Whenever you have a wound, no matter the size or the depth of it, it is of utmost importance to take proper care of it. Whether it’s a minor cut, scrape, or a deep wound, all it takes is a moment of recklessness or a slip of mind while cutting vegetables and the damage is done. Many of us have certainly come to a situation where dressing a wound properly raises questions and doubts and in order to clear that up, here are some of the crucial information regarding this quotidian problem.
Word of advice: If the wound is minor, you probably already know what to do, however, if there is heavy bleeding or if there is something embedded in the wound, seek medical attention immediately.
What is a wound dressing?
Gone are the times of cauterizing with a glowing sword and risking infection by dressing the wound with rags of suspicious origins. Today, a wound dressing is used by a doctor or patient himself to protect the wound from infections and to help it heal. Wound dressings are touching the damaged skin directly, and they are often confused with simple bandages, used to keep the dressing securely placed on the wound.
Dressings help the wound heal, protect it from infection and foreign objects, and they also help in stopping the bleeding and start the process of clotting. Wound dressings absorb excess blood and other fluids such as plasma thus preventing skin maceration, and they expedite the natural healing process. Another important role of the wound dressing is the reduction of psychological trauma by covering the wound from the view of the patient and others.
Uses and types of dressings
There are several types of dressings that can be used on various types of wounds. Through the course of history various materials have been used to dress the wound such as cobwebs, dung, honey, and various leaves, however in modern times most commonly used are dry or impregnated gauze, gels, plastic films, various foams, hydrocolloids, hydrogels, alginates, and, last but not least, polysaccharide pastes, beads, and granules. All of them provide different environments made for different types of wounds.
For absorption of excess fluids and regulating the moisture dry gauzes are usually the first choice. They have strong absorption power and dry the wound quickly. However, hydrocolloids are used to maintain a moist environment when needed, and if absorption of exudate is not needed it is best to use film dressings.
Dressings are also used for regulation of the chemical environment of the wound in order to prevent infection. This is where we most commonly use antiseptic chemicals such as povidone-iodine or boracic lint dressings. In order to reduce pain, wound dressings are often impregnated with different types of analgesics, and in the case of topical medication use, dressing such as latex or plastic which are impervious to moisture can help the absorption of these medications into the skin, thus expediting the healing process.
To secure a dressing and prevent foreign objects and bacteria from contacting the wound, bandages, and adhesive tapes are usually placed around them. Nowadays, many dressings come in a form of an “island”, surrounded by adhesives which make them easier to use and more sanitary.
Types of dressings
Usually, gauze pads that are used on relatively dry wounds. They are most often used due to the inexpensiveness and the simplicity of application, and, of course, the long history of use. Gauze pads/dressings are traditionally made from cotton and provide an absorbent and breathable protection for a wound. They often have a layer of perforated plastic film over the gauze to prevent adhesion of the wound to the dressing and maintain the absorption of excess fluids. They are most often referred to as band-aids and have become a common household object.
Used for wounds that need moisture in order to heal, such as those that need to be debrided. Wet-to-dry dressings usually include cotton or gauze soaked in a saline solution that is put on the wound and left there to dry, helping in drying out the wound and debriding it at the same time. It is important to take extra precautions in regards to the outside contamination, as these dressings do not provide protection against it.
Used to keep the wound environment moist. They are generally made of polyurethane and are usually gas-permeable and provide thermal insulation. Much unlike dry dressings (gauze) they do not shed fibers and can be used both on lightly and heavily discharging wounds. They can be left on top of the wound for several days as they do not cause maceration and should be changed when the exudate becomes visible at the edges of the dressing.
Used to help with the wound debridement. Hydrocolloid dressings also maintain moisture, thus promoting angiogenesis, fibrinolysis, speeding the healing process and keeping the oxygen out. They are usually used on burns, light to moderately exuding wounds, various necrotic wounds, and venous and pressure ulcers, also known as bed sores, and in the treatment of eczema. Hydrocolloid dressings adhere to the skin, they are non-breathable and biodegradable. Patients should expect a characteristic odor hydrocolloids produce once mixed with exudate fluids. They should be changed every three to seven days.
The best choice of dressing for wounds that exudate heavily. Alginate dressings are natural wound dressings usually, contain calcium fibers and sodium derived from natural sources such as seaweed. They can be used on pressure ulcers, diabetic foot ulcers, as well as venous ulcers. Alginates absorb moisture and are able to take up to twenty times their weight, which promotes healing of such exuding sores, preventing infection and further damage to the tissue and muscles. They also help with natural debridement and accelerate the regeneration of the skin. Alginates should be changed every two to seven days.
Hydrogel dressings (hydrated polymer)
This dressing contains 90% water in a form of a gel and helps with fluid exchange on the surface of the wound. Hydrogel dressings can be amorphous (packaged in tubes or spray bottles), impregnated (amorphous hydrogel saturated gauze), and sheet hydrogels (surrounded and supported by thin fiber; can have adhesive or non-adhesive borders). Hydrogel dressings are usually used for painful and necrotic wounds with little excess fluids and they help cool the wounds and provide moisture and help relieve the pain. They should be changed every one to three days.
Also known as combination wound dressings. Composed of several layers that usually include the contact layer which is non-adherent, the moisture-absorbing middle layer, and the bacteria-repellent outer layer. The inner layer prevents discomfort and trauma upon dressing change, the middle layer prevents maceration and keeps the optimal level of moisture, and may be made of a hydrogel, alginate, or hydrocolloid, while the outer layer is usually made of a semi-permeable film.
Can be used on low exuding wounds. They do not have absorbing properties and are commonly used for shallow wounds such as burns or dermabrasion. The skin surrounding the wound covered with film dressing should be kept dry and clean. The downside of film dressings is that they can only be used on dry wounds as excessive fluids may accumulate under them, and they tend to cause adhesive trauma upon removal.
Other dressings include honey, silver, and poly hexamethylene biguanide (PHMB). Honey, a common household product, can actually be used to treat wounds. However, one should avoid using raw honey, as it is more likely to cause and spread an infection, but luckily, nowadays, you can get pre-packaged honey dressings that are safe to use. Even though somewhat unconventional, honey has numerous healing properties, such as clearing infections, bacteria protection, and odor elimination.
Silver has been used for centuries in wound care all over the world, however, experts still argue over its beneficial properties in the healing process. In 2012 Cochrane review concluded that silver dressings were in no way better or more beneficial for the patient with diabetic ulcers than standard alginate dressings. The same year another systematic review found that dressings that contain silver were no better than non-silver dressings in the treatment of burn wounds. Furthermore, it has been found that silver may discolor the skin giving it a gray tint pursuant to the long-term use of silver-containing dressings.
Polyhexamethylene biguanide or PHMB-containing products are used as post-operative, surgical, and non-surgical dressings, as well as dressings for chronic wounds. PHMB is usually impregnated into gauze or foam in a form of a liquid or gel.
Odor absorbing dressings and solutions
It is well known that some types of wounds produce odor which can cause distress and trauma to the patient and the patient’s relatives and caregivers. In some cases, the odor may become so overpowering that it may make one isolate himself from the social environment, and alienate the family and friends. Such wounds are usually the leg ulcers and cancerous lesions, and the odor can be caused by a combination of bacteria. The most effective solution is to prevent the occurrence of odor before it commences by using systemic antibiotics or antimicrobial agents, however, in some cases this is not possible due to the state of the wound, particularly when it is necrotic of slouchy.
Applying hydrogel that contains a proper concentration of metronidazole is quite effective in treating wound odors. There are also some less conventional methods of treating such wounds, and they include honey, live yogurt, and larval therapy, especially effective in treating odor of necrotic wounds. In 1976, Butcher et al. have described the use of charcoal cloth as a treatment for wound odors among other uses.
Activated charcoal pads have been commercially produced since 1976 as they have proven to be effective in the treatment of malodorous wounds. It is believed that the carbon breaks down and forms minute pores that are able to remove unpleasant odors by attracting the odor molecules and keeping them at bay by electrical forces. Charcoal clothes in some forms can be placed directly onto the wound or as a secondary dressing used only for absorption of odorous molecules.
How to use wound dressings
Skin, being the largest organ of the body, is essential for proper functioning of the human organism, therefore properly taking care of the wounds is of utmost importance. There are several types of wounds that can be split into a few categories.
Necrotic wounds contain dead cells that are the result of inefficient local blood supply. The necrotic tissue is basically dead tissue that can cause harm to the surrounding area, therefore it should be treated with proper care. Necrotic tissue eventually turns black and can result from burn wounds and other chronic sores. It should be treated with moisture-retentive dressings such as hydrocolloids.
Slough is a yellow tissue that can be sound on the surface of the wound and consists mostly of pus. Slough-covered wounds should be treated with dressings that provide moisture retention and those with fluid absorbent properties such as alginates and some types of hydrocolloids. These dressings should be changed every three to four days.
Infected wounds occur when bacteria come to contact with the damaged skin and causes swelling, fever, and pain. Infected wounds should not be covered with semi-occlusive dressings. Instead, try alginates or hydrocolloids if the wound exudes heavily.
Minor burns should be treated with film or medicated tulle as dressings (a type of paraffin oil-impregnated fabric), and major burns require either medicated tulle or plastic wrap placed on the burn before the surgical intervention.
Lacerations happen when the skin is cut or torn and can be deep or shallow and vary in length and width. Lacerated wounds are best left open or dry once saturated, and one should place a paper tape as a support after the sutures have been removed to help the healing process even further.
Puncture wounds and bites are best left open or dry, and chronic wounds such as ulcers are best treated with hydrocolloids, foams, or alginates, which should be changed every five days.
If one is lucky enough to have his wounds heal completely, an important thing to remember is to take care of the remaining scar tissue. Scars form as the skin heals and the wound becomes stronger, and the scar area can get quite itchy during the first stage of the scab formation. Once the scab falls off, the wound area may look red and stretched, and the scar that forms in the place of the former wound will be smaller and considerably less elastic than the skin surrounding that area.
However, most scars fade after some time, although it can sometimes take years before one can see improvement, but there are also scars that never go away. Scar tissue is comprised of collagen, which can be used in the treatment of scars in the form of collagen injections. Other options are chemical peels that exfoliate the skin thus removing the scar, laser treatments, silicone and pressure dressings, surgery, and radiotherapy.
So, whichever type of wound or scar one may have, it is important to arm oneself with knowledge and to understand that healing, before everything, takes time and patience, along with professional care in the case of more serious types of wounds. Medicine has progressed so much in the past few decades that nowadays you can find solution for virtually any skin and tissue damage you experience, and choosing a doctor that is well informed about the latest advancements and wound treatments can help you save a lot of time, money, and most importantly, help you stay happy and healthy for a long time.