Dressing (medical)

An adhesive island dressing, in its original packaging (left) and on a person's wrist (right).

A dressing is an adjunct used by a person for application to a wound to promote healing and/or prevent further harm. A dressing is designed to be in direct contact with the wound, which makes it different from a bandage, which is primarily used to hold a dressing in place. Some organisations classify them as the same thing (for example, the British Pharmacopoeia) and the terms are used interchangeably by some people. Dressings are frequently used in first aid and nursing.

Core purposes of a dressing

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

• Stem bleeding – Helps to seal the wound to expedite the clotting process
• Absorb exudate – Soak up blood, plasma and other fluids exuded from the wound, containing it in one place
• Ease pain – Some dressings may have a pain relieving effect, and others may have a placebo effect
• Debride the wound – The removal of slough and foreign objects from the wound
• Protection from infection and mechanical damage, and
• Promote healing – through granulation and epithelialization

Types of dressing

Historically, a dressing was usually a piece of material, sometimes cloth, but the use of cobwebs, dung, leaves and honey have also been described. However, modern dressings ^[1] include gauzes (which may be impregnated with an agent designed to help sterility or to speed healing), films, gels, foams, hydrocolloids, alginates, hydrogels and polysaccharide pastes, granules and beads. Many gauze dressings have a layer of nonstick film over the absorbent gauze to prevent the wound from adhering to the dressing. Dressings can be impregnated with antiseptic chemicals, as in boracic lint or where medicinal Castor oil was used in the first surgical dressings ^[2]

In the 1960s, George Winter published his controversial research on moist healing. Previously, the accepted wisdom was that to prevent infection of a wound, the wound should be kept as dry as possible. Winter demonstrated that wounds kept moist healed faster than those exposed to the air or covered with traditional dressings.

Various types of dressings can be used to accomplish different objectives including:

• Controlling the moisture content, so that the wound stays moist or dry. An example of a moisture-rateining dressing is Aquacel, which is a "hydrofiber" that is indicated, for example, for partial-thickness burns.^[3]
• Protecting the wound from infection,
• Removing slough, and
• Maintaining the optimum pH and temperature to encourage healing.

Occlusive dressings, made from substances impervious to moisture such as plastic or latex, can be used to increase the rate of absorption of certain topical medications into the skin.

Usage of dressings

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. This is because it will come in to direct contact with the wound, and sterility is required to fulfil the 'protection from infection' aim of a 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 fulfil some of the basic tenets of a dressing – usually stemming bleeding and absorbing exudate.

Applying and changing dressings is one common task in nursing.

An "ideal" wound dressing is one that is sterile, breathable, and conducive for a moist healing environment. This will then reduce the risk of infection, help the wound heal more quickly, and reduce scarring.

See also

• Hydrocolloid dressing

References

1. ^ "www.dressings.org". SMTL. http://www.dressings.org/. Retrieved 2007-02-24. 
2. ^ "Report upon the Use of a Mixture of Castor oil and Balsam of Peru as a Surgical Dressing". pubmedcentral. http://www.pubmedcentral.nih.gov/pagerender.fcgi?tool=pmcentrez&pageindex=1&artid=1425429. Retrieved 2007-01-26. 
3. ^ Caruso, D. M.; Foster, K. N.; Hermans, M. H. E.; Rick, C. (2004). "Aquacel Ag?? In the Management of Partial-Thickness Burns: Results of a Clinical Trial". Journal of Burn Care & Rehabilitation 25 (1): 89–97. doi:10.1097/01.BCR.0000107202.85453.63. PMID 14726745.  edit [1]