Let’s talk about wound dressings

This is the 4011 article

of Medical Care

Wound Dressing

I often listen to patients or their family members in the outpatient clinic to make such a request, “Doctor, please help us to prescribe the best ointment, the price is not critical, as long as the wound grows fast”. Does that mean that the more expensive the dressing is, the better it is for the wound? Today, let’s talk about those things about wound dressings.

We are most familiar with sterile gauze dressings over wounds. Did you know that before 1865, even if you had a noble status, once there was a wound, you could not use sterile gauze. Because the British Victorian surgeon Joseph Lister established a new sterilization method with carbolic acid as a sterilant in 1865, he was the first to apply sterile gauze to wound care. Before the 18th century, people used natural items such as tea, feathers, leaves and soil as wound dressings to relieve wound pain and promote wound healing.

The use of sterile gauze greatly reduces the incidence of wound infection and promotes wound healing. However, the pain of dressing change caused by the adhesion of the cotton gauze dressing to the wound tissue, the secondary injury of the wound, and the deficiencies in the treatment of refractory wounds are becoming more and more obvious in the clinical dressing change process.

In 1962, Dr. George Winter of the University of London conducted experiments on pigs and found that wounds covered with polyethylene sheets healed faster. Therefore, a new moist therapy of “sterile, moist and closed” wound surface was proposed, which laid the foundation for the modern theory of moist wound treatment. In 1963, Hinman confirmed the same results on human wounds. In 1974, the first new type of dressing polyurethane film dressing was born. Then, all kinds of dressings came on the scene. (The order of appearances is ranked according to the strokes of the surname, and the whole article is not extensive).

Hydrogel

Predominantly water-containing and water-insoluble polymers. It keeps the wound moist and promotes autolytic debridement. The downside is that it does not block bacterial invasion, may cause maceration of the surrounding skin, and cannot be used on wounds that are profuse and infected.

Hydrocolloid dressing

Mainly contains sodium carboxymethyl cellulose, animal gum, pectin, etc. It can keep the wound moist, promote autolytic debridement, and absorb a small amount of exudate. The disadvantage is that the glue formed by absorbing wound exudate is easy to be confused with infection, and it is not suitable for wounds with a lot of exudation.

Alginate Dressing

Extracted from seaweed, it is a soft non-woven fiber that can absorb 17~20 times its own weight in exudate. The calcium salts in the dressing exchange ions with the sodium salts secreted by the wound and blood to form a gel and have a hemostatic effect. There are strips and sheets, which can be used for wound packing. The disadvantage is that it needs to be fixed with external dressings and is not suitable for dry wounds.

Hydrophilic fibers

is a soft fiber made from sodium carboxymethyl cellulose fiber. Absorb exudate to form a gel-like property to keep the wound moist, and absorb vertically without macerating the surrounding skin. An outer dressing is also required for fixation and cannot be used for dry scab wounds.

Foam Dressing

Consists of polyurethane foam and polyethylene foam. For the prevention of pressure injuries, moderate to heavy exuding wounds. The disadvantage is that it is not suitable for dry wounds and scabbed wounds.

Superabsorbent wound pad

is a dressing pad consisting of a multi-layer dressing with a core of superabsorbent polyacrylate. Activation with Ringer’s solution is required.

Silver Dressing

As the name suggests, silver ions are added to the dressing, and the continuously released silver ions have broad-spectrum antibacterial effects. Not for use in patients allergic to silver. It is also not recommended to use it in a large area for a long time to avoid silver poisoning.

Charcoal Dressing

Can absorb odors. Insufficient activated carbon generally loses its activity after absorbing the exudate.

Hypertonic saline dressingp>

A non-woven dressing containing crystalline hypertonic sodium chloride. It absorbs wound exudate until isotonic, can absorb bacteria and necrotic tissue; reduce edema and promote healing. The downside is that it cannot be used on healthy granulation tissue.

Gauze Dressing

The oil gauze dressing is divided into chemical oil gauze and medicinal oil gauze. It is often used as an inner dressing for wounds. It does not damage the granulation tissue and new epidermis, and the dressing can be removed painlessly. The disadvantage is that it cannot absorb exudate.

Collagen Dressing

Contains 90% collagen and 10% calcium alginate, suitable for granulation wounds. An outer dressing is required and should not be used on infected wounds.

Iodine dressing

People use slow-release iodine-containing dressings to treat many different types of infected or suspected infected wounds. However, the use of iodine-containing dressings has clear contraindications: thyroid disease, known or suspected iodine allergy, pregnant or breastfeeding women, newborns and infants before six months of age.

So many dressings, is it dazzling to see? You must ask me, which one is the best? As the patient mentioned at the beginning of the article asked for expensive silver ion dressings, but his wounds did not ooze much, and in the stage of epithelial crawling, relatively low-cost hydrocolloid dressings were enough. So I can tell responsibly Everyone: There is no best dressing, only the best.

Author: Shanghai Eighth People’s Hospital Physical Examination Center

Lifang Liu