![Adhesive dressing-20100202](https://upload.wikimedia.org/wikipedia/commons/4/40/Adhesive_dressing-20100202.jpg)
A dressing is a sterile pad or compress
applied to a
wound
A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...
to promote
healing
With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells i ...
and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a
bandage
A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to or to restrict the movement of a part of the body. When used with a dressing, the dressing is applie ...
, which is most often used to hold a dressing in place. Many modern dressings are self-adhesive.
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:
* Stop
bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
– to help to seal the wound to expedite the
clot
A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of c ...
ting process;
* Protection from
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
– to defend the wound against germs and mechanical damage;
* Absorb
exudate
An exudate is a fluid emitted by an organism through pores or a wound, a process known as exuding or exudation.
''Exudate'' is derived from ''exude'' 'to ooze' from Latin ''exsūdāre'' 'to (ooze out) sweat' (''ex-'' 'out' and ''sūdāre'' 'to ...
– to soak up blood, plasma, and other fluids exuded from the wound, containing it/them in one place and preventing
maceration;
* Ease
pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
– either by a medicated
analgesic
An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...
effect, compression or simply preventing pain from further trauma;
*
Debride
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.
In po ...
the wound – to remove slough and foreign objects from the wound to expedite healing;
* Reduce
psychological stress
In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Exces ...
– to obscure a healing wound from the view of the patient and others.
Ultimately, the aim of a dressing is to promote
healing
With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells i ...
of the wound by providing a sterile, breathable and moist environment that facilitates
granulation
Granulation is the process of forming grains or granules from a powdery or solid substance, producing a granular material. It is applied in several technological processes in the chemical and pharmaceutical industries. Typically, granulation invo ...
and
epithelialization
Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue.
In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier agains ...
. This will then reduce the risk of infection, help the wound heal more quickly, and reduce scarring.
Types
![PackagesOfGauze](https://upload.wikimedia.org/wikipedia/commons/f/ff/PackagesOfGauze.JPG)
![1490 Beheading of John the Baptist anagoria Adhesive Bandage](https://upload.wikimedia.org/wikipedia/commons/0/03/1490_Beheading_of_John_the_Baptist_anagoria_Adhesive_Bandage.jpg)
Historically, dressings were made of a piece of material, usually a
cloth
Textile is an umbrella term that includes various fiber-based materials, including fibers, yarns, filaments, threads, different fabric types, etc. At first, the word "textiles" only referred to woven fabrics. However, weaving is not the ...
, but the use of cobwebs, dung, leaves and honey have also been described.
However, modern dressings include dry or impregnated
gauze
Gauze is a thin, translucent fabric with a loose open weave. In technical terms "gauze" is a weave structure in which the weft yarns are arranged in pairs and are crossed before and after each warp yarn keeping the weft firmly in place. ...
, plastic films, gels, foams,
hydrocolloids, alginates, hydrogels, and polysaccharide pastes, granules and beads. They all provide different physical environments suited to different wounds:
* Absorption of
exudate
An exudate is a fluid emitted by an organism through pores or a wound, a process known as exuding or exudation.
''Exudate'' is derived from ''exude'' 'to ooze' from Latin ''exsūdāre'' 'to (ooze out) sweat' (''ex-'' 'out' and ''sūdāre'' 'to ...
, 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
Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
and
water vapour
(99.9839 °C)
, -
, Boiling point
,
, -
, specific gas constant
, 461.5 J/( kg·K)
, -
, Heat of vaporization
, 2.27 MJ/kg
, -
, Heat capacity
, 1.864 kJ/(kg·K)
Water vapor, water vapour or aqueous vapor is the gaseous pha ...
;
* Maintaining the optimum temperature to encourage healing;
* Mechanically debriding a wound to remove
slough
Slough () is a town and unparished area in the unitary authority of the same name in Berkshire, England, bordering west London. It lies in the Thames Valley, west of central London and north-east of Reading, at the intersection of the M4 ...
.
* Pressure dressings are commonly used to treat burns and after skin grafts. They apply pressure and prevent fluids from collecting in the tissue.
Dressings can also regulate the chemical environment of a wound, usually with the aim of preventing
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
by the impregnation of topical
antiseptic
An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...
chemicals. Commonly used antiseptics include
povidone-iodine
Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may a ...
,
boracic lint
Boracic lint () is a type of medical dressing made from surgical lint that is soaked in a hot, saturated solution of boracic acid and glycerine and then left to dry.
It has been in use since at least the 19th century, but is now less commonly u ...
dressings or historically
castor oil
Castor oil is a vegetable oil pressed from castor beans.
It is a colourless or pale yellow liquid with a distinct taste and odor. Its boiling point is and its density is 0.961 g/cm3. It includes a mixture of triglycerides in which about ...
.
Antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
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.
Bioelectric
Bioelectromagnetics, also known as bioelectromagnetism, is the study of the interaction between electromagnetic fields and biological entities. Areas of study include electromagnetic fields produced by living cells, tissues or organisms, the ...
dressings can be effective in attacking certain
antibiotic-resistant
Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. ...
bacteria and speeding up the healing process.
Dressings are also often impregnated with analgesics to reduce pain.
The physical features of a dressing can impact the efficacy of such
topical medication
A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
s. Occlusive dressings, made from substances impervious to moisture such as
plastic
Plastics are a wide range of synthetic or semi-synthetic materials that use polymers as a main ingredient. Their plasticity makes it possible for plastics to be moulded, extruded or pressed into solid objects of various shapes. This adaptab ...
or
latex
Latex is an emulsion (stable dispersion) of polymer microparticles in water. Latexes are found in nature, but synthetic latexes are common as well.
In nature, latex is found as a milky fluid found in 10% of all flowering plants (angiosperms ...
, can be used to increase their rate of absorption into the skin.
Dressings are usually secured with
adhesive tape and/or a
bandage
A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support to or to restrict the movement of a part of the body. When used with a dressing, the dressing is applie ...
. 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
Gauze is a thin, translucent fabric with a loose open weave. In technical terms "gauze" is a weave structure in which the weft yarns are arranged in pairs and are crossed before and after each warp yarn keeping the weft firmly in place. ...
,
lint,
adhesive bandage
An adhesive bandage, also called a sticking plaster, medical plaster, or simply plaster in British English, is a small medical dressing used for injuries not serious enough to require a full-size bandage. They are also known by the genericized tra ...
(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
Rayon is a semi-synthetic fiber, made from natural sources of regenerated cellulose, such as wood and related agricultural products. It has the same molecular structure as cellulose. It is also called viscose. Many types and grades of viscose f ...
, and
polyester
Polyester is a category of polymers that contain the ester functional group in every repeat unit of their main chain. As a specific material, it most commonly refers to a type called polyethylene terephthalate (PET). Polyesters include natural ...
. 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
Cellulose is an organic compound with the formula , a polysaccharide consisting of a linear chain of several hundred to many thousands of β(1→4) linked D-glucose units. Cellulose is an important structural component of the primary cell wall ...
, or
polyamide
A polyamide is a polymer with repeating units linked by amide bonds.
Polyamides occur both naturally and artificially. Examples of naturally occurring polyamides are proteins, such as wool and silk. Artificially made polyamides can be made through ...
materials. Cotton bandages can act as a secondary dressing while compression bandages provides good compressions for
venous ulcer
Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." ...
s. On the other hand,
tulle gras dressing which is impregnated with
paraffin oil is indicated for superficial clean wound.
Interactive products
![Hydrofaser Gelbildung](https://upload.wikimedia.org/wikipedia/commons/5/55/Hydrofaser_Gelbildung.jpg)
Several types of interactive products are: semi-permeable film dressings, semi-permeable foam dressings, hydrogel dressings, hydrocolloid dressings, hydrofiber and alginate dressings. Apart from preventing bacteria contamination of the wound, they keep the wound environment moist in order to promote healing.
Semi-permeable film dressing: This dressing is a transparent film made up of
polyurethane
Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic chemistry, organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethan ...
. 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
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy.
In p ...
(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.
Semi-permeable foam dressing: This dressing is made up of foam with
hydrophilic
A hydrophile is a molecule or other molecular entity that is attracted to water molecules and tends to be dissolved by water.Liddell, H.G. & Scott, R. (1940). ''A Greek-English Lexicon'' Oxford: Clarendon Press.
In contrast, hydrophobes are no ...
(attracted to water) properties and outer layer of
hydrophobic
In chemistry, hydrophobicity is the physical property of a molecule that is seemingly repelled from a mass of water (known as a hydrophobe). In contrast, hydrophiles are attracted to water.
Hydrophobic molecules tend to be nonpolar and, th ...
(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
Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size ...
. Secondary dressings are not required. However, it requires frequent changing and is not suitable for dry wounds.
Silicone
A silicone or polysiloxane is a polymer made up of siloxane (−R2Si−O−SiR2−, where R = organic group). They are typically colorless oils or rubber-like substances. Silicones are used in sealants, adhesives, lubricants, medicine, cooking ...
is a common material that make up the foam. The foam is able to mold according to the shape of the wound.
Hydrogel dressing: This dressing is made up of synthetic polymers such as
methacrylate Methacrylates are derivatives of methacrylic acid.
* Methyl methacrylate
* Ethyl methacrylate
* Butyl methacrylate
* Hydroxyethyl methacrylate
* Glycidyl methacrylate
Glycidyl methacrylate (GMA) is an ester of methacrylic acid and glycidol. Co ...
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.
Hydrocolloid dressing
A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and adheres to the skin, so no separate taping is needed.
The active surface of the dressing is coated with a cross-l ...
: This type of dressing contains two layers: inner
colloid
A colloid is a mixture in which one substance consisting of microscopically dispersed insoluble particles is suspended throughout another substance. Some definitions specify that the particles must be dispersed in a liquid, while others extend ...
al layer and outer waterproof layer. It contains gel forming agents such as
carboxymethylcellulose
Carboxymethyl cellulose (CMC) or cellulose gum is a cellulose derivative with carboxymethyl groups (-CH2-COOH) bound to some of the hydroxyl groups of the glucopyranose monomers that make up the cellulose backbone. It is often used as its sodiu ...
,
gelatin
Gelatin or gelatine (from la, gelatus meaning "stiff" or "frozen") is a translucent, colorless, flavorless food ingredient, commonly derived from collagen taken from animal body parts. It is brittle when dry and rubbery when moist. It may also ...
and
pectin
Pectin ( grc, πηκτικός ': "congealed" and "curdled") is a heteropolysaccharide, a structural acid contained in the primary lamella, in the middle lamella, and in the cell walls of terrestrial plants. The principal, chemical component of ...
. 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.
Alginate dressing: This type of dressing is made up of either sodium or calcium salt of
alginic acid
Alginic acid, also called algin, is a naturally occurring, edible polysaccharide found in brown algae. It is hydrophilic and forms a viscous gum when hydrated. With metals such as sodium and calcium, its salts are known as alginates. Its colou ...
. 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.
Hydrofiber dressing: Made up of sodium
carboxymethyl cellulose
Carboxymethyl cellulose (CMC) or cellulose gum is a cellulose derivative with carboxymethyl groups (-CH2-COOH) bound to some of the hydroxyl groups of the glucopyranose monomers that make up the cellulose backbone. It is often used as its sodiu ...
, hydrofibers can absorb high amounts of wound discharge, forming a gel and preventing
skin maceration
Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. It was first described by Jean-Martin Charcot in 1877. Maceration is caused by excessive amounts of fluid remaining in contact with th ...
.
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.
Usage of dressings
![Left lower leg cellulitis wound covered with paraffin gauze after dressing](https://upload.wikimedia.org/wikipedia/commons/8/84/Left_lower_leg_cellulitis_wound_covered_with_paraffin_gauze_after_dressing.png)
Applying a dressing is a
first aid
First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial in ...
skill, although many people undertake the practice with no training – especially on minor wounds. Modern dressings will almost all come in a prepackaged
sterile
Sterile or sterility may refer to:
*Asepsis, a state of being free from biological contaminants
* Sterile (archaeology), a sediment deposit which contains no evidence of human activity
*Sterilization (microbiology), any process that eliminates or ...
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 of medical personnel.
See also
*
*
Hydrocolloid dressing
A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and adheres to the skin, so no separate taping is needed.
The active surface of the dressing is coated with a cross-l ...
*
Hydrogel dressing
*
Field dressing (bandage)
A field dressing or battle dressing is a kind of bandage intended to be carried by soldiers for immediate use in case of (typically gunshot) wounds. It consists of a large pad of absorbent cloth, attached to the middle of a strip of thin fabric us ...
*
Nano-oligosaccharide factor (NOSF)
References
{{Major drug groups
*