In Wound Care, Choose Wisely

Choices—we make hundreds of choices each day. Have you ever thought about how fortunate we are to have choices in most all things? We can choose what to eat, who to like, where to go to school, where to live, what profession to choose, whom to marry, or what toothpaste to buy. With so many choices, choosing wisely can be confusing and difficult. Many times our choice is not between the good or the bad, but between the better and the best. When it comes to making a choice about wound care dressings, is one really better than another? Is there one best wound dressing that will meet all the needs of the wound so healing can occur? Unfortunately, it sometimes seems that choosing the correct wound dressing is little more than just personal preference or what happens to be available at the moment. 

Wound healing, however, is a complex process in which the wound progresses through a series of steps for the wound to heal. There are many changes going on in the wound, often at the same time, during the entire healing process. Each phase of wound healing has its own particular issues that should be specifically addressed at the appropriate time if we are to assist the wound in progressing from one phase of healing to the next. The wound dressing should be chosen based on the needs of the wound at the time and the ability of the dressing to meet and correct those needs. Unfortunately, because of a deficiency of knowledge of the basic science of wound healing, choosing the appropriate and most beneficial dressing for the wound at the appropriate time is still problematic. 

What would constitute the “ideal” wound dressing? There are some characteristics of an “ideal” wound dressing that can meet the unique needs of the healing wound. They include: protecting healthy cells in the wound bed, maintaining an optimal pH and temperature for wound healing, maintaining a moist wound environment, preventing or minimizing wound contamination and infection, helping remove slough and necrotic tissue, improving edema and lymphedema, maximizing the formation of a functional extracellular matrix, and stimulating cell function or supplying functioning cells.¹ All of these functions revolve around knowing, identifying, and correcting the abnormalities in the wound microenvironment. The treatment must take into account each person’s individual comorbidities and genetic makeup and how they affect healing. That is quite a requirement for any wound dressing! 

There is no one dressing that can correct all abnormalities of the healing wound—one size will not fit all. Until more research is done, we must rely on our clinical experience and what evidence about wound dressings exists to choose the appropriate dressing that will meet the needs of the wound and then utilize it at the appropriate time to encourage healing. Good luck making your choice!