Saturated foam dressings can cause maceration of healthy skin if left in contact with the wound. Foam and low adherence dressings during granulation stage. Managing wound exudate and controlling maceration are key to wound healing. It follows, therefore, that for some wounds, but by no means all, optimal wound management may involve the sequential application of a number of ideal dressings that are selected according to the condition of the wound as it progresses towards healing. Superabsorber dressings can be an appropriate solution to effectively contain excessive exudate and manage symptoms including. Dressings and the prevention of maceration and other forms of moisturerelated skin damage. Traditionally wettodry gauze has been used to dress wounds. In a moist wound environment they attract and irreversibly bind wound bacteria and fungi butcher, 2011 due to the coating of dacc. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including. The causes and prevention of maceration of the skin. Inappropriate dressing selection may also cause skin maceration in the diabetic foot. Films are not absorptive dressings, and skin surrounding the wound may macerate if fluid is allowed to collect under the film.
The algivon plus dressings contain 100% manuka honey which makes it an ideal choice for wet wounds, ulcers, and burns. Tubular bandages can also be used to secure a non adherent dressing. Managing wound pain in patients with burns using soft silicone dressings. When applied to dry wounds, as well as sloughing or necrotic wounds, they can make and keep them clean by. Wounds uk supplement 4 wounds uk, 2008, vol 4, no 2 wounds uk, 2008, vol 4, no 2 5 the increased risk of infection.
Maceration occurs when skin is in contact with moisture for too long. Cutimed sorbact dressings however, have been proven to be safe to use for longer periods due to the unique mode of action haycocks, 2011. A good understanding of how wounds heal, the dressings available and how they work should enable nurses to make an appropriate selection. Treatment of wounds with heavy or purulent drainage. The duoderm dressing is indicated for wounds, including diabetic ulcers, pressure ulcers, surgical wounds, traumatic wounds, and seconddegree burns. It is not recommended for wounds that are not excessively draining or the ones with eschar. Types of wound dressings currently used to promote optimal. Wounds uk, 2005, with kind permission of the publishers.
If there is too little exudate retained in a wound, the dressings will start to adhere to the wound bed, causing pain and damage to the granulation tissue at dressing changes. Foam dressings wound management bnf content published. Foam dressings are frequently used in wound care to assist with the management of wound exudate, helping to prevent maceration of the wound bed, protect the surrounding skin and prevent crossinfection. In addition, the wound will tend to become sloughy or necrotic, as the irrigating effect of the exudate is lost. These are nonabsorbent and waxcoated, making them both airtight. An evaluation of allevyn adhesive and nonadhesive foam.
Alginates are not suitable for dry wounds since they can stick to the wound and cause trauma when removed. Allevyn is a range of moist wound environment dressings designed specifically for the management of chronic and exuding wounds. Wound dressings have been used to clean, cover, and protect the wound from the external environment. Hampton s 2015 selecting wound dressings for optimum healing. The final article in the series is about wound complications and how to deal with them. Superabsorbent dressings are designed to absorb and retain exudate. Tulle dressings can be extended out to 5x15, 10x30. If not managed effectively, exudaterelated problems may lead to periwound maceration, increased infection risk and poor patient compliance due to a loss of confidence in the treatment wounds international, 2012. Maceration, excessive wound exudate and skin stripping are discussed below. Highly absorbent dressings and continence pads should be used to draw moisture away from the skin and should be changed frequently. The reinforced alginate fibres in algivon plus release the honey in a slow and sustained manner to maintain the integrity of the dressing. This is a parallel group, randomized controlled trial to compare the early outcomes of postoperative wounds around the hip and proximal thigh dressed with povidoneiodine soaked gauze dressings. Bacteria levels in the wound are reduced through absorption of the exudate into the dressing.
If used under compression bandaging or compression garments, the fluidhandling capacity of the foam dressing may be. Tulle dressings impregnated with honey are suitable for shallow wounds. Maceration of the skin around wounds is a common wound care problem. When applied to the skin or wound, they feel cool and. Our advanced dressings are developed through open, ongoing conversations with end users and healthcare professionals. This principle also applies to dfu refer to diabetic foot team for advice. What are the different types of wound care dressings. The type of dressing used for dressing a wound should always depend on various factors, including the type of injury, the size, location, and severity. Effective exudate management can reduce time to healing, reduce dressing change frequency, and nurse input, thereby optimising healthcare efficiency. Concerns of increased risk of infection under occlusive dressings have not been substantiated in clinical trials. Alginate, hydrocellular foam and hydropolymer dressings are all effective in managing wound exudate young, 2000. Best management of exudate and maceration nursing in. Low adherent dressingssuitable for use on flat, shallow wounds with low exudates low adherent dressings are cheap and widely available. These factors can adversely affect patients quality of life and have cost implications for healthcare providers.
Protecting the integrity of the periwound skin wounds uk. Hydrogel wound dressings are 80% to 99% waterorglycerinbased wound dressings that are available in sheets, gels, or impregnated gauzes. Seemingly every week, practice nurses receive flyers advertising new wound dressings. Julie smith takes us back to basics, and explores the physiology of exudate and methodology of. These are sterile gauze pads and bandages that absorb extra moisture. Wounds uk, aberdeen dealey 2006 the physiology of wound healing. Alginate dressings also act as a haemostatic, but caution is needed because blood clots can cause the dressing to adhere to the wound surface. A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds. Algivon plus is an alginate dressing impregnated with honey. Management of these complex wounds therefore requires a. How to select a wound dressing the pharmaceutical journal. In the uk between 2012 and 20, for example, it is estimated that 2. Hydrogels can only absorb a minimal amount of fluid.
There are several ways of preventing exudaterelated damage to. We want patients with nonhealing wounds to be free of pain and discomfort and make their life easier. Antimicrobial dressings for wound contamination antibiotics only for infected wounds not just colonizedcontaminated cultures not generally recommended because all wounds are contaminated if culture indicated, cleanse wound bed with saline, then express drainage from wound bed. Responses should vary based on the need of the patient, the type and location of the wound and what stage of the healing process the wound is in.
A wound dressing must provide a moist environment, remove the excess of exudate, avoid maceration, protect the wound from infection and maintain an adequate exchange of gases. Inadequate dressings can lead to leakage and may be bulgy and. This article describes wound dressings currently available in the uk. With the myriad of dressings available, dressing selection can be a challenging and complex process. To avoid maceration and optimise healing, the exudate and moisture levels should be assessed regularly and appropriate dressings chosen, with realistic wear times estimated for each wound at each dressing change. Moisture under occlusive dressings not only increases the. Debridement is not advised for pressure ulcers to heels in the absence of good arterial circulation as the risk of infection in these cases outweighs the delayed healing wounds uk, 20. But since they contain high waterglycerin content they are able to donate moisture to dry wounds.
Dressings that create and maintain a moist environment, however, are now considered to provide the optimal conditions for wound healing. A collagen dressing can be used for chronic or stalled wounds, ulcers, bed sores, transplant sites, surgical wounds, second degree or higher burns and wounds with large surface areas. A few of the common downsides to foam dressings include the requirement of a separate dressing that keeps it in place, failure to change the dressing on time may lead to periwound maceration. Evidencebased practice in wound care and, indeed, all aspects of health policy are part of 21st century medicine. Alginate dressings are highly absorbent and suitable for use on exuding wounds, and for the promotion of autolytic debridement of debris in very moist wounds. Regardless of the approach used, when the necrotic eschar eventually separates from the healthy tissue, it leaves a wound. A balance must be struck in treatment between containing heavy drainage and preventing maceration and maintaining a moist wound environment. The role of dressings in the treatment of moisturerelated skin damage. Benbow 2010 suggests that wound and dressingrelated pain is underestimated and poorly managed and may lead to extended healing times. Alginate dressings are used for moderate to high amounts of wound drainage, venous ulcers, packing wounds and pressure ulcers in stage iii or iv. They control exudate well, and are comfortable because of their pliability and low adherent properties. Wounds with heavy or purulent drainage woundsource. This is exacerbated by the fact that many affected areas are difficult to dress, for example, those that are adjacent to wounds, in the perianal margin or around. Depending on the amount of seepage youre experiencing, your doctor may recommend that you change to a hydrofiber dressing which wicks the fluid discharge away from the wound or an alginate dressing a carbohydratebased biofilm designed to absorb heavy wound discharge.