So, What Do I Put on This Wound? The Wound Dressing Puzzle: Part III

Cynthia A. Worley


Dermatology Nursing. 2005;17(4):299-300. 

In This Article


"... to know even one life has breathed easier because you have lived. This is to have succeeded." - Ralph Waldo Emerson

The quest for the "ultimate" wound dressing has led many wound care clinicians to assume that there is one dressing that can be used on everything! I've known practitioners who think that one dressing can be used on all wounds and proceed to do so. Years ago, I remember receiving a consult from a nurse who stated that the wound was draining so heavily that she had changed the dressing three times in 1 hour. I arrived on the floor quickly, only to discover that she was using a transparent film on a heavily draining wound. Fluid was pooling under the dressing and undermining the seal (not to mention what the frequent removal of an adhesive dressing was doing to the periwound skin).

The choice of wound dressing should be predicated upon several conditions usually discovered during a thorough assessment (as discussed in previous columns). Status of the immune system and the patient's nutritional state, accurate diagnosis of the type of wound, and previous treatment are all critical to making the right dressing selection. The physical conditions of the wound will also dictate the appropriate dressing. Factors such as condition of the periwound skin, amount of drainage, possibility of infection, and condition of the wound bed give the clinician the necessary information to make the right dressing choice. We teach many of our patients and their families wound care protocols, so it is imperative that the procedure be easy to follow and supplies can be obtained readily. In the instance where both a primary (wound contact layer) and secondary dressing are used, the frequency of primary dressing changes will dictate the secondary dressing used. A secondary dressing with a strong adhesive, designed for several days of wear time, is not appropriate when using a primary dressing that requires daily changes.

Silicone dressings, specialty absorptive dressings, transparent films, and wound fillers will be discussed.


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