Dressing Selection for wound.

1. How to select Dressing ?
Subhas Banerjee
HHBS-Hartmann
Kolkata, India

2. Basic Principles
• Remove necrotic tissue and foreign bodies or particles-
Wash the wound with Normal saline, Irrigate with hydro
Irrigator, Apply hydrogel, debriding dressing etc
• Identify and eliminate infection-Wash with NS, apply silver
dressing Antimicrobial.
• Obliterate dead space- By surgical/mechanical process or
irrigate regularly. Use Hydro Irrigator.
• Absorb excess exudate- use Alginate dressing,combine
dressing.
• Maintain a moist wound surface- Basic objective of wound
healing.
• Provide thermal insulation- Foam dressing, Film dressing
• Protect the healing wound from trauma and bacterial
invasion- use Post-op dressings

3. Wound Care Product Selection
• Wounds are dynamic and will require different approaches during
healing process
• Continually reassess patient and wound
• Topical therapy is one part of the nurses role - must eliminate cause
and support host
• Use wound care mobile apps to measure the wound size, depth of
the wound, fibrine, necrosis,granulation etc. do the assessment,
analysis.
• Nutritional status, Glucose level, Growth factor etc.
• Blood flow into the wound, blood and lymphatic flow out of the
wound.

4. Wound Care Product Selection:
Other Considerations
• Frequency of change, like Debriding dressing 24 hrs,
Hydrocolloid 5-7 days
• Ease or difficulty of procedure- Black or yellow slough or
necrosis- Wash with NS, Irrigate, surgical/mechanical
procedure. Use Hydro Irrigator of to avoid pain and bleeding.
• Care giver- Train to change dressing, reduce cost.
• Availability of products- Advanced wound care products are
not available easily in all pharmacy so advise where the
product is available or go for conventional products those are
easily available.
• Cost & Hygiene factors- must be affordable or agreed by
patient .

5. Wound Care Product Selection: Other
Considerations
• Is wound partial or full thickness?
• Is wound dry or draining?
• Is wound superficial or deep?
• Location of wound in human body ?
• Need to develop treatment protocols based on
wound characteristics rather than wound type.
• Many accidental and chronic wounds with cavity
pocket and large size, we can’nt apply normal
dressing, think for NPWT if it is affordable by patient.

6. Types of Topical Wound Dressings
• Hydrocolloid dressings ( Hydrocoll)
• Hydrogel dressings
• Alginate dressings ( Sorbalgon)
• Transparent film dressings ( Tegaderm)
• Foam dressings ( Permafoam)
• Absorption dressings ( Hyzisorb)
• Gauze dressings, Combine dressing ( Hyzisorb)
• Composite dressings ( Cosmopor E)
• Biologic dressings, Collagen.
• Bandage ( Hyzigrip)
• Other

7. • Dressings will create an environment that may
facilitate healing.
• If underlying causes are not treated then the
wound is unlikely to heal.
• Remember there is no miracle dressing that will
heal all wounds!!!

8. Clinical appearance of wound bed.
Colour continum
Colour Physiological State
Black Necrotic
Yellow Sloughy
Red Granulating
Pink Epithelializing
Yellowish/white patch/odor Infected?

9. What will happen if we don’t use
dressings.
The principal reasons for applying a dressing can therefore be summarised
as follows.
• To produce rapid and cosmetically acceptable healing,
• To remove or contain odour,
• To reduce pain,
• To prevent or combat infection,
• To contain exudate,
• To cause minimum distress or disturbance to the patient,
• To hide or cover a wound for cosmetic reasons.
• A combination of two or more of the above.

10. The product related factors may therefore
be summarised as follows:-
• conformability
• mass or volume (for cavity wounds)
• fluid handling properties
• sensitisation potential
• odour absorbing properties
• antibacterial activity
• haemostatic properties
• permeability to tissue fluid and microorganisms
• ease of use
• pain related factors
• fibre-fast
• non toxic.

11. The major patient related factors may be
summarised as follows:-
 wound aetiology,
 state of continence,
 known sensitivity to medicated dressings,
 fragile or easily damaged skin,
 the need to bathe or shower frequently,
 Compliance
 Economic considerations relate to cost and availability

12. Conclusion
• As no one dressing is suitable for the management of all types of
wounds,
• Few are ideally suited for the treatment of a single wound during all
stages of the healing cycle,
• Successful wound management depends upon a flexible approach to the
selection and use of products based upon an understanding of the
healing process combined with a knowledge of the properties of the
various dressings available.
• Without such knowledge and careful consideration of all the factors
described above, dressing selection is likely to be arbitrary and
potentially ineffective, wasteful both in terms of time and physical
resources.

13. S.Banerjee
Kolkata, India