SURGICAL DRESSINGS

Wound-care materials come in a wide variety of product classes, including the following:

Alginate dressings. These are derived from brown seaweed and contain calcium alginate, which turns into a sodium alginate gel when it comes in contact with wound fluid. They are available as pads or ropes.  These dressings are used on wounds that exude moderate to heavy amounts of fluid. They are useful for packing wounds, although strip-packing gauze may be preferable for deeper wounds because it is easier to retrieve.  Common applications of alginate dressings include treatment of acute surgical wounds, leg ulcers, sinuses, and pressure sores. These dressings should not be used on third-degree burns. Neither are they advisable for wounds that are dry or are secreting only small amounts of fluid, because their powerful absorbing capability may dry out the wound. These are primary dressings that need be covered by a secondary dressing.

Biosynthetic dressings. These are composites of biological (often animal-derived) and synthetic materials such as polymers.  These dressings are used on burns and other wounds.  Some persons may be allergic to these dressing materials.

Collagen dressings. These are made from collagen, a protein obtained from cowhide, cattle tendons, or birds. They are available as particles or gels.  These dressings are commonly used to  hasten wound repair and are often used on stubborn wounds.  They are most effective on wounds that contain no dead tissue. Collagen dressings should not be used in dry wounds, third-degree burns, or on any patient who is sensitive to bovine (cow) products.

Composite dressings. These are similar to plastic adhesive strips and include an adhesive border, a non-adhesive or semi-adhesive surface that is applied to the wound, an absorbent layer, and a bacterial barrier.  These dressings are sometimes used alone and sometimes in combination with other dressings.  Deep wounds should first be packed with wound-filler material.  These dressings should not be cut, and are not recommended for use on third-degree burns.

Contact layers. A low-adherent layer of perforated or woven polymer material designed to stop a secondary absorbent dressing from sticking to the surface of a wound.  Contact layers are designed for use in clean wounds that contain no dead tissue. They are not recommended for infected, shallow, dry, or infected wounds, or on third-degree burns.

Gauze. This woven fabric of absorbent cotton is available in a number of formats and materials, including cotton or synthetic, non-impregnated, and impregnated with water, saline, or other substances. Gauze is sold as surgical swabs, sheets, rolls, pads, sponges, and ribbon.  Gauze is used to pack wounds and also for debridement and wicking.  It is especially desirable for packing deep wounds. When using gauze to pack wounds, a loose packing technique is preferred.

Growth factors. These short-chain proteins affect specific target cells. They exist naturally in humans, and can be transplanted from one part of the body to another or manufactured outside the body.

Hydrocolloid dressings. Used for leg ulcers, minor burns, pressure sores and traumatic injuries, these self-adhesive dressings form a gel as they absorb fluid from the wound. They consist of materials such as sodium carboxymethylcellulose (an absorbent), pectin, and gelatin that are attached to a foam sheet or a thin polyurethane film.  Hydrocolloid dressings are used for leg ulcers, minor burns, pressure sores, and traumatic injuries. Because they are not painful to remove, hydrocolloid dressings are often employed in pediatric wound management. Because of their absorbent capabilities, they are used on wounds that are secreting light to moderate amounts of fluid.

Hydrofibers. Similar in appearance to cotton, carboxymethylcellulose fibers turn into a gel when they come into contact with wound fluid. They are available as ribbons or pads and are highly absorbent.  Hydrofibers are highly absorbent, so they are particularly useful for wounds that are draining heavily.  For this reason, they are not recommended for dry wounds or wounds with little secretion, because they may result in dehydration. Hydrofibers should not be used as surgical sponges or on third-degree burns.

Hydrogels. These are sold as sheets and in gel form, and are primarily used to supply moisture to wounds. Depending on the state of the tissue, they can either absorb fluid or moisten the wound. An electrically conductive aloe vera gel is available to provide electrotherapy to wounds.  Hydrogels are often used on wounds that contain dead tissue, on infected surgical wounds, and on painful wounds. They should not be used on wounds with moderate to heavy secretions. As with all dressings, it is important to check and follow the directions of the manufacturer. In the case of hydrogels, directions on some products indicate they are not to be used on third-degree burns.

Hydropolymers. These foamed-gel products consist of multiple layers. The surface layer is designed to expand to fill the contours of a wound and, at the same time, draw away fluids.  Hydropolymers are typically used on wounds with minimal to moderate drainage. They are not indicated for dry wounds or third-degree burns.

Leg compression/wrapping products. These are designed to apply external pressure to improve blood flow and resolve chronic edema in the feet and legs. They are available in a broad range of formats, including stockings, compression bandages, or pneumatic pump.  Leg compression/wrapping products are used to increase blood flow and reduce edema in the lower extremities of the body. A medical doctor should be consulted before using these products on people with edema. In many cases, topical dressings are used under these products.

Polyurethane foam dressings. These are sheets of foamed polymer solutions with small open chambers that draw fluids away from the wound. Some of these foam products offer adhesive surfaces. They are available as sheets and rolls, as well as in various other formats suitable for packing wounds.  Polyurethane foam dressings are very absorbent and are typically used on wounds with moderate to heavy secretions. They should not be used on third-degree burns or on wounds that are not draining or that have sinuses or tunneling.

Superabsorbents. These are particles, hydropolymers, or foams that act like the material inside diapers, with a high capacity for rapid absorption.  Superabsorbents are employed on wounds that are secreting heavily, or in applications requiring extended wear. A packing material is commonly employed under this product. Superabsorbents should not be used on third-degree burns or wounds that are either dry or have minimal secretions.

Transparent films. These consist of a thin, clear polyurethane sheet that, on one side, has a special adhesive that does not stick to moist surfaces like those found on a wound. They prevent bacteria and fluids from entering the wound through the dressing, but allow limited circulation of oxygen.  Transparent films are often employed as a secondary cover for another, primary dressing. They are used on superficial wounds and on intact skin at risk of infection. It is important to remove transparent films very carefully to avoid damaging fragile skin.

Other assorted wound-care products. These include adhesive bandages, surgical tapes, adhesive skin closures, surgical swabs, paste bandages, specialty absorptive dressings, support bandages, retention bandages, elasticized tubular bandages, lightweight elasticized tubular bandages, foam-padded elasticized tubular bandages, and plain stockinettes.

Recommended intervals between dressing changes vary widely among product classes. The materials used in some dressings require that they be changed several times a day. Others can remain in place for one week.  Manufacturer's directions should be consulted and followed.Please insert your text here.