Dressing (medical)

An adhesive island dressing, in its original packaging (left) and on a person's wrist (right).

A dressing is a sterile pad or compress^[1] applied to a wound to promote healing and/or prevent further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place.

Core purposes of a dressing

A dressing can have a number of purposes, depending on the type, severity and position of the wound, although all purposes are focused towards promoting recovery and preventing further harm from the wound. Key purposes of a dressing are:

• Stem bleeding – to help to seal the wound to expedite the clotting process;
• Absorb exudate – to soak up blood, plasma, and other fluids exuded from the wound, containing it/them in one place;
• Ease pain – to have an actual pain-relieving effect, whereas some others may have a placebo effect;
• Debride the wound – to remove slough and foreign objects from the wound;
• Protection from infection – to defend the wound against germs and mechanical damage;
• Promote healing – to contribute to recovery via granulation and epithelialization; and
• Reduce psychological stress – to obscure a healing wound from the view of others.

Types of dressing

Two packages of gauze. One 10 cm by 4.1 m. The other 5 by 5 cm.

Three types of gauze

Depiction of a dressing on a face from a painting from 1490

Historically, a dressing was usually a piece of material, sometimes cloth, but the use of cobwebs, dung, leaves and honey have also been described. However, modern dressings^[2] include gauze (which may be impregnated with an agent designed to help sterility or to speed healing), films, gels, foams, hydrocolloids, alginates, hydrogels and polysaccharide pastes, granules and beads. Many gauze dressings have a layer of nonstick film over the absorbent gauze to prevent the wound from adhering to the dressing. Medical grade honey continues to be used in combination with modern dressings, and there is moderate evidence that honey is more effective than antiseptic followed by gauze for healing wounds infected after surgical operations.^[3] Dressings can be impregnated with antiseptic chemicals, as in boracic lint or where medicinal castor oil was used in the first surgical dressings.^[4] Bioelectric dressings such as Procellera can be effective in attacking certain antibiotic-resistant bacteria^[5] and speeding up the healing process.^[6]

Various types of dressings can be used to accomplish different objectives including:

• Controlling the moisture content, so that the wound stays moist or dry. An example of a moisture-retaining dressing is Aquacel, which is a "hydrofiber" that is indicated, for example, for partial-thickness burns.^[7]
• Protecting the wound from infection;
• Removing slough; and
• Maintaining the optimum pH and temperature to encourage healing.

Occlusive dressings, made from substances impervious to moisture such as plastic or latex, can be used to increase the rate of absorption of certain topical medications into the skin.

Biologics, skin substitutes, biomembranes and scaffolds

Advancements in the clinical understanding of wounds and their pathophysiology have commanded significant biomedical innovations in the treatment of acute, chronic, and other types of wounds. Many biologics, skin substitutes, biomembranes and scaffolds have been developed to facilitate wound healing through various mechanisms. This includes products such as monoterpenes, Epicel, Laserskin, Transcyte, Dermagraft, AlloDerm/Strattice, Biobrane, Integra, Apligraf, OrCel, GraftJacket and PermaDerm. A systematic review of these products with mechanisms and clinical outcomes is summarized by Vyas, et al.^[8]

Usage of dressings

Applying a dressing is a first aid skill, although many people undertake the practice with no training – especially on minor wounds. Modern dressings will almost all come in a prepackaged sterile wrapping, date coded to ensure sterility. This is because it will come in to direct contact with the wound, and sterility is required to fulfill the 'protection from infection' aim of a dressing.

Historically, and still the case in many less developed areas and in an emergency, dressings are often improvised as needed. This can consist of anything, including clothing or spare material, which will fulfill some of the basic tenets of a dressing – usually stemming bleeding and absorbing exudate.

Applying and changing dressings is one common task in nursing.

An "ideal" wound dressing is one that is sterile, breathable, and conducive for a moist healing environment. This will then reduce the risk of infection, help the wound heal more quickly, and reduce scarring.

See also

• Hydrocolloid dressing

References

1. ↑ "First Aid Equipment, Supplies, Rescue, and Transportation". Hospital Corpsman. Naval Education and Training Command. 2003. pp. 3–1. 
2. ↑ "www.dressings.org". SMTL. Retrieved 2007-02-24. 
3. ↑ Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N (6 March 2015). "Honey as a topical treatment for wounds". Cochrane Database of Systematic Reviews. 3: CD005083. doi:10.1002/14651858.CD005083.pub4. PMID 25742878. 
4. ↑ Gallant, A. E. (1897). "Report upon the Use of a Mixture of Castor oil and Balsam of Peru as a Surgical Dressing". Annals of Surgery 26 (3): 329–339. PMC 1425429. PMID 17860484. 
5. ↑ Kim, H; Makin, I; Skiba, J; Ho, A; Housler, G; Stojadinovic, A; Izadjoo, M (24 Feb 2014). "Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens". Open Microbiol J 8 (1): 15–21. doi:10.2174/1874285801408010015. PMC 3950956. PMID 24627730. 
6. ↑ Banerjee, Jaideep; Ghatak, Piya Das; Roy, Sashwati; Khanna, Savita; Sequin, Emily K.; Bellman, Karen; Dickinson, Bryan C.; Suri, Prerna; Subramaniam, Vish V.; Chang, Christopher J.; Sen, Chandan K. (3 March 2014). "Improvement of Human Keratinocyte Migration by a Redox Active Bioelectric Dressing". Plos One 9 (3): e89239. Bibcode:2014PLoSO...989239B. doi:10.1371/journal.pone.0089239. 
7. ↑ Caruso, D. M.; Foster, K. N.; Hermans, M. H. E.; Rick, C. (2004). "Aquacel Ag?? In the Management of Partial-Thickness Burns: Results of a Clinical Trial". Journal of Burn Care & Rehabilitation 25 (1): 89–97. doi:10.1097/01.BCR.0000107202.85453.63. PMID 14726745. 
8. ↑ Vyas KS, Vasconez HC. Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare. 2014; 2(3):356-400. http://www.mdpi.com/2227-9032/2/3/356/htm