Dressing (medical)

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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 protect the
wound from further harm.[2] 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. Many
modern dressings are self-adhesive.

Contents
 1 Medical uses
 2 Types
o 2.1 Passive products
o 2.2 Interactive products
o 2.3 Bioactive products
 3 Usage of dressings
 4 See also
 5 References

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

 Stem bleeding – to help to seal the wound to expedite the clotting process;
 Protection from infection – to defend the wound against germs and mechanical damage;
 Absorb exudate – to soak up blood, plasma, and other fluids exuded from the wound,
containing it/them in one place and preventing maceration;
 Ease pain – either by a medicated analgesic effect, compression or simply preventing
pain from further trauma;
  Debride the wound – to remove slough and foreign objects from the wound to expedite
healing;
 Reduce psychological stress – to obscure a healing wound from the view of the patient
and others.

Ultimately, the aim of a dressing is to promote healing of the wound by providing a sterile,
breathable and moist environment that facilitates granulation and epithelialization. This will then
reduce the risk of infection, help the wound heal more quickly, and reduce scarring.[3]

Types

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, dressings were made of a piece of material, usually a cloth, but the use of cobwebs,
dung, leaves and honey have also been described.

However, modern dressings[4] include dry or impregnated gauze, plastic films, gels, foams,
hydrocolloids, alginates, hydrogels, and polysaccharide pastes, granules and beads. They all
provide different physical environments suited to different wounds:[2]

 Absorption of exudate, to regulate the moisture level surrounding the wound- for
example, dry gauzes absorb exudate strongly, drying the wound, hydrocolloids maintain a
moist environment and film dressings do not absorb exudate;
 Gas permeability and exchange, especially with regard to oxygen and water vapour;
 Maintaining the optimum temperature to encourage healing;
 Mechanically debriding a wound to remove slough.
 Pressure dressings are commonly used to treat burns and after skin grafts. They apply
pressure and prevent fluids from collecting in the tissue.[5]

Dressings can also regulate the chemical environment of a wound, usually with the aim of
preventing infection by the impregnation of topical antiseptic chemicals. Commonly used
antiseptics include povidone-iodine, boracic lint dressings or historically castor oil.[6] Antibiotics
are also often used with dressings to prevent bacterial infection. Medical grade honey is another
antiseptic option, and there is moderate evidence that honey dressings are more effective than
common antiseptic and gauze for healing infected post-operative wounds.[7] Bioelectric dressings
can be effective in attacking certain antibiotic-resistant bacteria[8] and speeding up the healing
process.[9]

Dressings are also often impregnated with analgesics to reduce pain.

The physical features of a dressing can impact the efficacy of such topical medications.
Occlusive dressings, made from substances impervious to moisture such as plastic or latex, can
be used to increase their rate of absorption into the skin.

Dressings are usually secured with adhesive tape and/or a bandage. Many dressings today are
produced as an "island" surrounded by an adhesive backing, ready for immediate application –
these are known as island dressings.

Passive products

Generally, these products are indicated for only superficial, clean, and dry wounds with minimal
exudates. They can also be used as secondary dressings (additional dressings to secure the
primary dressing in place or to absorb additional discharge from the wound). Examples are:
Gauze, lint, adhesive bandage (plasters), and cotton wool. The main aim is to protect the wound
from bacterial contamination. They are also used for secondary dressing. Gauze dressing is made
up of woven or non-woven fibres of cotton, rayon, and polyester. Gauze dressing are capable of
absorbing discharge from wound but requires frequent changing. Excessive wound discharge
would cause the gauze to adhere to the wound, thus causes pain when trying to remove the gauze
from the wound. Bandages are made up of cotton wool, cellulose, or polyamide materials. Cotton
bandages can act as a secondary dressing while compression bandages provides good
compressions for venous ulcers. On the other hand, tulle gras dressing which is impregnated with
paraffin oil is indicated for superficial clean wound.[10]

Interactive products

Several types of interactive products are: semi-permeable film dressings, semi-permeable foam
dressings, hydrogel dressings, hydrocolloid dressings, and alginate dressings. Apart from
preventing bacteria contamination of the wound, they keep the wound environment moist in
order to promote healing.[10]

Semi-permeable film dressing: This dressing is a transparent film made up of polyurethane. It

allows the movement of water vapor, oxygen, and carbon dioxide into and out of the dressing. It
also plays an additional role in autolytic debridement (removal of dead tissue) which is less
painful when compared to manual wound debridement inside the operating theater. It is highly
elastic and flexible, thus is closely adhered to the skin. As the dressing is transparent, wound
inspection is possible without removing the dressing. Due to the limited absorption capacity,
such dressing is only used in superficial wounds with low amount of discharge.[10]

Semi-permeable foam dressing: This dressing is made up of foam with hydrophilic (attracted to
water) properties and outer layer of hydrophobic (repelled from water) properties with adhesive
borders. The hydrophobic layer protects the wound from the outside fluid contamination.
Meanwhile, the inner hydrophilic layer is able to absorb moderate amount of discharge from the
wound. Therefore, this type of dressing is useful for wound with high amount of discharge and
for wound with granulation tissue. Secondary dressings are not required. However, it requires
frequent changing and is not suitable for dry wounds. Silicone is a common material that make
up the foam. The foam is able to mold according to the shape of the wound.[10]

Hydrogel dressing: This dressing is made up of synthetic polymers such as methacrylate and
polyvinyl pyrrolidine. It has high water content, thus provides moisture and cooling effect for the
wound. The dressing is easy to remove from the wound without causing any damage. The
dressing is also non-irritant. Therefore, it is used for dry necrotic wound, necrotic wound,
pressure ulcers, and burn wound. It is not suitable for wounds with heavy discharge and infected
wounds.[10]

Hydrocolloid dressing: This type of dressing contains two layers: inner colloidal layer and outer
waterproof layer. It contains gel forming agents such as carboxymethylcellulose, gelatin and
pectin. When the dressing is in contact with the wound, the wound discharge are retained to form
gel which provides moist environment for wound healing. It protects the wound from bacterial
contamination, absorbs wound discharge, and digests necrotic tissues. It is mostly use as
secondary dressing. However, it is not used in wound with high discharge and neuropathic
ulcers.[10]
Alginate dressing: This type of dressing is made up of either sodium or calcium salt of alginic
acid. This dressing can absorb high amount of discharge from a wound. Ions present in the
dressing can interact with blood to produce a film that protects the wound from bacterial
contamination. However, this dressing is not suitable for dry wounds, third degree burn wound,
and deep wounds with exposed bone. It also requires secondary dressing because wounds can
quickly dry up with alginate dressing.[10]

Bioactive products

Advancements in understanding of wounds have commanded 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.[11]

Usage of dressings

Application of paraffin gauze on the cellulitis wound on the leg.

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. Sterility is necessary to prevent infection from
pathogens resident within the 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.

See also
 History of wound care#Wound-site dressing
 Hydrocolloid dressing
 Hydrogel dressing
 Field dressing (bandage)
References
1.

 "First Aid Equipment, Supplies, Rescue, and Transportation". Hospital Corpsman. Naval
Education and Training Command. 2003. pp. 3–1.
  Zarrintaj, Payam; Moghaddam, Abolfazl Salehi; Manouchehri, Saeed; Atoufi, Zhaleh;
Amiri, Anahita; Amirkhani, Mohammad Amir; Nilforoushzadeh, Mohammad Ali; Saeb,
Mohammad Reza; Hamblin, Michael R; Mozafari, Masoud (October 2017). "Can regenerative
medicine and nanotechnology combine to heal wounds? The search for the ideal wound
dressing". Nanomedicine. 12 (19): 2403–2422. doi:10.2217/nnm-2017-0173. PMID 28868968.
  Eaglstein, William H. (2001-02-01). "Moist Wound Healing with Occlusive Dressings: A
Clinical Focus". Dermatologic Surgery. 27 (2): 175–182. doi:10.1046/j.1524-
4725.2001.00299.x. ISSN 1524-4725. PMID 11207694. S2CID  6036583.
  "www.dressings.org". SMTL. Retrieved 2007-02-24.
  "pressure dressing". thefreedictionary.com.
  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.
  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 (3):
CD005083. doi:10.1002/14651858.CD005083.pub4. PMID 25742878.
  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.
  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. PMC 3940438. PMID 24595050.
  Selvaraj, Dhivya; Viswanadha, Vijaya Padma; Elango, Santhini (28 November 2015).
"Wound dressings – a review". Biomedicine (Taipei). 5 (4): 22. doi:10.7603/s40681-015-0022-9.
PMC 4662938. PMID  26615539.

1.  Vyas KS, Vasconez HC (September 2014). "Wound Healing: Biologics, Skin

Substitutes, Biomembranes and Scaffolds". Healthcare. 2 (3): 356–400.
doi:10.3390/healthcare2030356. PMC 4934597. PMID 27429283.
2.

 v
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 e

First aid
  v
 t
 e

Medicated dressings (D09)

 v
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Major chemical drug groups

Categories:

 Medical dressings

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