Wound Dressings: Key to Wound Management

As this journal transitions from Ostomy Wound Management to Wound Management & Prevention, I am pleased and proud to begin a new regular column, Back to Basics. For those entering or newer to the practice of wound care, we hope to provide a meaningful understanding of the basic tools of our wound care trade. For seasoned clinicians with many years of practice in this arena, we hope revisiting historically standard dressings and highlighting newer technologies can enhance provision of topical care. There are reportedly more than 3000 wound dressings on the market¹; understanding the basics should improve clinician ability to select the most appropriate combination and/or specialty dressing.

As we approach patients to develop a treatment plan, numerous decisions are necessary and may occur simultaneously. Even though some deciding factors may require more consideration than others — for example, determining wound etiology using diagnostic tests — the clinician must simultaneously choose a dressing. Determining the true etiology of the wound is of utmost importance because this information will drive the plan of care (eg, compressing the leg with chronic venous insufficiency and offloading the diabetic foot or pressure injury), but in the meantime, the wound must be dressed.

Although wounds are dynamic and can change rapidly, basic information can be assessed to initiate care. Clinicians can ask these basic questions:
•    Is the wound bed dry?
•    Is the wound draining?
•    Is there space in the wound?
•    Is the wound filled in and needs cover and protection?

Is the wound bed dry?
We are in our fifth decade of understanding the need to utilize a moist wound environment to enhance wound healing; the number of advanced dressing products exploded in the 1980s and 1990s, with the early supporting work dating back into the 1960s.^2,3 Creation of a moist wound environment was soon equated with autolytic debridement, improved granulation tissue, and reduced pain. Creating the optimal balance of moisture is the ultimate goal of environmental wound dressings.

Is the wound bed draining?
Most clinicians subscribe to the mantra, Drainage Drives Dressing Decisions. Optimal management of the drainage (ie, exudate) includes ensuring the wound is not too dry, where desiccation of cells and ultimate cellular death occurs, and not too wet, with drainage potentially striking through to outer dressings and clothing and creating an environment for bacterial growth and overwetting or macerating the periwound skin. The goal is moisture that enhances cellular growth and protects the periwound skin.

Is there space to fill?
Filling wound space is a key goal in choosing dressing materials. Leaving a space open to fill with fluid can allow for bacterial growth and inhibit cell migration. Loosely filling the wound space, undermining, and tunnels with a packing material that makes intimate contact with the wound bed further improves exudate absorption and protection of the periwound skin.⁴

Is the wound bed filled in?
As wound healing progresses, final closure results from epithelial migration across the moist wound surface. At this point, covering and minimally disturbing the wound bed is the optimal goal. This most often can be accomplished by using a single dressing type that covers and protects and is removed as infrequently as possible to allow for cell migration without injury or disruption.

Many wound dressings are available to help us meet these goals. In upcoming issue, we will begin to unravel the options and decision making as well as other concomitant processes that must take place for successful wound management. In the next issue: Clean It Like You Mean It!

1. Wound dressings. Available at: https://woundeducators.com/resources/wound-dressings/. Accessed December 13, 2018.

2. Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962;20:193–194.

3. Hinman CD, Mailbach HI. Effects of air exposure and occlusion on experimental human skin wounds. Nature. 1963;200:377.

4. Ovington, LG. Hanging wet-to-dry dressings out to dry. Adv Skin Wound Care. 2002:15(2):79–84.