Chapter 18: Wound management
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Pre‐procedural considerations
Equipment
Dressings are grouped into categories under generic descriptions that reflect the products’ properties and indications for use (see Table 18.4 for details of groups of dressings). The dressing that is applied directly to the wound bed (such as a primary wound contact layer) is the primary dressing. Not all primary dressings require a secondary dressing (e.g. a hydrocolloid does not).
A secondary dressing is applied on top of the primary dressing. An example is foam, although a foam can also be used alone as a primary dressing. Non‐adhesive foams are helpful for patients with sensitivities to adhesives and will require securing with bandages (tubular or roll). Note that a dressing used to hold another in place in this way would be a secondary dressing.
Silicone‐based products can be beneficial in protecting delicate wound beds and the peri‐wound area due to their protective and atraumatic properties (Yarwood‐Ross [120]). Dry dressings (such as gauze) do not fulfil the criteria for an ideal dressing and should not be used as a primary contact layer as they are likely to adhere, cause trauma and disturb healing (Sood et al. [98]).
It is important clinicians understand not only a dressing's properties but also how it behaves. For example, some dressings appear dry but ‘gel’ on contact with the wound, which maintains a moist environment, and are non‐adhesive, thus becoming ‘wet’ (examples include hydrofibres, alginates and hydrocolloids). The wound itself has the ability to produce moisture. Wet dressings, such as hydrogels, can make a wound too wet and be responsible for maceration if used inappropriately (Hampton and Collins [43]).
Procedure guideline 18.1
