Dressings for Chronic wounds

Dr. Joel Arudchelvam

Consultant Vascular and Transplant Surgeon
 Dressings for Chronic wounds

• Definition of chronic wound / dressing

• Types of dressings

• Summary of use of various dressings

• When to change

• What not to do
 Chronic ( non healing ) ulcer /
wound
• Wounds / ulcers not showing signs of healing
after 6 weeks.
 Wound dressings
• The material which is applied to the surface of
the wound to cover
•
– 1ry – dressing which touches the wound
– 2ry – dressing used to cover the primary dressing
 Ideal wound dressing
Dressings are applied to wounds for
• To provide a protective cover
• To maintain moisture
• To absorb exudates

In addition an ideal dressing

• Does not induce pain or itching
• Easy to change
• Allows gaseous exchange
• Cheap
• Freely available
 Types of Wound Dressings
• Gauze
• Tulle
• Hydrocolloid
• Hydrogel
• Alginate
• Foam
• Transparent film
• Etc.
 Gauze
• Cheap
• Freely available

• Dry
• Painful on removing
• Damages epithelium
 Tulle
• Cheap
• Freely available
• Easy removal
– E.g : Vaseline
 Hydrocolloid Dressings
• Made up of pectin based material
• Absorb exudate
• Come in various shapes and sizes
 Hydrogel Dressings
• Made up of water in a polymer
• Used in dry wounds
 Alginate Dressings
• Made from seaweed
• Absorb moderate amounts of drainage
• becomes a gel when it comes into contact with
wound fluid
 Foam Dressings
• Made up of polyurethane foam
• Absorbs large amounts of fluid
• Available in various sizes and shapes
 Silver Dressings
• Reduce bio burden - through slow release of
silver ion into the wound

• e.g. Acticoat, Biatin Ag, Atruman Ag

Vacuum Assisted Closure VAC
 Vacuum Assisted Closure VAC
• Mechanisms of action
– Macro strain
– Micro strain

• Macrostrain - visible contraction which

occurs when negative pressure is
applied.

– Draws wound edges together

– Provides direct and complete wound
bed contact
– Removes exudate
 Vacuum Assisted Closure VAC

• Microstrain - micro deformation

at the cellular level

– Reduces edema
– Promotes granulation tissue
formation by facilitating cell
migration and proliferation
 Vacuum Assisted Closure VAC

• Indications for use

– Large wounds
– Cavities
– Large amount of exudate
 Summary
Wound type Dressing
Dry Hydrocolloid, Hydrogel

Exudating wound Hydrocolloid, foam

Dead space / cavity Alginate, foam, VAC

Gauze, tulle and gel Most wounds

Wound with slough , dead tissue –

needs wound toilet.
 When to change dressings
• When there is an indication to change

– Soaking / smelling
– Need to inspect – pain , swelling , fever, ect.

• Discuss with doctor before changing

 Avoid in chronic wounds
• Iodine (Betadine)
• Hydrogen peroxide
• Other toxic agents
 Avoid
• Do not tie gauze bandage tightly around
limbs, digits – causes ischaemia
• Use – plaster , crepe instead
Thank You