DermatologyTimes ®

MARCH 2017
table of the month 99
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Decision Tree - Types of wounds and dressing options

Wound
Dressings
WOUND TYPE DRESSING OPTIONS REVIEW TIMES
Dry necrotic wound Moisture retention eg hydrocolloid, 3-4 days
semi-permeable
Slough - covered wounds Moisture retention and fluid absorption 3-4 days
eg hydrocolloid, alginate
Infected wound Avoid semi-occlusive dressings. Consider 1-2 days
alginate or hydrocolloid if high exudate
Graze, abrasions - clean Film, tulle, fixation sheet or dry 2 days
Graze, abrasions - soiled Dry or tulle 2 days
Puncture wounds or bites Open or dry 2 days
Laceration - sutured Open or dry, consider paper tape 3-7 days
lacerations support after suture removal
Burn-minor burns Film, medicated tulle, fixation sheet 4-5 days visual review, leave
dressing on if healing
Burn-major or requiring admis- Plastic wrap prior to surgical review, Inpatient review
sion eg special areasBurns medicated tulle
Chronic wounds eg ulcers, Hydrocolloid, alginate, foam 5 days
PEG sites, etc

DRESSING CHOICES

Photo: Shutterstock / BERNATSKAYA OXANA

DRESSING TYPES EXAMPLES ADVANTAGES DISADVANTAGES INDICATIONS CONTRAINDICATIONS

Semi-permeable - thin, OpSite, Some moisture evaporation. Reduces Exudate may pool, Superficial Highly exudative
adhesive, transparent Tegaderm pain. Barrier to external contamination. may be traumatic to remove. wounds. As a sec- wounds.
polyurethane film Allows inspection. ondary dressing.

Non adherent - moist (Tulle Jelonet, Reduces adhesion to wound. Does not absorb exudate. Burns. Wounds Allergy
Gras Dressing) - gauze Unitulle Moist environment aids healing. Requires secondary dressing. healing by sec-
impregnated with paraffin or Bactigras, May induce allergy or delay heal- ondary intention.
similar. May be impregnated Sofra-Tulle ing when impregnated.
with antiseptics or antibiotics

Non adherent -dry - thin per- Melolin, Low wound adherence. Not suitable in high exudate. Can Wounds with Dry wounds
forated plastic film coating Melolite, May absorb light exudate. dry out and stick to wound. May moderate exu- (may cause tissue
attached to absorbent pad Tricose require secondary dressing. date. dehydration)

Fixation sheet - porous poly-
ester fabric with adhesive
backing
Fixomull, Can be used directly on wound site. Dressing needs washing with Wounds with Infected wounds
Hypafix, Conforms to body contours, good pain soap and water, pat-dried twice mild exudate, allergy to adhesives
Mefix relief and controls edema, Remains per- daily. Requires application of oil not needing
meable allowing exudate to escape and prior to removal - ideally soaked frequent review.
be washed and dried off wound.Dressing in oil and wrapped in cling film
changes can be left for 5-7 days. overnight.

Calcium Alginate, Natural Kaltostat Forms gel on wound and hence moist May require secondary dressing. Moderately or Dry wounds
polysaccharide from sea- environment. Reduces pain. Can pack Not recommended in anaerobic highly exudative or hard eschar
weed cavities.Absorbent in exudative wounds. infections. Gel can be confused wounds. Need
Promotes hemostasis. Low allergenic. with slough or pus in wound. for hemostasis

Foam dressings - polyure- PolyMem Moist, highly absorbent and protective. Set size of foam may be limited Wounds with mild Dry wounds, wounds
thane foam dressing with by wound size. to moderate that need frequent
adhesive layer incorporated exudate. review

Hydrocolloid dressings - poly- Duoderm Retains moisture, painless removal. Avoid on high exudate wounds Burns (small), Dry wounds, infection
urethane film coated with Abrasions
adhesive mass

Paper adhesive tapes - adhe- Micropore Non allergenic. Provides wound support. Non absorbent Small wounds Exudative or large
sive tape may be applied wounds
directly to healing laceration

Republished, with permission from resources at The Royal Children’s Hospital, Melbourne, Australia www.rch.org.au/clinicalguide