Dressing Selection and Topical Therapy
Match the dressing to the wound
Decide from four questions: how much exudate, what tissue is in the bed, is it infected, and how deep is it? Add periwound condition, pain at dressing change, cost, and patient preference.
Categories
- Transparent films: no exudate, partial-thickness, autolytic; avoid on infected or heavily draining wounds.
- Hydrocolloids: light to moderate exudate, form a gel; avoid on infected wounds and diabetic foot ulcers.
- Hydrogels: dry or sloughy beds needing moisture; not for heavily draining wounds.
- Foams: moderate to high exudate, absorbent and cushioning; silicone versions protect fragile skin.
- Alginates and hydrofibers: high exudate and bleeding control; need moisture to function and are not for dry beds.
- Contact layers: atraumatic and nonadherent, useful under compression or on painful fragile skin.
- Specialty: charcoal for odor, superabsorbents for heavy drainage, topical antimicrobials for localized infection, cyanoacrylate or zinc products for periwound protection.
Adjuncts and cautions
Negative pressure wound therapy can help clean, perfused, exudative wounds but is contraindicated over malignancy, untreated osteomyelitis, exposed vessels or organs, and non-enteric fistulae. Avoid adhesives on fragile skin and never leave a dressing in place past its saturation point.
Traps
- Hydrogel on a wet wound; alginate on a dry one.
- Occlusive films or hydrocolloids over infection.
- Using gauze as a primary dressing and desiccating the bed.
- Changing dressings by habit rather than by saturation or wear time.
Rule of thumb
Dry: add. Wet: absorb. Dead: debride. Dirty: treat. A shallow, heavily draining venous ulcer with intact periwound skin gets a hydrofiber or foam under compression, plus a skin protectant to the surrounding skin.