Surgical dressing types and how to manage major wound types

1. Wound dressings
Dr Ammar Hashim

2. Pathophysiology

3. Wound Healing
HEMOSTASIS ( 5–10 minutes )
INFLAMMATORY PHASE (DAYS 1
TO 6)
FIBROPROLIFERATIVE PHASE
(DAY 4 TO WEEK 3)
MATURATION/REMODELING
PHASE (WEEK 3 TO 1 YEAR)

5. Sabiston Textbook of Surgery Schwartz’s Principles of Surgery

6. Dressing types

7. Moisture :
Speeds
epithelialization
Warmth :
Increased tensile
strength (better
perfusion)
Sabiston Textbook of Surgery

8. Occlusion of a wound with dressing material helps healing by controlling
the level of hydration and oxygen tension within the wound. It also
allows transfer of gases and water vapor from the wound surface to the
atmosphere.
Occlusion affects both the dermis and epidermis, and it has been shown
that exposed wounds are more inflamed and develop more necrosis than
covered wounds.
Occlusion also helps in dermal collagen synthesis and epithelial cell
migration and limits tissue desiccation
Schwartzâs Principles of Surgery

9. The ideal dressing does not exist, many types
of dressings help achieve certain goals
Schwartz’s Principles of Surgery

10. AO Manual of Soft-Tissue Management

11. Adapted from Lionelli GT, Lawrence WT. Wound dressings. Surg Clin North Am. 2003;83:617–638.

12. Adapted from
Lionelli GT,
Lawrence WT.
Wound dressings.
Surg Clin North
Am. 2003;83:617–
638.

13. Adapted from
Lionelli GT,
Lawrence WT.
Wound dressings.
Surg Clin North
Am. 2003;83:617–
638.

14. https://www.rch.org.au/clinicalguide/guideline_index/Wound_dressings_acute_traumatic_wounds/
Decision on wound and dressings

18. Hydrocolloid and Hydrogel Dressings
Hydrocolloid and hydrogel dressings attempt to combine the
benefits of occlusion and absorbency. Hydrocolloids and hydrogels
form complex structures with water, and fluid absorption occurs with
particle swelling, which aids in atraumatic removal of the dressing.
Absorption of exudates by the hydrocolloid dressing leaves a
yellowish-brown gelatinous mass after dressing removal that can be
washed off.
Hydrogels allow a high rate of evaporation without compromising
wound hydration, which makes them useful in burn wound treatment.

19. Hydrocolloid
▪ Absorb fluid.
▪ Promote autolytic debridement.
Indications :
▪ Clean, low to moderate exuding wounds.
▪ Combined presentation with silver for antimicrobial
activity.
Precautions :
▪ Do not use on dry/necrotic wounds or high exuding
wounds.
▪ May encourage overgranulation.
▪ May cause maceration.

20. Hydrogel
▪ Rehydrate wound bed.
▪ Moisture control.
▪ Promote autolytic debridement.
▪ Cooling.
Indications:
▪ Dry/low to moderate exuding
wounds.
▪ Combined presentation with silver
for antimicrobial activity.
Precautions:
▪ Do not use on highly exuding
wounds or where anaerobic
infection is suspected.
▪ May cause maceration.

21. Foam
▪ Absorb fluid.
▪ Moisture control.
▪ Conformability to wound bed.
Indications:
▪ Moderate to high exuding
wounds.
▪ Special cavity presentations in
the form of strips or ribbon.
▪ Low-adherent versions available
for patients with fragile skin.
▪ Combined presentation with
silver or PHMB for antimicrobial
activity.
Precautions:
▪ Do not use on dry/necrotic
wounds or those with minimal
exudate.

22. Alginates
▪ Absorb fluid.
▪ Promote autolytic debridement.
▪ Moisture control.
▪ Conformability to wound bed.
Indications:
▪ Moderate to high exuding wounds.
▪ Special cavity presentations in the
form of rope or ribbon.
▪ Combined presentation with silver
for antimicrobial activity.
Precautions:
▪ Do not use on dry/necrotic
wounds.
▪ Use with caution on friable tissue
(may cause bleeding).
▪ Do not pack cavity wounds tightly.

23. Hydrofiber
Venous, pressure
and diabetic ulcers
Surgical wounds
Partial thickness
burns
Traumatic wounds
Oncology wounds.
https://www.woundsinternational.com/download/wint_article/6723

24. Films
▪ Moisture control.
▪ Breathable bacterial barrier.
▪ Transparent (allow
visualization of wound).
Indications:
▪ Primary dressing over
superficial low exuding
wounds.
▪ Secondary dressing over
alginate or hydrogel for
rehydration of wound bed.
Precautions:
▪ Do not use on patients with
fragile/compromised
periwound skin.
▪ Do not use on moderate to
high exuding wounds.

25. Medicated Dressings
Agents delivered in the dressings include benzoyl peroxide, zinc
oxide, neomycin, and bacitracin-zinc. These agents have been
shown to increase epithelialization by 28%.

26. Medicated Dressings
Silver-impregnated
Indications:
▪ Critically colonized wounds or clinical
signs of infection.
▪ Low to high exuding wounds.
▪ Combined presentation with foam
and alginates/CMC for increased
absorbency. Also in paste form.
Precautions :
▪ Some may cause discoloration.
▪ Known sensitivity.
▪ Discontinue after 2 weeks if no
improvement and reevaluate.
AO Manual of Soft-Tissue Management

27. Medicated Dressings
Iodine-impregnated
Indications:
▪ Critically colonized wounds or
clinical signs of infection.
▪ Low to high exuding wounds.
Precautions :
▪ Do not use on dry necrotic tissue.
▪ Known sensitivity to iodine.
▪ Short-term use recommended (risk
of systemic absorption).
Cadexomer Iodine Gel is indicated for use in cleaning wet ulcers and wounds
such as venous ulcers, pressure injuries, diabetic ulcers, and infected traumatic
and surgical wounds.
povidone iodine impairs wound healing and it is different from cadexomer iodine

28. Mechanical Devices
Sabiston Textbook of Surgery

29. Wound drainage
Non-draining wound can be covered with semiocclusive dressing.
Drainage of less than 1 to 2 mL/d may require a semiocclusive or absorbent
nonadherent dressing.
Moderately draining wounds (3–5 mL/d) can be dressed with a nonadherent primary
layer plus an absorbent secondary layer plus an occlusive dressing to protect normal
tissue.
Heavily draining wounds (>5 mL/d) require a similar dressing as moderately draining
wounds, but with the addition of a highly absorbent secondary layer.
Schwartz’s Principles of Surgery

30. Pressure sores

31. Pressure sores
Oxford handbook for Post-operative Complications

32. References
- Sabiston Textbook of Surgery
- Schwartz’s Principles of Surgery
- Oxford handbook for Post-operative Complications
- International Consensus. Acellular matrices for the treatment of wounds. An expert working group review.
Wounds International 2010. Available at http://woundsinternational.com (Accessed on March 2013).
- Reproduced with permission from: McCardle J, Chadwick P, Edmonds M, et al. International Best Practice
Guidelines: Wound Management in Diabetic Foot Ulcers. Wounds International, 2013. Copyright © 2013
Schofield Healthcare Media LTD. Available from: www.woundsinternational.com.
- AO Manual of Soft-Tissue Management
- Jeffrey E. Janis - Essentials of Plastic Surgery

33. Thank You