Wound dressings: principles and practice

doi:10.1016/j.mpsur.2014.07.001

Surgery (Oxford)

Volume 32, Issue 9, September 2014, Pages 462-467

https://doi.org/10.1016/j.mpsur.2014.07.001 Get rights and content

Abstract

Knowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types.

Section snippets

Pathophysiological considerations informing dressing choice and development

Although wounds are either classified as acute or chronic and are then further subdivided into subcategories such as pressure ulcers, venous leg ulcers, diabetic foot ulcers, traumatic wounds and surgical wounds, the basic function of dressings used in their care remains the same, that is to provide a protective barrier to prevent bacterial contamination and absorb exudate. Work by Winter in the 1960s² established that a moist wound environment was conducive to improved wound healing with more

What constitutes an ideal dressing?

It is important, not only that a dressing performs the function it claims, but that it does so in a cost and clinically effective way. Cost effectiveness is achieved by accurate clinical assessment and diagnosis and the appropriate choice of treatment.⁵ This may not always be achieved by using the cheapest product and may be dependent as much on dressing wear time as product selection.⁶ Factors such as healing time, nursing costs, frequency of dressing changes and requirements for other

Wound assessment and choosing and appropriate dressing

Closed surgical wounds require a different approach to open acute and chronic wounds. NICE guidance on surgical site infection⁸ emphasizes the importance of maintaining optimal physiological conditions during surgery and anaesthesia. The role of dressing selection is a secondary factor in wound outcome and a simple interactive dressing is recommended such as an occlusive film with pad, topical antimicrobial agents should not be used routinely. When applying a postoperative dressing the dressing

Wound dressings

Figure 1 describes a selection process for currently available and commonly used dressings based on wound depth, exudate levels and wound bed characteristics. Details on individual dressings can be found at www.dressings.org or from publications such as the Wound Care Handbook 2014-2015. Many NHS Trusts have their own wound care formulary from which to select a restricted range of products. When selecting dressings decisions should be made on the basis of the treatment goal, the timeline for

Topical negative pressure therapy

The introduction of TNPT has redefined modern wound treatment and improved the management of complex wounds. TNPT has been found to improve wound healing; to stabilize the wound and assist wound contracture, to stimulate angiogenesis and to remove wound exudate and decrease peri-wound oedema. In its simplest form localized negative pressure is applied to a closed foam or gauze-based wound dressing fitted to a cavity wound sealed under a film dressing. A number of commercial systems are

Detecting and modifying inflammation

One reason for delayed wound healing is a persistent destructive inflammatory response within the wound with elevated levels of proteases destroying attempts to establish a new extracellular matrix. A diagnostic kit has been introduced to monitor metaloprotease (MMP) activity in the wound and a range of protease modulating dressings are available, the majority derived from freeze dried, oxidized cellulose and bovine collagen, designed to reduce MMP activity and enhance growth factor

Dressings replacing or restoring the extracellular matrix

A range of dressing products have been developed that attempt to restore a functioning extracellular matrix. These range from the application of a degradable solution of amelogenin, a natural protein originally isolated from periodontal ligament, which assembles into a replacement membrane, to complex cellular or acellular constructs which are implanted into and gradually downgraded within the wound.

Conclusion

The majority of wounds heal without complication and in a timely manner. In some acute and chronic wounds, the healing process is, however, delayed and in these wounds careful assessment should identify potential causes of non-healing and allow targeted therapeutic intervention. Understanding the basic mechanisms involved in wound healing and knowledge of the type and function of available wound dressings will allow a systematic approach to dressing selection that is integrated into an

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Wound healingWound dressings: principles and practice

Abstract

Section snippets

Pathophysiological considerations informing dressing choice and development

What constitutes an ideal dressing?

Wound assessment and choosing and appropriate dressing

Wound dressings

Topical negative pressure therapy

Detecting and modifying inflammation

Dressings replacing or restoring the extracellular matrix

Conclusion

Am J Infect Control

J Hosp Infect

Evidence-based wound care in the UK

Int Wound J

Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig

Nature

A new methodology for costing wound care

Int Wound J

Wound healing
Wound dressings: principles and practice