light exudate or dry wounds
Risk of dehydrating wound bed and delaying
Wound Healing (risk of scab formation)

Foam Dressing
Technique
Rinse wound residue with each
bandage change
Change dressing daily to every 3 days
Efficacy
Improves Pressure Ulcer healing time
Used before Hydrocolloid Dressing
See Wound Dressing for sample protocol
Belmin (2002) J Am Geriatr Soc 50:269

Foam Dressing
Disadvantages
No trial data on effectiveness in Pressure Sores
Avoided in light exudate or dry wounds
Risk of dehydrating wound bed and delaying
Wound Healing (risk of scab formation)
Advantages
Conformable
Can be used for absorption or wound insulation
Minimize maceration of peri-wound edges (can
be used in areas of fragile skin)
Can be used under compression (e.g.
Unna Boot)

Hydrogel Dressing
Characteristics
Absorptive
Adhesive or non-adhesive
Moisture retentive
Indications
Light to moderately exudative wounds
Autolytic Debridement
Thin, stringy yellow eschar
Dry necrotic eschar
Infected wound (amorphous hydrogels such as Intrasite)
Monitor wound daily if infected
Filler for deep or extensive wounds
Carrier for topical medications
Type 2 to 4 Pressure Sores

Hydrogel Dressing
Technique
Change dressing every 5 to 7 days
Apply gel
Tongue blade
Syringe (20 to 50 cc) filled with gel

Cover wound site

Gauze
Foam Dressing (e.g. Lyofoam)

Secure
Transparent Film Dressing (e.g. Tegaderm)
Paper tape

Hydrogel Dressing
Advantages
Conformable
Fills ulcer cavity to maintain moist healing environ
Cooling, soothing sensation and analgesia
Assists Autolytic Debridement

Disadvantages
Requires moderate level of care
Maceration of peri-wound edges
Requires fixatives and dressings to hold in place
Avoided in wounds with heavy exudate
No trial data supporting use
Secondary hypergranulation tissue may delay healing
Leafy, friable beefy red tissue
Remove with silver nitrate or Sharp Debridement

Transparent Film Dressing

Characteristics
Semipermeable
Allows gaseous and oxygen exchange across polyurethane
membrane
Retains exudate to create moist environment
Adhesive
Moisture retentive
Indications
Non-exudative wounds
Autolytic Debridement
Type 1 to 2 Pressure Sores
Secure other Wound Dressings
Protect vulnerable areas from friction injury
Elbows
Heels
Coccyx
Skin tear

Transparent Film Dressing

Contraindications
Absolute
Cavity wounds
Wounds with sinus tracts, undermining or tunneling

Relative
Infected Wounds (especially anaerobic)
Wounds with excessive exudate
Unless combined with foam, gauze, or hydrogel

Technique
Change dressing every 3 to 7 days
Check dressing daily (transparent)
Consider protecting skin edge from maceration
Stomal adhesive wafer
Vaseline
Zinc oxide

Advantages

Transparent Film
Dressing

Requires less care than traditional dressing (gauze)

Conformable
Water resistant
Wound visualized without dressing removal
Protects against secondary infection
No additional dressing needed (no tape or wrap)

Disadvantages

Expensive
Maceration of peri-wound edges (wound border must be intact)
Too frequent dressing changes may strip skin
No absorptive capacity (can only use in non-exudative wounds)
Difficult to apply
No data showing efficacy in Pressure Ulcers
Contraindicated in infected wounds
Separates from skin in high friction areas

IMPREGNATED GAUZE
Types: Hypertonic Saline Gauze
(Mesalt)
Indicated for exudate absorption for
cleaning wounds
Change gauze daily
May result in some tissue destruction
Switch to Hydrogel Dressing once
exudate reduced

IMPREGNATED GAUZE
Types: Iodoform Gauze (Iodine
impregnated gauze)
Indicated for tunneling wound with foul
discharge
Change gauze daily
May cause tissue destruction (limit to
<5 days)
Switch to less toxic alternative once
discharge reduced

IMPREGNATED GAUZE
Types: Vaseline Gauze (Petrolatum
impregnated gauze)
Indicated for wound protection and
wound hydration
Change every 2 to 4 days
Particularly effective in extremity skin
tears
Apply vaseline gauze to affected area
Secure gauze with Kerlix wrapped around
extremity

Saline Gauze Dressing

Characteristics
Absorptive
Nonocclusive
Nonadhesive
Moisture retentive (gauze must
be kept moist)

Saline Gauze Dressing

Indications
Light to moderately edudative wounds
Wounds with sinus tracts, tunneling or undermining
Deep wounds
Types 2 to 4 Pressure Sores
Mechanical Debridement (Wet-to-Dry dressing)

Technique: Wet-to-Moist Dressing

Change twice daily
Wet to Moist Dressing Example

First layer: wet 4x4 gauze with saline

Second layer: Vaseline Gauze
Third layer: dry 4x4 gauze
Kerlix dressing to hold in place

Saline Gauze Dressing

Technique: Wet-to-Dry Dressing
(Debridement only)
Debrides at the expense of removing
healthy tissue
Wet-to-Moist dressing is preferred in most cases

Technique

Apply gauze wet with normal saline to wound

Allow gauze to dry
Remove dressing with attached wound debris
Repeat several time

Saline Gauze Dressing

Advantages
Inexpensive and efficacious

Disadvantages
Requires more intense wound care (due to repeated
moistening, reapplication)
Consider Hydrocolloid Dressing as simpler alternative

Maceration of peri-wound edges

Leaves lint or fiber residue in wound
Requires tape or film to secure in place
Wet-to-dry removes normal tissue with debridement
Adherance to healthy granulation tissue if dries
May destroy healthy epithelial cells and slow healing
Use wet-to-moist dressing to avoid this

THANK YOU FOR

YOUR ATTENTION.