Surgical dressings

P.W. III rd
year
Definition:
Dressing represents all the means and
methods to ensure protection of a tissue
or organ toward aggressive action of
various agents (gastric dressing, anti-
inflammatory dressing).
Surgical dressing is the act through
which asepsis of a wound is achieved and
maintained for the purpose of its healing.
Requires: competence, qualified
knowledge, skills, notions of asepsis
Materials needed:
Substances for wound asepsis
Appropriate instruments
Protective material
Means for fixing the dressing
Antiseptic substances:
There are various solutions that are
designed to realize cleaning and
disinfecting the wound and adjacent skin
Examples:
- hydrogen peroxide
- betadine
- chloramines
- boric acid
- alcohol
- Dakin solution (Na hypochlorite)
- iodine tincture
Instruments:
All instruments used must be sterile
Forceps: anatomical and surgical forceps, port buffer forceps,
Pean, Kocher forceps
Bandage scissors, straight scissors (one arm sharp and one
round tip), scissors for thread curved and straight
device for applying and removing the metal clips
button probe, grooved probe, lavage catheter
Volkmann curette
suture materials
syringes, needles
kidney trays
surgical gloves
Serving forceps shall be kept in a pot with antiseptic
solution (chloramine)
Do not dress more patients with the same instrument
 Protective materials for
dressings
Compresses
Compressive dressings
Rigid and protective dressings
Special dressings
 Materials for dressings
Compresses
The purpose of use:
direct contact with the wound
the absorption of secretions
protection against contamination
mechanical protection
 Materials for dressings
Examples:
Front of gauze
Cotton
Gauze and natural fibers compresses
Occlusive dressings (hydrocolloids,
foaming agents, hydrogel
 General characteristics
of a dressing
lightweight
not irritant
sterile /sterilizable
absorptive
impermeable to the exterior germs
elastic compression in the wound
 Types of dressings
Natural: contain cellulose, which has
hydrophilic properties gauze, bud,
cotton wool, staple
Synthetics: hydrophobic with little
hydrophilic properties and high
elasticity foil and synthetic bandage
(polyester, polypropylene, polyamide
and silk acetate)
 Wound dressings made of
natural materials
They are the most used and the cheapest
Gauze (compress and bandage)
- canvas rare fabric, made of cotton, with high absorption
capacity (10 grams absorbs 20 grams of water)
cotton gauze and staple have reduced absorbent power,

being however more elastic

Wool

1. Made of cotton:
- it is used cotton wool: white, with homogeneous
structure, traction resistance, long fibers (over 2cm),
burns almost completely and have high absorption
capacity (18-20 x weight)
- Used as an absorbent and protective dressing
2. Staple fiber:
- Paper leaf with less absorbing power
 Characteristics:
Compresses with high absorbent capacity by
impregnation with secretions will be less
permeable to air
Cotton compresses tend to adhere to the
wound. To avoid this inconvenience it can be
soaked with various ointment or impregnated
with metal salts (zinc, aluminum, silver)
Wool due to increased adherence to the
wound, will be placed between two gauze
compresses
Occlusive hydroactive dressings
Covers the wound and surrounding areas in order to
maintain a high humidity
1. Adhesive film (polyurethane)
Advantages: - elastic, thin, transparent
- permeable for vapors and gas
- impermeable external surface
- thermal isolation
- impermeable for bacteria
Disadvantages: - adheres only to the dry skin
- poor absorption
- accumulation of secretions, collections
Indications: - clean scratched wounds
- decubitus ulcers grade I
- skin graft harvest site
2. Hydrocolloid dressing:
Double-layered structure (the internal side hydroactive and
external side of hydrophobic polyurethane)
Advantages: - adhere to wet and dry wounds
- outer layer impermeable for bacteria
- good absorption
- not injures the skin
- reduces pain in the wound
Disadvantages: - can not be applied on the infected wounds
(stimulates multiplication of bacteria)
- relatively expensive
Indications: - skin ulcers
- wet and dry necrosis
- burns
- painful wounds
- skin graft harvest site
3. Hydrogel
Sandwich-type layered structure (middle gelatinous layer,
covered with transparent urethane film for not adhering to
the wound)
Advantages: - permeable for vapors and gases
- increased absorption
- after removing the outer layer increases the
permeability for water
- anti-adhesive properties
- transparency (monitoring wound)
Disadvantages: - multiplication of germs in the wound
- the cost
Indications: - skin ulcers
- wet and dry necrosis
- burns
- painful wounds
- skin graft harvest site
4. Alginate
Products from brown seaweed.
Advantages: - high power absorption
- recommended for secreting and
infected wounds
- does not injure skin
Disadvantage: - increased price
Indications: - deep split wounds
- infected wounds secreting
- abrasions
- skin ulcers
5. Flexible porous materials
(polyurethane)
On the outside fine pores and on the internal side
greater in diameter pore - absorption by capillarity
Advantages: - good thermal isolation
- absorbs exudate
- reduce pain in the wound
- outer layer impermeable for bacteria
- permeable for gases and vapors
Disadvantages: - expensive
Indications: - incomplete necrectomy infected
wounds
- burns
- heavily secreting wounds
- wounds before grafting
Common characteristics
Reduces pain in the wound
Accelerates re-epithelization (over 50%) by
lowering the oxygen in the wound,
macrophages will release growth factors
which stimulate the granulation
Are maintained for a long time in the
wound: 3-8 days
Local hygiene is possible
Collects under the dressing a large amount
of liquid risk for germs multiplication
 Means for fixing the dressing
1. Adhesive tape
Itis a strip of fabric made of cotton, rubberized, of
different widths and lengths, adhesive on one of its faces
Tohave a good grip, the skin should be shaved and
degreased
The advantage of using it is that it allows easy
supervision of the operated area and does not
embarrassed functions of that segment
Disadvantages: painful detachment capacity accession is
short, impermeability to air, which causes maceration of
the skin under the tape
To avoid this last inconvenience there are perforated tabs
 2. Galifix
It is a solution of colophonium (rosin - conifer resin)
Content: colophonium, alcohol, benzene, sunflower oil
Itis a solution, adhesive to the skin, which is used
applying a thin layer to the skin around the dressing,1-2
cm wide and wait for 30-60 sec to form a film on the
surface, after which the gauze is applied for mounting
the dressing
The advantage is that it provides a good attachment of
the bandage, providing protection of the wound against
microbial invasion from the outside
The disadvantages are given by the cases of
intolerance, expressed through urticarial eruptions and
the fact that, at agitated patients, can come off easily
by gauze traction
3. The bandages as a means for fixing the
wound
4. There are some regions of the body
that is difficult to set appropriate dressing,
galifix or adhesive fixation is inefficient
and that the enswathement is slow and
difficult to maintain
The specific regions are head and face
but also other body parts behave the
same.
In these situations the wound sutured is
covered with a roll of gauze that you get
the stitches, making the so-called
Bourdonet
Conditions of a good dressing
To be done under aseptic conditions
This implies that the protective materials and
the instruments with which the dressing is made
are sterile
The instruments used for a patient should not be
used for other patients in order to prevent the
circulation of germs from a wound to another
Hands should be previously disinfected and
should not touch the wound
The wound should be cleaned and disinfected
using antiseptic solutions
Conditions of a good dressing
To be absorbent
In the case of secreting woundsthe absorption of
secretions is a requirement of the process of wound
healing
The highest power of absorption has the cotton wool
Gauze dressing does not absorb a large amount of
secretions, but by overlapping of the layers realises
a capillary system who leads the secretions towards
the outside
To be protective
A good dressing should protect the wound from
germs entering from outside
For better isolation, the top layer should exceed the
one beneath it
Conditions of a good dressing
Not to be painful
Maneuvers done when performing a dressing
should be gentlenot to trigger additional pain to
the patient
In the case of aggressive maneuvers (eliminating
collections, tissue necrosis, installing or replacing
the drain tubes, exploring of some tracts), it is
recommended local anesthesia or even general
anesthesia
Also, fixing dressings with adhesive substances or
bandages should not be too tight and should not
limit the movements of the respective segment if
there is no indication to that effect
 Conditions of a good dressing
To be changed in time
Changing of a dressing depends on the evolution of the
wound.
In case of aseptic wounds, without secretions, the change is
done as rarely as possible.
In case of secreting wounds, changing the dressing will be
done according to the amount of secretions. There are
situations when it is necessary to change the dressing more
than once per day.

Also, when the patient complains of pain at the wound site,

or when he has fever, without other explanation, will be
mandatory to control the wound, and on this occasion, the
dressing will be changed.
 Principii de baz n schimbarea
pansamentului
De obicei, schimbarea pansamentului e
efectuat de 2 persoane
Asepsia: se folosesc instrumente sterile,
scoase din ambalaj chiar nainte de folosire
Pentru protecia personalului i a pacientului
se folosesc mnui de unic folosin, iar n
caz de contact direct cu plaga, mnui de
unic folosin sterile
Eliminarea pansamentelor folosite: imediat
dup scoaterea pansamentului, acesta se
arunc n sacul pentru deeuri; instrumentele
folosite sunt trimise imediat la streilizare
 Principii de baz n schimbarea
pansamentului
Aseptizarea minilor nainte i dup schimbarea
pansamentului
Separarea pacienilor cu plgi infectate
Nu se converseaz: vorbirea deasupra plgii
deschise, fr masc, este interzis
nchiderea ferestrelor pentru a preveni
contaminarea cu praf
Aplicarea medicamentelor (unguente, pudre) se
face cu spatule sterile sau aplicatoare speciale
nlocuirea pansamentelor, dac exist semne de
acumulare crescut a secreiilor
nainte de aplicarea noului pansament se
schimb mnuile
 Schimbarea pansamentului unei
plgi aseptice
Aseptizarea minilor i punerea unei mti i
bonete
mbrcarea unor mnui de unic folosin
Leucoplastul prea aderent se ndeprteaz
eventual cu benzin iodat
Pansamentul de fixare se scoate cu grij i se
arunc n sacul colector
Plaga se cur cu o a doua pens, de la interior
spre exterior, n spiral; astfel se evit
antrenarea florei cutanate de la exteriorul plgii
spre centru
Aplicarea unor comprese noi
Acoperirea cu mijloace de fixare
 Schimbarea pansamentului plgilor
septice
Dac pacientul prezint dureri, se recurge la
administrarea unui analgetic
Materialele de fixare aderente se dezlipesc cu
benzin iodat
Leucolplastul se scoate cu grij i se arunc n sacul
colector
Compresele rmase se ndeprteaz cu o pens
steril
Plaga se cur n spiral, dinspre exterior spre
interior cu o a doua pens, pentru a preveni
rspndirea germenilor din plag
Schimbarea mnuilor i penselor
Aplicarea compreselor cu a treia pens
Acoperire cu material adeziv
 Tipuri de pansamente
1. Pansament protector
Utilizat n plgi care nu secret i nu sunt drenate
Se realizeaz cu mai multe straturi de comprese (2-3)
fixate cu leucoplast
n loc de comprese se pot folosi rini sintetice, care
pulverizate n plag, se solidific n contact cu aerul i
formeaz o pelicul fin protectoare
2. Pansament absorbant
Se aplic pe plgile drenate sau secretante i este alctuit
dintr-un strat de comprese i un strat de vat hidrofil, a
crui grosime este n funcie de cantitatea secreiilor
3. Pansament compresiv
Este indicat n scop hemostatic, pentru imobilizarea unei
regiuni sau pentru reducerea unei caviti superficiale
dup puncionare