Wound care part 4. Dressing
Over the last 3 weeks we have gone over the identification, cleaning and closing of wounds. This week we tackle the last part. Dressing the wound. Dressing is probably the most important part. Why you ask? Even if you stop the bleeding, find all the wounds, clean the wound and close the wound, if you fail on the dressing, you have more than likely condemed you patient to an infection.
When you close a wound all you do is bring the damaged tissues together. Until the skin heals there is no protection to the delicate tissues underneath. If you used steri strips or the skin glues then the danger of infection is reduced but not eleminated. Sutures and staples leave 2 new entrances for each staple or stitch.
No single dressing is suitable for all types of wounds. Often a number of different types of dressings will be used during the healing process of a single wound.
Dressings should perform one or more of the following functions:
Maintain a moist environment at the wound/dressing interface
Absorb excess exudate without leakage to the surface of the dressing
Provide thermal insulation and mechanical protection
Provide bacterial protection
Allow gaseous and fluid exchange
Absorb wound odor
Be non-adherent to the wound and easily removed without trauma
Provide some debridement action (remove dead tissue and/or foreign particles)
Be non-toxic, non-allergenic and non-sensitising (to both patient and medical staff)
Sterile
Seems like a lot for a simple cover doesn’t it? By not knowing the ins and outs of dressings sometimes a poor dressing will make good wound treatment for naught. As you can see the days of a a gauze 4×4 and some tape is long gone. We use litterally a different dressing for EACH type of wound. Lets cover the basic dressings that will cover and overlap most wound types.
Classification of wound dressings
Synthetic wound dressings can be broadly categorized into the following types.
Type Properties
Passive products Traditional dressings that provide cover over the wound, e.g. gauze and tulle dressings
Interactive products Polymeric films and forms which are mostly transparent, permeable to water vapour and oxygen, non-permeable to bacteria, e.g. hyaluronic acid, hydrogels, foam dressings
Bioactive products Dressings which deliver substances active in wound healing, e.g. hydrocolloids, alginates, collagens, chitosan, keratin and silver
Wound types and dressings
The following table describes some of the many different types of wound dressings and their main properties.
Dressing type
Gauze: Dressings can stick to the wound surface and disrupt the wound bed when removed
Only use on minor wounds or as secondary dressings.
| Wound type | Dressing type | |
|---|---|---|
 |
Clean, medium-to-high exudate (epithelialising) |
|
 |
Clean, dry, low exudate (epithelialising) |
|
 |
Clean, exudating (granulating) |
|
 |
Slough-covered |
|
 |
Dry, necrotic |
|
Telfa ® Non stick dressing.
Dressing does not stick to wound surface. Suitable for flat, shallow wound. Useful in patient with sensitive skin.
Semipermeable film
Sterile sheet of polyurethane coated with acrylic adhesive
Transparent allowing wound checks Suitable for shallow wound with low exudate. Tegaderm®
Hydrocolloids
Composed of gelatin, pectin, elastomers and adhesives that turn into a gel when wound fluids is absorbed. This creates a warm, moist environment that promotes debridement and healing
Depending on the hydrocolloid dressing chosen can be used in wounds with light to heavy draining wounds, sloughing or granulating wounds
Available in many forms (adhesive or non-adhesive pad, paste, powder) but most commonly as self-adhesive pads
E.g. DuoDERM®, Tegasorb®
Hydrogels
Composed mainly of water in a complex network or fibres that keep the polymer gel intact. Water is released to keep the wound moist
Used for necrotic or sloughy wound beds to rehydrate and remove dead tissue. Do not use for moderate to heavily exudating wounds
E.g. Tegagel®, Intrasite®
Alginates
Composed of calcium alginate (a seaweed component). When in contact with wound, calcium in the dressing is exchanged with sodium from wound fluid and this turns dressing into a gel that maintains a moist wound environment
Good for exudating wounds and helps in debridement of sloughing wounds
Do not use on low exudating wounds as this will cause dryness and scabbing
Dressing should be changed daily
E.g. Kaltostat®, Sorbsan®
Credit for the dressing tables to Derm Net New Zealand http://www.dermnetnz.org/procedures/dressings.html
These modern dressings, in the modern world have cut infections drastically. But if you are out in the middle of no where or SHTF, Zombie attack etc. You know that the new items work, but what do you do with out? Well we have options that are not mainstream medical devices.
Pectin (Yup the same stuff you use to an jelly and jams) added to a wound or sugar free additive free gelatin. (The one in the Chinese food asle). This added to a wound prior to dressing will do the same a a Hydrocolloid style dressing.
Those that live near the coasts and can find brown seaweed. Seaweed has been called, ” The Marinars Cure” Another techinque is to use pulverised seaweed and mix with Aloe Vera juice to form a paste. back to the Chinese fod asle,
Agar Agar, is powdered seaweed. Just be carefull to avoid the colored flavored and if possible the bleached varities. For folks that are land locked, freshwater seaweed is NOT the same. The majority are actually algae and will cause a bad infection.
One item thatis extremely useful for its antimicorbial properties is Collidial Silver. We use silver impregnated dressing all the time in the hospital setting. A silver soaked dressing will go a long way to prevent infection.
Antibacterial salves.
Neosporin® is a great topical antibiotic. But its one that can cause an infection if the directions are not folowed. Wounds need to have dressing changed at least every 24 hours. Neosporin placed on the wound, and after about 24 hours of exposure to air it breaks down the active ingredients.What us left is a petrolium base that attracts dirt and bacterial. With out the active ingreidients you just seal in the bacteria and make the perfect enviroment to grow.
In the suture news letter we talked about wicking.Where the braided suture acts like a wick and draws in outside contaminiamts in to the wound. Strike through is the term here. When a wound oozes thought the dressing and is visable on the outside of the dressing that is a direct route to the wound. Neosporin type topical ointments that are left on to long and the active ingrediant breaks down can cause infection by strike through.
Herbal based salves.
The same restrictions that apply to the store bought salves apply here. Change often and apply liberaly is the key.
My personal favorite is one table spoon of Calendula, Yarrow Chaperral and Thyme dried herb. 8 ounces of coconut oil and enough beeswax to hold together at warm temps. I use the crock poit method on warm and let it heat at 110 degs for 4 or so hours strain through a wire mesh, re warm and then a papertowel, coffee filter etc.
Earlier we talked about the non stick dressing. Telfa. If a long enough situation happens and telfa isnt avaiable then the application of ointments or your home made Hydrocolloids or Alginates to a gauze pad will help reduce the sticking. Also bandages made of linen and coated work better against the wound vs gauze pads.
Now that the wound is covered its time to consider if any addtional protection is needed. Most minor cuts scapes and punctures can do well with just the primary dressing. Moderate to severe wounds need more protection besides to primary. Here is where rolled gauze comes in handy. By padding the wound further damage or injury will prevented.
Wound care as you all can see by this series of news letters is much more than the Wipe it off and put a bandaid on it. That make work for
The key points here are :
Maintain a moist environment at the wound/dressing interface
Absorb excess exudate without leakage to the surface of the dressing
Provide thermal insulation and mechanical protection
Provide bacterial protection
Allow gaseous and fluid exchange
Absorb wound odor
Be non-adherent to the wound and easily removed without trauma
Provide some debridement action (remove dead tissue and/or foreign particles)
Be non-toxic, non-allergenic and non-sensitising (to both patient and medical staff)
Sterile.
On last point. The homemade Hydrocolloids and alganates. These should be as sterile as possible. One method I have used is to spread them out on a cookie sheet and bake the powders at 250-275 deg F for about 30 minutes. Then using sterilzed vacuum seal bags and a sterile spoon add in the powders to the bags and then seal. To sterileze the vaccum seal bags, I choose then ones that can be boiled and microwaved. I pre make the pouches and boil them covered for 20 minutes then they are shaken to removed most of the water. I then add in some Everclear, shake the bg nd pour out, The Alcohol removes the water and takes care of what the boiling water didnt take care of.
Wound care is a LOT more than putting a bandaid on a wound and hoping for the best. By using the knowledge we have gained over the centuries we can give a person with a bad wound a fighting chance to survive and thrive.
And don’t forget to check out the Medic Shack Home page. We have a multitude of classes to suit all levels of medical preparedness
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