Plain roller gauze is widely available but presents significant drawbacks for effective wound healing. This dressing is dry and non-occlusive, allowing the wound bed to dry out, which often leads to a hard scab that slows the natural repair process. As wound fluid (exudate) dries into the mesh, the gauze adheres to delicate, newly formed tissue, causing pain and trauma upon removal. Modern wound care has shifted from the “dry to dry” approach to “moist wound healing,” recognizing that cells migrate and multiply more efficiently in a humid environment. This change necessitates advanced dressings that actively manage moisture to promote faster, less painful recovery.
Dressings That Retain Moisture
For wounds that are dry, shallow, or have minimal fluid production, specialized moisture-retaining dressings create an optimal healing environment.
Hydrocolloid Dressings
Hydrocolloid dressings are semi-occlusive barriers composed of gel-forming agents, such as sodium carboxymethylcellulose, backed by a waterproof film. When they contact a small amount of wound fluid, they form a cohesive gel that locks in moisture and prevents dehydration. This mechanism supports autolytic debridement, which is the body’s natural process of breaking down and removing dead tissue.
Hydrogel Dressings
Hydrogel dressings are designed to add moisture to a dry wound bed, often containing up to 90% water within a polymer base. They are available as an amorphous gel or as an impregnated sheet, useful for rehydrating necrotic tissue or softening a dry scab. The high water content provides a cooling effect, which significantly reduces discomfort and pain. These are focused on hydration and are not suitable for wounds with moderate or heavy drainage.
Options for Highly Exudative Wounds
When a wound produces substantial drainage, specialized absorbent dressings are required to manage the fluid efficiently and prevent maceration, which is the breakdown of surrounding healthy skin from excessive moisture.
Foam Dressings
Foam dressings, typically made of polyurethane, have a highly porous structure that allows them to absorb large volumes of exudate while providing cushioning and thermal insulation. The semi-permeable outer layer helps maintain a moist environment while allowing excess moisture vapor to escape. This balance promotes healing and prevents skin breakdown. These dressings are often used for pressure ulcers, venous leg ulcers, and other wounds with moderate to heavy fluid output because they minimize the frequency of painful dressing changes.
Alginate Dressings
Alginate dressings are derived from brown seaweed and are an excellent choice for wounds with heavy drainage, especially those with cavities or tracts. They are composed of calcium and sodium ions that react with the sodium in the wound exudate to form a soft, hydrophilic gel. This gel fills the wound space, conforms closely to the tissue, and helps maintain the desired moist environment while effectively pulling away significant fluid. Alginates can absorb up to 20 times their weight and possess mild hemostatic properties, assisting in controlling minor bleeding.
Non-Adherent Layers and Protective Barriers
Non-adherent contact layers act as a protective interface between the wound and a secondary absorbent dressing. These layers are often fine meshes or perforated films coated with soft silicone or petrolatum. They are designed to allow exudate to pass through to the outer dressing without bonding to the delicate new tissue. The use of a contact layer ensures atraumatic removal, significantly reducing patient pain and preserving the integrity of the fragile wound bed.
Transparent Film Dressings
Transparent film dressings are thin, flexible sheets that are impermeable to water and bacteria but remain permeable to oxygen and moisture vapor. They are primarily used for superficial wounds with minimal or no exudate, such as skin tears or IV sites, where they provide a protective seal. The transparency allows for continuous visualization of the wound without removal, enabling easy monitoring for signs of infection or healing progression. These dressings are self-adhesive and conform well to body contours, ensuring a secure barrier against external contaminants.