When selecting a dressing for autolytic debridement, observe the patient’s wound characteristics to help make the best choice.
First, check the appearance of the wound bed. Determine what type of tissue is exposed and whether the volume of exudate is small, moderate, or large. If the wound is being packed, how many dressings does it soak?
Next, inspect the wound depth. Match the type of dressing to the depth of the wound. For shallow wounds, use a transparent film or hydrocolloid dressing. For deep wounds with cavities, a transparent film dressing should not be used. Instead, a foam or alginate dressing is a better choice. The cavities of deep wounds should be filled with an absorbent product.
The secondary or outer dressing must be able to remain in place until the next scheduled dressing change. Transparent films will lift off prematurely with moderate to large amounts of drainage from the wound.
Lastly, check the condition of the periwound skin. Is the skin around the wound macerated? Can a dressing with adhesive properties be used, or is a dressing that will not stick and damage the surrounding skin needed?
If the patient’s skin is sensitive to tape or the dressing needs to be changed often, use strips of hydrocolloid dressing to create a window around the wound. Apply tape to these strips rather than to the skin to reduce irritation.
Adapted from Ayello E, Baranoski S, Kerstein M, Cuddigan J. Wound debridement. In: Baranoski S, Ayello EA, editors. Wound Care Essentials: Practice Principles. Springhouse, PA: Lippincott Williams & Wilkins; 2004. p 122.