Choosing a Wound Dressing Based on Common Wound Characteristics

Abstract

Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings.

Tania Phillips, MD, FAAD, FRCPC

Figure 1.

An example of eschar overlying a wound bed. This is a patient with polyarteritis nodosa. Notice the thick, adherent fibrinous material. Hydrogel sheet was applied to the wound for 10 days, this softened the eschar. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 2.

Example of a wound with moderate amount of exudate, this is a traumatic injury that resulted in an ulceration. A hydrofiber dressing was applied to the wound to absorb the exudate. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 3.

An example of a fully granulated wound bed. (A) This is a venous ulcer on the right lateral malleoli. Notice minimal exudate and 100% granulation tissue evident on the wound bed. A hydrocolloid was applied to the wound. Over the primary dressing, the patient wore compression stockings. (B) After 4 weeks the wound had healed. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 4.

An example of a partially granulated wound with fibrin adherent to the wound bed. (A) This is a venous ulcer on the patient's right medial malleoli. There is mild to moderate exudate. Granulation tissue is visualized within the fibrinous wound bed. Bedside debridement was performed. Patient was prescribed a collagenase. The collagenase was applied daily to the wound bed with a foam dressing. (B) After 3 weeks the wound had 100% granulated. A hydrocolloid was applied to the wound. Over the primary dressing, the patient wore compression stockings. (C) By week 6 the wound had healed. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 5.

An example of a highly colonized wound. (A) This is a highly colonized wound. There is excessive purulent exudate without the signs of infections (red, warm, tender). A wound culture was obtained, which grew back normal skin flora. Bedside debridement with a curette was performed. The silver dressing was held in place with telfa dressing; over both dressings the patient wore tubular elastic compression stockings. (B) Six weeks later, the wound partially healed and the film of colonization was well controlled, the same dressings were continued. (C) By week 8 the wound had healed. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound