WOUND
DRESSING
BY
DR.ARCHANA JHA
PLASTIC SURGERY
07/04/2022
OUTLINE
• INTRODUCTION
• TYPES OF WOUND DRESSING
• CLASSES OF WOUND DRESSING
• APPERANCE OF WOUND/CHOICE OF DRESSING AGENT
• SELECTION OF WOUND DRESSING
• BENEFIT OF WOUND DRESSING
• PREPARATION OF WOUND DRESSING MATERIALS
• STEPS OF WOUND DRESSING
• CARE OF THE PATIENT AND MATERIALS
• CONCLUSION.
INTRODUCTION
• A wound is a break or cut in the continuity of any body structure, internal or
external caused by physical means.
• Wound dressing is a sterile protective covering applied to a wound/incision
with aseptic technique with or without medications.
• Classification of wound:
• According to status of skin integrity
Open wound
Closed wound
• According to the cause of the wound
intentional or surgical wound
unintentional wound
• According to severity of injury
abrasion wound
Penetrating wound
Perforated wound
Puncture or stab wound.
• According to cleanliness/ contamination
clean wound
clean contaminated wound
Contaminated wound
Dirty wound
TYPES OF DRESSING
1) Dry dressing;
It is used in clean sutures, operated wounds.
They can be changed after certain intervals.
2) Wet dressing;
They are made wet by using jelly, paraffin, antibiotic solutions, etc.
They are to be changed from time to time, and are used in ulcers commonly
CLASSES OF WOUND DRESSING
• Non-adherent fabrics
• Absorptive dressings
• Occlusive dressings
• Creams, ointments and solutions.
NON-ADHERENT FABRICS
• Used for protection and it creates moist environment.
• Non-adherent fabrics are fine-mesh guaze with supplement to augment
occlusive properties with good antibacterial characteristics.
• Examples; scarlet red, Vaseline guaze, xeroform.
ABSORPTIVE DRESSINGS
• Absorptive dressings are used for wounds that have significant amount
of exudate or wound with high bacterial counts. It will thus reduce the
bacterial load within the wound while removing the exudate produced.
1) Absorptive gauze; these are wide mesh gauze which help in removing
exudates and prevent maceration. Examples; wide-mesh gauze.
2) Foams; these are hydrophobic polyurethane sheets that provide
protection and absorption of exudate. Examples; Lyofoam, curafoam.
OCCLUSIVE DRESSINGS
• Occlusive dressing will help to enhance the rate of epithelization twice as
that of a wound that is left uncovered.
• Placement of an occlusive dressing over the wound provides a mildly acidic
PH and low oxygen tension on the wound surface, which is a good
environment for the proliferation of fibroblasts and formation of granulation
tissue.
• Occlusive dressings could be;
1) Biological; homograft, xenograft, skin substitutes
2) Non-biological; films, hydrocolloids, hydrogels.
CREAMS, OINTMENTS AND SOLUTIONS
• Solutions; acetic acid, povidone iodine, silver nitrate, silver sulfadazine.
• Ointments; bacitracin, neomycin, polymyxin B sulfate.
• Others; normal saline, EUSOL, Honey.
HYDROGEL
• Absorbs 5 times own weight
Hydrophilic polysaccharide particles
• Cooling soothing effect
• Facilitates autolytic debridement
• Delivered in many forms
amorphous gel, sheets, strands
• Can stay in place for 24hours
• Indications; mildly exuding wounds, clean wounds, partial thickness
wounds.
HYDROCOLLOID
• Absorbency and film dressing
Highly absorbent gel (polyurethane)
Oxygen and water vapor permeable
• Adhesion and elasticity
• Bacterial barrier
• Allows for autolytic debridement
• Can stay in place for 72hours
• Indications; venous ulcers, pressure ulcers, diabetic ulcers, 1st and 2nd degree
burns.
CALCIUM ALGINATES
• Absorbs up to 30times weight
• Comes in many forms
sheets, tubes, loose fibers packs.
• Maintains a moist wound environment
• Can stay in place 24 to 72 hours.
• Indications; wound with large amount of drainage.
FOAM
• Highly absorbent (20 times weight)
Non adherent wound contact layer, hydrocellular foam, water proof
outer layer.
• Allows for autolytic debridement and gaseous exchange
• Can be left in place for 72 to 96 hours.
• Indications; highly exudative wound requiring a non-stick surface (e.g
venous stasis).
ENZYMATIC DEBRIDEMENT
• Indications; a wound requiring debridement of fibrinous exudate,
other necrotic material or slough
• Removes; senescent fibroblast (i.e cant produce cytokines or
collagen), necrotic tissue harboring bacteria.
ANTIMICROBIALS
• Indications; infected wounds, wounds with bacterial counts greater
than 105
• Antimicrobials include;
Silvedene
Sulfamylon
Acticoat
Iodoflex
Polysporin/bacitracin
APPERANCE OF WOUND
• Wound with clean granular base
• Wound with carter
• Wound with necrotic/ non-viable tissue
• Wound with exudate
• Wound with sinus, tunnel, undermining
• Wound with infection
Wound with clean granular base
• Objectives; protect & keep moist
• Treatments;
Hydrocolloid
Hydrogel
Vacuum assisted closure(VAC) device
WOUND WITH CRATER
• Objective; fill the space with uniform contact
• Treatments;
Hydrocel
Algantes
Foam
Hydrocolloid
Vacuum assisted closure (VAC) device.
WOUND WITH NECROTIC/NON-VIABLE
TISSUE
• Objective; Debride and cleanse
• Treatments;
Enzymatic dressing
Hydrogel dressing
Calcium alginates
Pulse irrigation
Vacuum assisted closure (VAC) device
Hypertonic salts
WOUND WITH EXUDATE
• Objectives: Absorb and contain
• Treatments:
Alginate
Foam
Vacuum assisted closure (VAC) device.
WOUND WITH SINUS, TUNNEL,
UNDERMINING
• Objectives; prevent pre-mature closure, absorb exudate
• Treatments: loose packing
Impregnate guaze with hydrogel
Calcium alginate if high drainage
Vacuum assisted closure (VAC) device.
WOUND WITH INFECTION
• Objectives: Decrease local bacterial count
• treatments:
Pulse irrigation
Long-acting time-release antibiotic
Short-acting antibiotic or antimicrobial
Vacuum assisted closure (VAC) device.
SLOW HEALING WOUNDS
• Tropical negative pressure
• This therapy involves the controlled application of sub-atmospheric
pressure to the local wound environment, using a sealed wound dressing
connected to a vacuum pump.
• The continued vacuum draws out fluid from the wound and increases
blood flow to the area.
• The vacuum may be applied continuously or intermittently, depending on
the type of wound being treated and the clinical objectives
• Typically, the dressing is changed two to three times per week.
KEYS TO SELECTING DRESSINGS
• Must use clinical judgment
• Keep wound bed continuously moist
• Keeps surrounding skin dry
• Control exudate without desiccating (drying out) wound bed
• Caregiver time
BENEFIT OF WOUND DRESSINGS
• To prevent infection
• To prevent further tissue damage
• To promote healing
• To absorb inflammatory exudate and to promote drainages
• To convert the contaminated wound into a clean wound
• To prevent hemorrhage
• To prevent skin excoriation
• To apply medication in place.
PREPARATION OF
MATERIALS/EQUIPMENTS
•Sterile tray
• Unsterile tray
• Topical agents for cleaning wound
STERILE TRAY
• Artery forceps : to clean the wound
• Dissecting forceps :
• Scissors : for debridement or to cut gauze
• Sinus forceps: to open or pack the sinus tract
• Safety pins: to fix the drain in case the drains are cut short
• Small bowl: to take the cleaning solution
• Gloves, mask and gown: used during large wound dressing
• Cotton balls, gauze: to clean and dress the wound
• Slit or dressing towel: to create a sterile field around the wound.
UNSTERILE TRAY
• Cleaning solution: to clean the wound and surrounding skin
• Ointment and powder: to be applied on the wound
• Vaseline gauze in SC: to prevent the dressing adhering to the tissue
• Ribbon gauze in SC: to pack the sinus tract or a penetrating wound
• Swab stick in SC: to apply medication if necessary
• Bandages, binders, pins: to fix the dressing in place
• Bowl with disinfectant solution: to discard the used instruments
• Kidney tray: to collect wastes
• Mackintosh and towel: to protect the bed linens
*SC: sterile container
TOPICAL AGENTS FOR CLEANSING
WOUND
• Mercurochrome 1 to 25% : skin antiseptic.
• Povidone iodine :
• Savlon 5% :
• Normal saline : non irritating antiseptics used for cleaning wounds
• Eusol solution:
• Hydrogen peroxide 1.5 – 3%: it is an oxidizing agent useful for softening and
removing crusted exudate and debris.
• Acetone, ether, turpentine: used for removing adhesive marks from the skin.
• Honey
*Eusol= Edinburgh university solution.
STEPS OF THE PROCEDURE
• Tie the mask : to prevent wound contamination with droplets
• Wash hand thoroughly: to prevent cross infection
• Put on gown(if necessary), gloves: to ensure asepsis
• Open the sterile tray, spread the sterile towel around the wound: to create a
sterile field around the wound
• Pick up a dissecting forceps and remove the dressings and put into a kidney
tray: if the dressing is adherent to the wound, pour physiologic saline and
wet it before removal.
• Note the type and amount of drainage present
• Ask the assistant to pour small amount of cleansing solution into the bowl.
CONT…
• Clean the wound from center to periphery discarding each swab after each
stroke.
• After thoroughly cleaning of the wound, dry the wound with dry swabs.
Discard the forceps
• Apply medications if necessary: to apply ointment directly to the wound may
be difficult. Apply a small portion on the dressing that goes directly over the
wound.
• Apply the sterile dressings. Apply the gauze pieces first and then the cotton
pads. Reinforce the dressing on the dependent parts where the drainage may
collect: cotton placed directly onto the wound may stick on the wound when
the discharge dries. Reinforcing the dressing will prevent oozing of the
drainage onto the bed of the patient.
Cont…
• Remove the gloves and discard it into the bowl
• Secure the dressings with bandages or adhesive tapes.
AFTER CARE OF THE PATIENT AND
MATERIALS
• Patient should be dressed up and bedding changed if soiled.
• Remove the mackintosh and towel.
• Take all the equipments, materials and wastes to the utility room
• Wash hands
• Record the procedure; condition of the wound, type and amount of drainage,
condition of sutures.
• Asses the patient general well being
• Give medication(analgesics, antibiotics) and take samples for investigation, if
necessary.
CONCLUSION
• Wound dressing is an important aspect of wound care, as it aids
wound Healing.
• Proper wound dressing technique is paramount for re-epithelization
of tissue and restoration of function.
•THANK YOU
