Hydrocolloids are composed of hydrophilic colloidal particles (such as gelatin or cellulose) within an adhesive mass (polysobutylene). They come as adhesive wafer dressings designed to interact with the wound bed by forming a gel over it as exudate is absorbed by the dressing, thus forming a protective layer over the wound and creating a moist wound healing environment. The absorptive layer of the dressing is covered by a completely impermeable film.
Hydrocolloids are indicated for wounds with low to moderate exudate, partial- or full-thickness wounds, and granulating or necrotic wounds. A frequent use of these dressings is for venous stasis ulcers. Hydrocolloids may be also used over absorptive wound fillers. They should not be used on infected wounds, heavily exudative wounds or on wounds with fragile surrounding skin. In addition to offering protection from sheer force, these dressings protect against exogenous bacterial contamination, and are relatively painless.
They are ideal at providing an environment for autolytic debridement of fibrinous slough. When applied, at least one inch of surrounding skin should be covered to ensure adherence. These dressings should be changed when exudate is within an inch of the dressing edge, which may be daily until exudate slows down, at which time hydrocolloids can be left on for up to seven days. Examples of hydrocolloids are DuoDERM and Cutinova Hydro.
Foams are composed most commonly of polyurethane polymers whose primary function is to absorb wound exudate. They come in thin and thick foams, adhesive and nonadhesive foams, foams used to pack wounds and sheet foams. Foams are indicated for wounds with moderate to high exudate, partial- or full-thickness wounds, and granulating or necrotic wounds. They can be used on infected wounds if changed daily, and they can be used over creams or ointments.
Foams are not recommended for dry wounds. Foams protect wounds well, facilitate autolytic debridement, and minimize granulation tissue. As with other dressings, at least one inch of surrounding skin should be covered, and foams can be left on the wound surface for up to seven days. Examples of foams are Lyofoam and Allevyn.
Alginates are composed of naturally occurring mannuronic or glucuronic acid polymers from brown seaweed. They come available as pastes, granules, powders, pads or ropes which soften, gel and conform to the wound, thereby functioning to absorb, exudate and fill dead space.
These dressings are indicated for wounds with moderate to high exudate, and may be used on partial- or full-thickness, and granulating or necrotic wounds. They may also be used on infected wounds if changed daily. Foams are well-suited to be used under other dressings such as hydrocolloids to increase dressing wear time. Sheets are generally used on shallow wounds, and ropes, pastes and strands are used to fill deep wounds Alginates should not be used on minimally exudative wounds because they will adhere to the wound and cause damage when removed. They should not be packed into very deep or tunneling wounds as they may easily be left behind and become a nidus for infection.
When applied, alginates should only fill one-third to one-half of the wound since they will expand with time. They require a secondary dressing based on the tendency of the wound to dry out, for example gauze coverage for a highly exudative wound. Alginates should be changed when exudate reaches the secondary dressing. Examples of alginates are Sorbsan and Carrasorb.
Prior to selection and application of wound dressings, there are several key components to wound management that must be addressed:
The choice of dressing material in clinical practice is often arbitrary and based on the clinician's personal experience. Many different dressings can achieve the same goal. The key to optimizing wound healing to adhere to these basic principles:
1. Perform dressing changes with sufficient frequency so that the dressing provides a moist wound environment, but not an overly saturated one.
2. If the wound is pink, healthy and free of infection, it requires only constant moisture.
3.Wounds must heal from the inside without the overlying skin sealing over unhealed deeper tissue. Therefore, all dead space must be eliminated by packing the wound. If packing a wound requires more than a single 4x4 gauze dressing, a Kerlix role should be used instead to eliminate the risk of a 4x4 gauze being retained.
4. Given that the pre-dressing conditions above are met, almost all wounds can be treated using only saline gauze or hydrogel and gauze.
5.Most importantly, frequent wound monitoring by the clinician is paramount—an ignored wound will not just "go away." Evaluation of a therapy's effectiveness is required. Failure of a wound to progress indicates that the patient's medical condition, the wound environment or the choice of wound dressing must be revisited.
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