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How to choose the right treatment and dressing for the wound

Calianno, Carol RN, CWOCN, MSN

Article: CE

Learn how to choose wisely from the more than 1,000 wound care products and interventions on the market.

Carol Calianno is a wound, ostomy, and continence nurse in the education department at Jeanes Hospital, part of Temple University Hospital System in Philadelphia, Pa. She’s also a part-time clinical instructor at Holy Family University, also in Philadelphia.

Pinpointing your patient’s problem can help you pick from the plethora of wound care products.

Identifying the cause of your patient’s wound, initiating the right interventions, and achieving your wound care goals can be very rewarding—and challenging. You’re faced with more than 1,000 wound care products and interventions, with new ones becoming available daily (see Commonly Used Wound Dressings). With the right information, you can help relieve your patient’s pain and stabilize or heal his wound. In this article, I’ll review basic wound types and how to manage them with the latest treatment options.

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The basics

The first step in wound care is to identify the factors that contribute to wound development. Chronic wounds are often caused by systemic and environmental factors. Complete a history and thorough physical assessment, including an assessment of the patient’s sensory and functional limitations, nutritional state, and continence and vascular status. During the course of treatment, these factors may need reassessment to identify changes that may affect wound healing.

Wound care isn’t just healing the wound; it’s healing the patient. To accomplish this, take a holistic approach to wound care. Identify the causative factors, then plan interventions to reduce, control, or eliminate them. Determine how well your patient understands his wounds and the factors that caused them, then help your patient become more involved in his healing.

Pain is a major factor in wound care. Patients with pain will be less willing to tolerate dressing changes or other interventions. Unrelieved pain can lead to limitations in movement and a decrease in general functional status. Providing analgesics to manage chronic and breakthrough pain is essential to managing the discomfort of the wound and the wound care interventions.

The next step is to provide appropriate local wound care. Your choice of dressings and interventions depends on the cause of the wound, type of wound, condition of the wound bed, depth of the wound, amount of drainage, and presence of infection. Dressings should provide adequate tissue hydration to support cell viability without overhydrating the wound bed. In addition to treating the wound, dressings protect the wound bed from trauma and contamination and shouldn’t damage surrounding tissue.

Regularly reassess your patient’s progress. If no improvement has been noted in 2 weeks, reassess the care plan and change it as needed.

Continuing patient education and encouragement is essential, especially during a long healing process. Patients can become discouraged and depressed when faced with a long recovery. Involving the patient’s family and community support systems, if possible, may relieve the patient’s anxiety and help the healing process.

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Assessing the wound

Your assessment will focus on these characteristics: wound measurement, appearance, exudate, and condition of the periwound skin. The findings can help you identify the type of wound and determine the right dressing for the wound.

  • Wound measurement. Measure length, width, and depth in centimeters. Measurements are usually obtained using a head-to-toe axis for length and a hip-to-hip axis for width. If this isn’t possible because the wound is large or irregularly shaped, document that the measurements were taken at the longest and widest parts of the wound. Depth is measured directly from the deepest point in the wound bed. Careful measurement of wound size is invaluable in evaluating the wound’s progress.
  • Appearance. Start your assessment at the center and work outward. A common method is to describe the color of the wound bed by percentages; for example, 70% red, 30% black. This is especially helpful when there’s uncertainty regarding the nature of the “red” tissue. Not all red tissue in a wound bed is a sign of healing. Granulation tissue presents as a red, vascular, and granular surface. Exposed muscle may appear pink to red, with a smooth surface. Yellow, tan, or gray tissue is devitalized and referred to as slough. Eschar is black or dark-brown devitalized tissue. Be sure to note the presence of tunnels or sinus tracts within the wound bed. Tunnels are larger and easily observed; sinus tracts are small, with a relatively narrow opening.

Assess the edges of the wound to determine if they’re fixed around the wound or if there is separation, if they are well defined or diffuse, if the edges are rolled under, or if there is new skin growth (epithelialization). Note scarring, callus formation (hyperkeratosis), and dry scaling. Undermining is a lifting of the skin margins around part or all of the wound, resulting in a pocket under the intact skin.

These factors can help you determine the age of the wound, if healing has started, or if pressure or infection is present.

  • Exudate. Assess the color, amount, consistency, odor, and nature of wound drainage (exudate) before choosing a dressing. Dressings absorb drainage or add moisture to a wound bed; some dressings do both.
  • Periwound tissue. Document the condition of the intact skin around the wound area. Assess for signs of infection, such as erythema, edema, induration, warmth, crepitus, and damage from previous dressings (such as skin tears from harsh adhesives). If the dressing can’t absorb all of the wound exudate, the periwound skin can be macerated.
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Common wound types

Many wounds have more than one etiology, but the most common types of wounds are caused by arterial or venous insufficiency, neuropathy, or pressure. Let’s take a closer look.

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Arterial wounds

Atherosclerosis is the most common cause of arterial wounds. Other causes include trauma and thrombosis. Initially, the wound may be misidentified as a skin tear or laceration or as caused by pressure from a shoe. However, because the underlying cause is chronic, the wound doesn’t heal.

Arterial wounds develop on the legs or feet distal to the narrowed or blocked artery. The patient may complain of leg cramps or pain when walking or when the legs are elevated. Patients typically have thin, hairless legs, with weak or absent peripheral pulses. Capillary refill time is prolonged around and distal to the wound area. The wound is typically small, well circumscribed, and partial to full thickness. The wound bed tends to be pale, with little or no inflammatory response and little to no exudate because of ischemia. Necrosis of the wound bed also is common, and eschar on the tip of one or more toes is a clear indication of impaired arterial perfusion. Wounds caused by arterial insufficiency often are extremely painful.

Interventions for arterial wound care depend on the extremity’s perfusion state: Until the arterial insufficiency is addressed, the wound won’t heal. Arterial vascular assessment is essential, and an antiplatelet regimen or surgical intervention may be indicated to improve arterial flow to the extremity.

When managing an arterial wound, follow these guidelines:

  • Use a dry dressing for dry, stable eschar on noninfected arterial wounds.
  • For moist or draining wounds, choose dressings that are changed frequently, to allow inspection of the wound bed.
  • Because you’ll need to assess the wound bed frequently, avoid dressings that are changed every 3 to 5 days, such as hydrocolloid dressings.
  • Monitor the wound carefully if moist dressings, such as hydrogels, are ordered.
  • Monitor wound and periwound areas regularly for subtle signs of infection.
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Venous wounds

Venous wounds are almost the exact opposite of arterial wounds: Instead of getting too little blood, the legs have too much because the damaged vein valves can’t adequately return blood to the heart.

Patients with chronic venous insufficiency often have pitting edema of the legs. Over time, the edema becomes firm and brawny as fibrin is deposited from the fluid leaking into tissue. Red blood cells leaking into the tissue release their hemoglobin, causing a gray-brown discoloration of the lower half of the calf, known as hyperpigmentation or hemosiderosis.

Venous wounds, the most common type of chronic leg wound, may begin as blisters, secondary to swelling, or evolve from a minor irritation, such as from a sock or scratching. Patients typically report their legs “feel heavy” and ache; they may have some relief with leg elevation. This is why a comprehensive history and physical assessment are key; more than 25% of patients with venous insufficiency also have arterial insufficiency. Compression therapy, the first-line choice for venous wounds, can’t be used in patients with coexisting arterial insufficiency.

Venous wounds often are large, with diffuse edges and yellow-white exudate. There may be a single wound or several wounds and a combination of partial- and fullthickness wounds. Wounds can occur from the ankle area to midcalf, but are most common near the medial malleolus. The wound bed is usually a combination of red, exposed tissue and slough, which can be loose or adhered to the wound bed. Necrotic tissue in the wound bed is rare, but it can occur with trauma to the wound site or coexisting arterial insufficiency. The periwound tissue often has thick crusts or scales and may be macerated from large amounts of exudate.

Patients often report dull, aching pain in their legs that intensifies with dressing changes and can be described as severe burning or stinging. Unless superficial nerves are exposed by the wound, patients may not have any pain.

Wound care is directed at absorbing exudate, removing the devitalized tissue, and protecting the wound from infection.

The first priority in venous wound treatment is to manage edema, usually with compression therapy. Multilayer or single layer wraps are used acutely to manage edema, therapeutic support stockings are used for maintenance therapy, and pneumatic pump devices may be used in the acute and maintenance treatment phases, as long as the patient doesn’t have arterial insufficiency. Dermatitis, scaling, and pruritus are common on the periwound area; local wound care management must include considerations to reduce irritant dermatitis and itching. A moisturizer may be used to relieve itching, but check the ingredient list to make sure it doesn’t include known irritants. For severe itching and dermatitis, a short-term topical steroid may be prescribed.

Follow these guidelines for caring for a patient with a venous wound:

  • Use dressings designed to absorb moderate to large amounts of exudate over open wound areas, such as hydrofibers (for example, Aquacel [ConvaTec], which is classified as an alginate by Medicare, but doesn’t contain seaweed derivatives), alginates, and foams.
  • Change dressings as needed to prevent exudate from leaking through the outer dressing and macerating periwound tissue.
  • Use compression therapy in conjunction with topical wound care to reduce edema and facilitate healing (single layer wraps: Circ Aid, SurePress, Setopress, Unna’s boot; multilayer wraps: Dyna-Flex, Profore).
  • Limit use of debriding agents (such as accuzyme and panafil, both from Healthpoint, and Collagenase Santyl ointment from Smith & Nephew, Inc.) to selected situations, then monitor carefully.
  • Avoid use of moisture-retentive dressings such as hydrogels.
  • Monitor wound and periwound areas regularly for signs of cellulitis and dermatitis.
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Neuropathic wounds

Although neuropathic wounds most commonly occur in persons with diabetes, they also can occur in patients with Hansen’s disease, spinal cord injury, and severe frostbite of the extremities. For more details, see Getting a Feel for Neuropathy.

Neuropathic wounds are most common over bony prominences and often occur on the foot below the ankle. The wounds are usually small and deep with thick callus formation at the wound edges (called hyperkeratosis). An infected wound may have thick, yellow slough and tan to black necrotic tissue in the wound bed. Noninfected wounds will have a red wound bed with a thick white-yellow callus formation encroaching over the wound bed. The amount and type of exudate depends on whether the wound is infected.

Remember that wounds with granulation tissue at the bases can become infected. Nonhealing wounds should be assessed for local tissue infection and osteomyelitis.

The first priorities in neuropathic wound treatment are to relieve pressure to the site and prevent infection. Bed rest and orthotic devices for the shoes can help relieve pressure; antibiotic therapy is given for infected wounds.

Follow these guidelines for managing the neuropathic wound:

  • Use dressings designed to absorb moderate to large amounts of drainage over open wound areas, such as hydrofibers or alginates.
  • Change dressings as needed to prevent exudate from leaking through the outer dressing and macerating periwound tissue.
  • Use pressure-relieving devices to reduce pressure to the wound site.
  • Chemical debridement agents can be used to remove slough from the wound bed, but regular sharp debridement usually is needed to minimize periwound callus formation.
  • Hydrogels can be helpful in maintaining a moist wound environment for wounds with little or no exudate.
  • Monitor wound and periwound areas regularly for signs of infection.
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Pressure ulcers

Pressure ulcers can be the most difficult and challenging wounds to care for. It’s important to remember that wounds covered with nonviable tissue can’t be staged. (For more information, see Assessing and Staging Pressure Ulcers.) Healing wounds can’t be reverse-staged because the healed defect does not have the same tensile strength or dermal and subcutaneous structures as noninjured intact skin.

The first priorities in pressure ulcer treatment are to relieve pressure to the site and prevent infection. After necrotic tissue is debrided , provide a moist wound environment. Fill the dead space in all cavity wounds. Never apply a flat wafer or dressing that leaves an open cavity under the dressing.

Remember that pressure ulcers won’t heal if the pressure isn’t relieved. Use body positioning and support surfaces on the bed and chair to support joints and keep skin surfaces from rubbing. Reposition the patient frequently if he’s immobile and keep the head of the bed at the lowest level safe for the patient, to reduce friction and shear from sliding down the bed.

Follow these guidelines for pressure ulcer care:

  • Use skin sealants over Stage I pressure ulcers or to protect the skin around open wounds (AllKare protective barrier, Hollister skin gel, No Sting barrier film, Skin-Prep protective dressing, SurePrep).
  • Use hydrocolloid dressings for shallow, noninfected pressure ulcers with small to moderate amounts of exudate.
  • Dressings designed to absorb moderate to large amounts of exudate include alginates, foams, and saline-impregnated gauze (for example, Mesalt).
  • Change dressings as needed to prevent exudate from leaking through the outer dressing and macerating periwound tissue.
  • As ordered, apply chemical debriding agents for slough on the wound bed.
  • Hydrogels can be helpful in maintaining a moist wound environment for wounds with little or no exudate.
  • Monitor the wound and periwound areas regularly for signs of infection.
  • Make sure that the patient is adequately hydrated and that his diet contains enough calories and protein to support healing.
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Other wound types

Here’s how to deal with some other common wounds:

Most surgical wounds are closed by sutures or staples and heal by primary intention. Wounds left open to heal by secondary intention (such as dehisced wounds) require a dressing to fill the dead space and a secondary dressing to cover the site. The type of dressing used to fill the dead space depends on the condition of the wound bed and the type and amount of drainage. Take care not to remove granulation tissue when removing the dressing.

The most common traumatic wounds are abrasions, lacerations, and skin tears. Care for these types of wounds is directed at preventing further trauma, closing wound edges to minimize scarring, and providing a moist healing environment.

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A good choice

By understanding wound etiology and the basic principles of wound healing, you’ll be able to choose which type of wound care product is best for your patient’s wound and can help optimize patient outcomes.

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Selected References

Bergstrom, N., et al.:Treatment of Pressure Ulcers. Clinical Practice Guideline, No. 15. Rockville, Md., U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Publication No. 95-0652, December 1994.
    Bryant, R. (ed):Acute and Chronic Wounds: Nursing Management, 2nd edition. St. Louis, Mo., Mosby, Inc., 2000.
      Calhoun, J., et al.: “Diabetic Foot Ulcers and Infections: Current Concepts,” Advances in Skin & Wound Care. 15( 1):31–42, January/February 2002.
      Goldman, R., Salcido, R.: “More Than One Way to Measure a Wound: An Overview of Tools and Techniques,” Advances in Skin & Wound Care. 15( 5):236–245, September 2002.
      Hess, C.: “Management of the Patient with a Venous Ulcer,” Advances in Skin & Wound Care. 13( 2):79–83, March/April 2000.
      Hess, C.: “Topical Products: Product Update 2002,” Advances in Skin & Wound Care. 15( 6):287–295, November 2002.
      Hunt, T., et al.: “Physiology of Wound Healing,” Advances in Skin & Wound Care. 13(Suppl., 2):6–11, March/April 2000.
      Krasner, D., et al. (eds):Chronic Wound Care: A Clinical Source Book for Healthcare Professionals, 3rd edition. Wayne, Pa., Health Management Publications, 2001.
        Kunimoto, B.: “Assessment of Venous Leg Ulcers: An In-Depth Discussion of a Literature-Guided Approach,” Ostomy Wound Management. 47( 5):38–49, May 2001.
        Ovington, L.: “Wound Care Products: How to Choose,” Advances in Skin & Wound Care. 14( 5):259–266, September/October 2001.
        Panel for the Prediction and Prevention of Pressure Ulcers in Adults:Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3. Rockville, Md., U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Publication No. 92-0047, May 1992.
          Snyder, R., Lanier, K.: “Offloading Difficult Wounds and Conditions in the Diabetic Patient,” Ostomy Wound Management. 48( 1):22–35, January 2002.
          Sussman, C., and Bates-Jensen, B. (eds):Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses. Gaithersburg, Md., Aspen Publications, 1998.
            Wound, Ostomy and Continence Nurses Society:Guideline for Management of Wounds in Patients with Lower Extremity Arterial Disease. Glenview, Ill., Wound, Ostomy and Continence Nurses Society, 2002.
              Wound, Ostomy and Continence Nurses Society:Standards of Care: Patients with Dermal Wounds: Pressure Ulcers. Costa Mesa, Calif., Wound, Ostomy and Continence Nurses Society, 1992.
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                Getting a feel for neuropathy

                All three types of neuropathy usually occur bilaterally, but the other physical changes vary.

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                The following changes can range from severe alterations in sensation to an insensate state:

                • burning, stabbing or shooting pain, usually relieved with walking
                • altered temperature perception
                • abnormal sensitivity to touch
                • paresthesia
                • hypersensitivity to normal tactile stimuli especially at night
                • absent ankle reflexes.
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                Atrophy of muscles in the feet cause shifting of the bones, leading to:

                • permanent flexion of toes (hammertoes)
                • flattening of the arch of the foot
                • gait changes.
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                • loss of skin temperature regulation; distal rubor without warmth
                • loss of sweat and oil gland function
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                Assessing and staging pressure ulcers

                Use this staging system that follows the recommendations of the National Pressure Ulcer Advisory Panel.

                • Stage I—a defined area of persistent redness (in light-skinned patients) or persistent red, blue, or purple colors (in darker-skinned patients). The skin is intact, but compared with surrounding skin may be warmer or cooler, feel firm or boggy, and have altered sensation such as pain or itching.
                • Stage II—a partial-thickness skin loss involving the epidermis or dermis and appearing as an abrasion, blister, or shallow crater.
                • Stage III—a full-thickness skin loss including damage or necrosis of subcutaneous tissue. Damage may extend to, but not through, the fascia. Adjacent tissue may be undermined.
                • Stage IV—a full-thickness loss with extensive skin damage, tissue necrosis, and possible damage to muscle, bone, tendons, or joint capsules. Sinus tracts and tunnels may be present.
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                Commonly used wound dressings

                By knowing which type of wound care product you need, you can select the specific product from your facility’s formulary. Remember that not all dressings in a product category are the same. Review the manufacturer’s product information and guidelines for safe application of all wound care products. The following information is a broad description of general product categories and isn’t meant to be inclusive.

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                Dry gauzes

                • Surgical wounds
                • Limit bleeding for first 24 hours after sharp debridement
                • Absorb exudate and wick drainage
                • Fill dead space
                • Secondary dressing
                • Protect dry gangrene area that can’t be debrided
                • Wounds that require a moist environment
                • Pain and bleeding of viable tissue
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                Wet-to-dry gauzes

                • Absorb exudate and wick drainage
                • Fill dead space
                • Debride moist necrotic wounds
                • Wounds that require a moist environment
                • Partial-thickness wounds
                • Pain and bleeding of viable tissue
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                Wet-to-moist gauzes

                • Infected wounds
                • Absorb exudate and wick drainage
                • Fill dead space
                • Debride necrotic wounds
                • Highly exudating wounds
                • Severe maceration of surrounding tissue
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                Transparent adhesive films

                Also called moisture vapor permeable dressings. Impermeable to bacteria and contaminants, they maintain a moist wound environment by trapping moisture on the wound surface.

                • Superficial wounds
                • Wounds with minimal exudate
                • Protection of intact skin
                • Moderate to heavily exudating wounds
                • Friable surrounding skin that can be injured by dressing removal
                • Wounds with sinus tracts
                • Full-thickness wounds

                Examples: Bioclusive (Johnson & Johnson Wound Management), CarraFilm (Carrington Laboratories, Inc.), OpSite (Smith & Nephew, Inc.), Suresite (Medline Industries, Inc.), 3M Tegaderm (3M Health Care)

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                Also called polymer gels, hydrogels are primarily used to maintain a moist wound environment; they can be used in wounds with minimal exudate. Gels and sheet gels cool wound surfaces. They’re soothing and comfortable, and they help reduce pain. Some sheet forms have occlusive backings and shouldn’t be used in infected wounds.

                • Abrasions, minor burns, and other partial-thickness wounds
                • Radiation injuries (must be approved by radiation oncologist if treatment is ongoing)
                • Maintain moist environment in healing wounds
                • Donor sites
                • First- and second-degree burns
                • Hydrate and autolytically debride nonviable tissue
                • Moderate to heavily exudating wounds
                • Infected wounds if dressing is occlusive
                • Fungal wounds
                • Third-degree burns
                • Avoid using only a sheet hydrogel over a cavity wound. (Dead space must be filled.)

                Examples (Tube gels): Carrasyn V (Carrington Laboratories, Inc.), Curasol (Healthpoint), IntraSite (Smith & Nephew, Inc.), Normlgel (Mölnlycke Health Care), NU-GEL (Johnson & Johnson Wound Management), 3M Tegagel (3M Health Care), woun’dres (Coloplast)

                Examples (Sheet gels): Aquasorb (DeRoyal), Elasto-Gel (Southwest Technologies, Inc.), NU-GEL (Johnson & Johnson Wound Management), Vigilon (Bard Medical Division)

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                Nonwoven fibers that are derived from seaweed; some products may have additives such as collagen. Used to aid autolytic debridement and to absorb exudate. Alginates can be used on infected wounds if the infection is being treated systemically and nonocclusive secondary dressings are used.

                • Exudating wounds with slough
                • Fill dead space and aid in debridement of sloughing wounds
                • Third-degree burns
                • Sensitivity to alginate, collagen, or other additives
                • Heavily bleeding wounds
                • Dry wounds

                Examples: Comfeel SeaSorb (Coloplast Corp.), Kaltostat (ConvaTec), Maxorb (Medline Industries, Inc.), PolyMem Calcium Alginate (Ferris), Restore CalciCare (Hollister, Inc.), Sorbsan (Bertek Pharmaceuticals), Kalginate (DeRoyal)

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                Odor-absorbent dressings

                These dressings have an encapsulated layer of activated charcoal that absorbs exudate and neutralizes odor. They can be used in combination with other dressings to aid in heavy exudate absorption and to minimize wound odors.

                • Neutralize odors in necrotic wounds
                • Provide comfort and palliative care for terminal patients with draining wounds
                • Infected or noninfected wounds with moderate drainage
                • Dry, superficial wounds

                Examples: CarboFlex (alginate, ConvaTec), Lyofoam C (foam, ConvaTec), Odor Absorbing Dressing (foam, Hollister, Inc.)

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                Promote the deposit of newly formed collagen in the wound bed. These dressings come in pads, gels, and particles. They can be used in deep wounds to fill dead space, absorb exudate, and provide a moist environment. A secondary dressing is usually required.

                • Tunneled or cavity wounds with drainage
                • Partial- and full-thickness wounds
                • Second-degree burns
                • Wounds with dry eschar
                • Sensitivity to additives

                Examples: Fibracol, Fibracol Plus (Johnson & Johnson Wound Management), hyCURE (Hymed Group Corp.), Kollagen-Medifil (BioCore Medical Technologies, Inc.)

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                Absorbent dressings made of polyurethane foam; many are waterproof and bacteria-proof. Certain foams are nonadherent and require a secondary dressing.

                • Moderate to heavily exudating wounds
                • Provides thermal insulation and a moist wound environment
                • Secondary dressing to provide additional absorption in deep wound; use with packing
                • Can be used under compression dressings to absorb heavy drainage
                • Dry wounds
                • Partial-thickness wounds with minimal exudate
                • Wounds with exposed muscle, tendon, or bone
                • Arterial ischemic lesions

                Examples: Allevyn foam dressing and cavity dressing (Smith & Nephew, Inc.), Flexzan (Bertek), Lyofoam (ConvaTec), PolyMem (Ferris Manufacturing Corp.), 3M Reston (3M Health Care), Tielle and Tielle Plus (Johnson & Johnson Wound Management)

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                These are adherent dressings, which are nonpermeable to water vapor and oxygen. They create a hypoxic wound bed that promotes autolytic debridement and healing through fibroblast proliferation and the stimulation of neoangiogenesis. Most hydrocolloid dressings are self-adhesive pads; a few come in paste form.

                • Wounds with minimal to moderate exudate
                • Wounds with slough or granulating wounds
                • Partial-thickness wounds
                • Protection of intact skin
                • Infected wounds
                • Wounds with sinus tracts
                • Deep cavity wounds
                • Heavily exudating wounds
                • Wounds with friable surrounding skin
                • Third-degree burns

                Examples: Comfeel Plus (Coloplast Corp.), Dermatell (Gentell), DuoDERM and SignaDRESS (ConvaTec), Exuderm (Medline Industries, Inc.), Restore (Hollister, Inc.), 3M Tegasorb (3M Health Care)

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                Nonadherent dressings

                Designed to provide a surface that doesn’t stick to the wound bed. Generally, these are primary dressings and require a secondary cover or wrap. Impregnated dressings are gauze impregnated with petrolatum, antibacterial, or bactericidal compounds. Nonimpregnated dressings are nylon or polyurethane coverings.

                • Skin grafts and donor sites
                • Abrasions and lacerations
                • Reduce bacterial proliferation in superficial wounds
                • Heavily exudating wounds
                • Sensitivity to antibacterial or bactericidal compound

                Examples: Adaptic (Johnson & Johnson Wound Management), Scarlet Red Ointment Dressing (Kendall Healthcare Products Co.), Vaseline Petrolatum Gauze and Xeroform Petrolatum Gauze (Kendall Healthcare Products Co.)

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                Composite dressings

                These dressings contain two or more products and are designed to provide multiple properties in a single dressing. Most composite dressings have an adhesive border.

                • Can be used as a primary or secondary dressing
                • Minimal, moderate, or heavily draining wounds, depending on the composition
                • Partial- and full-thickness wounds
                • Some composite dressings are occlusive and shouldn’t be used for untreated infected wounds.
                • Sensitivity to composite materials (for example, polyurethane, alginates, or adhesives)
                • Avoid using only a composite pad over a cavity wound.
                • Some composite types are contraindicated for heavily draining wounds, third-degree burns, and wounds with exposed tendon, muscle, or bone.

                Examples: Alldress (Mölnlycke Health Care), Covaderm Plus (DeRoyal), 3M Tegaderm + pad (3M Health Care), Stratasorb (Medline Industries, Inc.), 3M telfa Adhesive Dressing (Kendall Healthcare Products, Co.)

                © 2003 Lippincott Williams & Wilkins, Inc.