i bc27f85be50b71b1 (152 page)

BURNS AND WOUNDS

489

tions of every available dressing. It is the responsibility of the

therapist to read manufacturer's instructions for application, to know

the purpose of the dressing, and to make educated decisions when

choosing the appropriate dressing for a given wound at each stage of

the healing process. Clinicians should not rely on manufacturer's

claims of efficacy to justify a dressing's effectiveness. Although it is

not possible to identify every dressing, it is possible to catalog most

dressings into some basic categories: gauze, nonadherem dressings,

hydrocolloids, semipermeable films, hydrogels, foams, and calcium

alginates. Table 7-13 is a summary of the indications, advantages, and

disadvantages of different dressings.77-8o

Other Dressings

The V.A.C. (Vacuum Assisted Closure) (Kinetic Concepts, Inc., San

Antonio, TX) device assists in wound closure by applying localized

negative pressure to a special porous dressing positioned in or over

the wound. The porous dressing distributes negative pressure to the

wound and helps remove interstitial fluids. The negative pressure

applies noncompressive mechanical forces to the wound site and

draws the tissue inward, subjecting it to subatmospheric pressure.

The distortion causes epithelial cells to multiply rapidly and form

granulation tissue. The stretching also increases cell proliferation by

activating ion channels within the cells and releasing biochemical

mediators from the plasma membrane. It is also thought to Stimulate

the growth of new blood vessels. This device is worn continuously 24

hours a day. Dressings for noninfected wounds can be changed every

2-3 days or changed daily for infected wounds. Indications for this

therapy include diabetic ulcers, pressure ulcers, traumatic wounds,

meshed grafts, and flaps. Contraindications include fistulas, necrotic

tissue or eschar, untreated osteomyelitis, malignancy in wound, and

exposed arteries or veins.81.82

Cadexomer-iodine is an iodine-based wound filler (e.g., lodoflex,

iodoform) and is indicated in highly exudating wounds. It is highly

absorbent, provides a moist healing environment, and lowers the pH

of the wound. The iodine is slowly released, so it is not cytotoxic to

good tissue, but the bacteriostatic and bactericidal effects of iodine

remain.

Skin Substitutes and Biologicals

Although these will not be a first line of defense, therapists in the

acute care setting should be aware of other agents that may be used to

Table 7-13. Indications and Uses of Basic Types of Dressings

..

'"

0

Type of Dressing

Indication

Description

Advantages

Disadvantages

,.

()

'i

Gauze

May be used for any

Highly porous.

Readily available

May require frequenr

'"

type of wound if

Applied dry, wet-to-

Inexpensive

changes

()

properly applied

dry (i.e., the

Can cause skin macer-

�

and removed

dressing is put on

arion

:t

�

(although other

wet but will dry

Permeable to bacteria

0

�

dressings may be

before removal), or

Removal can be

0

0

more effective)

wet-to-wet (i.e., the

painful

"

dressing is pur on

�

0

'"

wet and removed

�

when wet).

:t

-<

�

Nonadherenr

Wounds with low-to-

Nonimpregnated or

Generally

May still adhere if

!:?

dressings

moderate drainage,

impregnated

nonirritating and

allowed to get too

r

for minor

(nonadherent

nonroxic

dry before

5!

'"

lacerations or

substance

Less likely to adhere

remOVing

'"

,.

�

abrasions, or as a

integrated into

to wound, causing

secondary dressing

dressing) dressings

less tissue

�

for deep full-

comprised of inert

disruption

thickness wounds

materials that

Relatively inexpensive

conform to the

wound surface.

Hydrocolloids

Parrial- or full-

Dressings that contain

Prevent secondary

Not for use with

rhickness wounds

absorptive particles

wound infection

anaerobic wound

with low-to-

that interact with

Impermeable to water,

infeccions

moderate drainage,

moisture to form a

oxygen, and

Removal may cause

including partially

gelatinous mass.

bacteria

skin rears on fragile

necrotic wounds

Cause the pH of the

Available in many

surrounding skin

Provide a moist

wound surface ro

forms (pastes,

wound environ-

decrease, thereby

powders, and

mem and promotes

inhibiting bacterial

sheers)

autolysis

growth.

Changed infrequently

Semipermeable films

Promote a moist

Transparent poly-

Conforms well

Highly adhesive, can

wound environ-

urethane with a

Allow for visual

be difficult to apply

ment for wounds

water-resistant

wound monitoring

Can cause skin rears,

wirh minimal

adhesive on one

especially on fragile

drainage

side.

skin

Semipermeable ro

water and oxygen

but impermeable to

bacteria.

..

c

Hydrogels

Partial-thickness

Gel composed of 96%

Highly conformable

Do not absorb much

'"

Z

wounds with

water or glycerin.

Safe for fragile skin

�

,.

minimal drainage,

Available in many

Z

c

or as a secondary

forms

"

0

dressing on a full-

c

Z

thickness wound

c

�

...

'"

....

Table 7-13. Continued

...

'"

N

Type of Oressing

Indication

Description

Advantages

Disadvantages

>

Foams

Partial- or full-thick

Polyurethane foam

Nonadherenr to skin

Expensive

�

ness wounds with

with twO surfaces: a

surface

�

minimal-ro-moderhydrophilic inner

"

Highly absorbable

m

ate drainage

surface and a

and conformable

J:

�

hydrophobic outef

Permeable to oxygen

o

surface.

(reduce risk of

1)

o

anaerobic infection)

"

Calcium alginates

Partial- and full

Fibrous sheets and

Highly conformable

Require a secondary

o

"

thickness wounds

rope derived from

dressing to keep

�

J: