Let's talk about wound dressings

This is the 4011th article of Da Yi Xiao Hu

Wound dressings

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In the outpatient clinic, patients or their families often ask, "Doctor, please prescribe the best ointment for us. It doesn't matter how expensive it is, as long as the wound heals quickly." Does that mean the more expensive the dressing, the better it is for the wound? Today, let's talk about wound dressings.

As for the dressings covering wounds, the most familiar to us is sterilized gauze. Did you know that before 1865, no matter how noble your status was, once you had a wound, you could not use sterilized gauze? Because Joseph Lister, a surgeon in the Victorian era of England, established a new sterilization method using carbolic acid as a sterilizing agent in 1865, and was the first to apply sterilized gauze to wound care. Before the 18th century, people used natural items such as tea, feathers, leaves and soil as wound dressings to relieve wound pain and promote wound healing.

The use of sterile gauze greatly reduces the incidence of wound infection and promotes wound healing. However, the pain of dressing change caused by cotton gauze dressing sticking to wound tissue, secondary damage to wound surface and its inadequacy in the treatment of refractory wound surface are becoming more and more obvious in the clinical dressing change process.

In 1962, Dr. George Winter of the University of London conducted an experiment on pigs and found that wounds covered and protected by polyethylene sheets healed faster. He then proposed a new moist therapy of "sterile, moist, and closed" wounds, laying the foundation for modern moist wound treatment theory. In 1963, Hinman confirmed the same result on human wounds. In 1974, the first new dressing, polyurethane film dressing, was born. Then, various dressings came on stage. (The order of appearance is ranked by the number of strokes of the surname, and there is no extension in the whole article).

Hydrogel

Mainly contains water and water-insoluble polymers. It can keep the wound moist and promote autolytic debridement. The disadvantage is that it cannot prevent bacterial invasion and may cause maceration of the surrounding skin. It cannot be used for wounds with excessive exudation and infection.

Hydrocolloid dressings

It mainly contains sodium carboxymethylcellulose, animal glue, pectin, etc. It can keep the wound moist, promote autolytic debridement, and absorb a small amount of exudate. The disadvantage is that the glue formed by absorbing wound exudate is easily confused with infection, and it is not suitable for wounds with a lot of exudate.

Alginate dressing

Extracted from seaweed, it is a soft non-woven fiber that can absorb 17 to 20 times its own weight of exudate. The calcium salt in the dressing produces ion exchange with the sodium salt secreted by the wound and blood to form a gel, which has a hemostatic effect. It is available in strips and sheets and can be used for wound filling. The disadvantage is that it needs to be fixed with an external dressing and is not suitable for dry wounds.

Hydrophilic fiber

It is a soft fiber made of sodium carboxymethylcellulose fiber. It absorbs exudate to form a gelatinous property to keep the wound moist, and absorbs vertically without soaking the surrounding skin. It also needs an outer dressing to fix it and cannot be used for dry scab wounds.

Foam dressing

Made of polyurethane foam and polyethylene foam. Suitable for the prevention of pressure injuries and wounds with moderate to heavy exudation. The disadvantage is that it is not suitable for dry wounds and scabby wounds.

Super absorbent wound pad

A multi-layered dressing pad with a superabsorbent polyacrylate core. Requires activation with Ringer's solution.

Silver dressing

As the name implies, silver ions are added to the dressing, and the continuously released silver ions have a broad-spectrum antibacterial effect. It cannot be used for patients who are allergic to silver. It is also not recommended to use it on a large area for a long time to avoid silver poisoning.

Charcoal dressing

It can absorb odors. The downside is that activated carbon generally loses its activity after absorbing the seepage.

Hypertonic saline dressing

It is a non-woven dressing containing crystallized hypertonic sodium chloride. It can absorb wound exudate until it becomes isotonic, adsorb bacteria and necrotic tissue, reduce edema, and promote healing. The disadvantage is that it cannot be used on healthy granulation tissue.

Oil gauze dressing

Oil gauze dressings are divided into chemical oil gauze and medicated oil gauze, which are often used as internal dressings for wounds. They do not damage granulation tissue and new epidermis, and can be removed painlessly. The disadvantage is that they cannot absorb exudate.

Collagen-containing dressing

Contains 90% collagen and 10% calcium alginate, suitable for wounds in the granulation growth stage. It requires an outer dressing and cannot be used for infected wounds.

Iodine dressings

People use slow-release iodine dressings to treat many different types of infected or suspected infected wounds. However, there are clear contraindications to the use of iodine dressings: thyroid disease, known or suspected iodine allergy, pregnant or breastfeeding women, newborns, and infants under six months of age.

Are you dazzled by so many dressings? You must be asking me which one is the best? As mentioned at the beginning of the article, the patient requested expensive silver ion dressings, but his wound did not have much exudation. In the epithelial crawling stage, a relatively low-priced hydrocolloid dressing would suffice. So I can tell you responsibly: there is no best dressing, only the most suitable one.

Author: Shanghai Eighth People's Hospital Physical Examination Center

Liu Lifang