In nearly all cases, open wounds should be bandaged to protect the wound from contamination and support the wound while it heals. In most cases, mechanical debridement of the wound bed is desired in the early stages of wound healing, prior to the formation of granulation tissue. In a compromised patient where anesthesia and surgical debridement are not possible, moist wound healing provides a safe means of wound debridement until the patient is more stable.

BANDAGE COMPONENTS

Primary Layer

Moist wound healing is the standard of care for wound management. Wet-to-dry bandages (adherent) are no longer recommended due to the indiscriminate debridement which compromises wound healing.

If non-surgical debridement is needed during early wound care (in presence of contamination and infection), hyperosmotic agents such as hypertonic saline dressings or honey can be used.

The current standard of care for open wound management is moisture retentive dressings (MRD). They facilitate debridement, granulation tissue formation and epithelialization and are applied directly to the wound.

Select the most appropriate MRD based on anticipated exudate production. See Table 2 for basic dressing guidelines.

Use aseptic technique when handling the MRD. Prior to placing the MRD on the wound bed, ensure that the dressing does not extend over the intact skin to prevent maceration. Consider the depth and shape of the wound when selecting the dressing.

For infected wounds, nanoparticle slow-release, silver-impregnated dressings and ionic silver-impregnated dressings show superior effectiveness. The hydrophilic silver-impregnated dressings release ionic silver into the gel that is produced at the wound exudate-dressing interface which provides consistent antimicrobial activity against a range of aerobic and anaerobic bacteria, including antibiotic-resistant strains, yeasts and filamentous fungi. If these dressings are not available, a non-adherent pad with antibiotic ointment (e.g. a combination of bacitracin zinc, neomycin sulfate, and polymyxin B sulfate) can be used on most wounds.