Dr. MUHIBULLAH BANGASHPG-1 ResidentSurgical-E UnitKTH, Peshawar

Definitions History of Surgical Dressings Properties of Ideal wound Dressings Types of Surgical Dressings Commonly used Surgical Dressings Miscellaneous Dressings Conclusion Videos

SURGICAL DRESSING:A dressing is a sterile pad or compress appliedto a wound to promote healing and preventfurther harm.

BANDAGE:A bandage is a piece of material used either tosupport a medical device such as a dressing orsplint, or on its own to provide support to thebody.

Historically, a dressing was usually a piece ofmaterial, sometimes cloth, but the use ofcobwebs, dung, leaves and honey have alsobeen described.

Previously, the accepted wisdom was that toprevent infection of a wound, the woundshould be kept as dry as possible.

1860, English surgeon, Joseph Lister, began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%.

1870, Robert Wood Johnson, co-founder of“Johnson & Johnson”, began producinggauze and wound dressings treated withiodine.

1960, George Winter published hiscontroversial research on moist healing. Hedemonstrated that wounds kept moisthealed faster.

1990, the surgical dressings expanded into thewell-recognized groups of products, such asvapor-permeable adhesive films, hydrogels,hydrocolloids, alginates, and synthetic foamdressings. Additionally, new groups of products,such as antiadhesive, mostly silicone meshes;tissue adhesives; barrier films; and silver- orcollagen-containing dressings, were introduced.Finally, combination products and engineeredskin substitutes were developed.

Primary Dressing: A dressing that touches thewound

Secondary Dressing (Bandage): Keeps theprimary dressing in site

Some dressings function as primary dressingonly. However some could function both asprimary as well as secondary dressing

Provide mechanical and bacterial protection Maintain a moist environment at the

wound/dressing interface Allow gaseous and fluid exchange Remain nonadherent to the wound Nontoxic, nonsensitizing, and nonallergic Well acceptable to the patient (e.g., providing

PAIN RELIEF and not influencing movement) Cost effective

Highly absorbable (for exuding wounds) Absorb wound odor Sterile Easy to use (can be applied by medical

personnel or the patient) Require infrequent changing Available in a suitable range of forms and

sizes

CLASSIFICATION: Dry dressings Moisture-keeping dressings Bioactive Dressings Skin Substitutes

Most commonly available dressings Tend to absorb wound moisture. Tightly Adherent to granulation Tissue – will

break upon removal

EXAMPLES: Gauze and bandages Membranes and foils Foams Tissue adhesives

Nonadherent to the wound Heals faster Do not break granulation tissue on removal Comparatively less painful

EXAMPLES: Pastes, creams and ointments Nonpermeable, semipermeable membranes

or foils, Hydrocolloids Hydrogels Combination products.

They play a significant active role in wound healing because

enhance granulation tissue formation Reduce slough formation Inhibits bacteria Some provide growth factors

EXAMPLES: Antimicrobial dressings Interactive dressings Single-component biologic dressings Combination products

Skin substitutes are heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin, either temporarily or permanently, depending on the product characteristics.

EXAMPLES: Epidermal substitutes

(autologous or allogenic)

Acellular skin (dermis) substitutes(allogenic or xenogenic)

Autologous and Allogenic skin Skin substitutes containing living cells.

Gauzes Foams Polymeric films

(Opsite) Tissue adhesives Tulles Hydrocolloids Hydrogels Debriding agents

Enzymatic dressings Bead dressings Silicone dressings Human Amniotic

Membrane Porcine skin

Most readily available simple wound dressings Non-adherent coating Absorbs exudate Promote desiccation in wounds Can be used as a primary or secondary dressing Inexpensive Highly permeable Relatively non-occlusive FORMS: squares, sheets, rolls, and packing strips.

polyurethane porous sponges or polyurethanefoam films

Light-to-medium exuding wounds (Absorbent) Left on the wound surface for up to 7 days,

depending on exudate volume. Not recommended for any kind of dry

wounds!! Can be shaped to fit deep cavities and

granulating wounds.

Semipermeable film dressings Primary adhesive transparent Waterproof Impermeable to bacteria Breathable Ultra thin & high elasticity

Examples: Opsite Bioclusive Tegaderm

Uses: General wound care Skin biopsies Donor sites Superficial partial thickness burns Surgical incisions Securing of peripheral IV lines central venous catheters

Contraindicted in highly exudative wounds

contain CYANOACRYLATE which polymerize in an exothermic reaction on contact with either a fluid or a basic substance

Used for SIMPLE LACERATIONS, which otherwise might require the use of fine sutures, staples, or skin strips

cosmetic results similar/better than traditional suturing

Needleless & Painless method of wound repair

Does not require follow-up visits for suture removal

Strength of healed tissue seen at 7 days Ensure that wound edges are appropriately

adapted and that no adhesive passes between wound borders

Tulle: A light, thin type of cloth that is like anet

They comprise a gauze cloth impregnatedwith paraffin for non-traumatic removal

Antiseptics/Antibiotics are added forprevention or treatment of infection.

Does not stick to wound surface Suitable for flat, shallow wound Useful in patient with sensitive skin Require a secondary dressing

Soft paraffin dressing Contains chlorhexidine which is an ANTISEPTIC Allows the wound to drain freely into an

absorbent secondary dressing Used for covering wounds such as superficial

burns, lacerations, abrasions, graft sites and legulcers.

It consists of a cotton fabric, impregnatedwith a base composed of white soft paraffin,anhydrous lanolin, and 1.0% FramycetinSulphate

Framycetin is an antibiotic of theaminoglycoside group

It is used for Infected wounds, combining lowadherence with antimicrobial activity.

Hydrocolloids slowly absorb fluids, leading to achange in the physical state of the dressing &the formation of gel covering the wound.Thus, they are called interactive dressings

Provide moist wound environment Promote the formation of granulation tissue Provide PAIN RELIEF by covering nerve endings

with both gel and exudate. Constituents are methylcellulose, pectin,

gelatin, and polyisobutylene.

USES: Both acute wounds and chronic wounds Desloughing purpose For different stages of light-to-heavily exuding

wounds

Initially, dressings need to be changed daily,but once the exudate has diminished, dressingsmay be left for up to 7 days

Do not use on infected wounds!!

Brand: DueDERM®

Contain WATER i.e., > 70-90%They have some important characteristics of an IDEAL DRESSING Cool the surface of the wound, resulting in

MARKED PAIN REDUCTION Maintain the moist wound environment For use on dry or necrotic wounds or on

lightly exuding wounds Can be used at all stages of wound healing

except for infected or heavily exuding wounds

May MACERATE the healthy skin (mostly wound border areas), decreasing the keratinocyte reepithelialization ratio or leading to over wetting of split-skin donor sites.

Available as sheet dressings or gels. Brands: Tegagel®, Intrasite®

GEL FORM

SHEET FORM

Provide acidic environment Enhance healing via debriding action Only used in Necrotic sloughing skin ulcers

EXAMPLE: Benoxyl-benzoic acid

Activate fibrinolysis and liquefy pus on CHRONIC SKIN ULCERS

Example: Varidase-streptokinase/streptodornase

Remove bacteria and excess moisture by CAPILLARY ACTION

Useful in Deep Granulating Wounds

EXAMPLES: Debrisan® Iodosorb®

Available as Sheeths & Pastes

May reduce Hypertrophic scarring andKeloid formation

Work as Antiadhesives useful in covering split-skin donor sites or

fresh meshgrafts

MAKING THE SCARS MORE COSMETICALLY ACCEPTABLE via: flattening of scarring tissue increasing elasticity reducing discoloration

An ALGINATE dressing is a natural wounddressing derived from different types of algaeand seaweeds.

Best used on wounds that have a LARGEAMOUNT OF EXUDATE

Can absorb Exudate upto 20 times their ownweight

Available as Sheaths and Ropes

BRANDS: Kaltostat® Sorbsan®

Obtained from the placenta after delivery To cover burn wounds. Can be prepared relatively inexpensively

CHARACTERISTICS OF AN IDEAL SKIN SUBSTITUTE: Excellent adherence to the wound Very low immunogenicity Decrease of pain Bacterial control Stimulation of healing

It is translucent, allowing inspection of thewound.

Can be applied on superficial second-degreeburns, deep second-degree burns after earlydebridement and donor sites

To cover 1:3 meshed autografts Extremely effective in sterilizing contaminated

wounds and cleaning burns of bacteria within3-5 days.

Have to be changed DAILY Need to be covered with gauze to prevent

desiccation Can be kept refrigerated for 6 weeks They can be frozen for longer storage

Porcine skin is the most common source of xenograft because of its high similarity to human skin.

Well-suited temporary dressing for the coverage of second-degree burns, especially after early excision.

It usually promotes scar-free healing Average healing period of about 10 days. suitable overlay to cover widely meshed (1:8

to 1:12) autografts

Promote the deposit of newly formed collagenin the wound bed

These dressings chemically bind to MatrixMetalloproteinases (MMPS) found in theextracellular fluid of wounds. MMPs normallyattack and break down collagen, so dressingscontaining collagen give MMPs an alternativecollagen source, leaving the body’s naturalcollagen available for normal wound healing.

Mainly used for Chronic Nonhealing Wounds

Bilayer Skin Substitute Constructed of a Silicon Film with a Nylon

fabric partially imbedded into the film towhich Collagen has been chemically boundand cross-linked

Used in Severe burns and Donor sites significantly reduce local wound pain speed up the healing process

Tissue engineering is the use of a combination of cells, engineering and materials methods to improve or replace biological functions

Engineered skin substitutes have been developed to address the need for wound coverage and tissue repair as conventional wound dressings have significant limitations for skin regeneration

EXAMPLES: TransCyte® was the first human-based,

bioengineered, temporary skin substitute for the treatment of Full and Partial thickness burns

Integra® serves to prepare the wound bed in preparation for transplantation with autologous split-thickness skin three weeks later

Currently, NO engineered skin substitute can replace all of the functions of intact human skin

Determine and address cause of wound Establish plan of care that includes dressings

that will address principles of moist wound healing

Keep dressings as simple as possible Assure Pain is addressed