Wound Cleansing and Dressing Selection

Current Concepts in 

Wound Cleansing and 

Dressing Selection 

Jane O’Driscoll, PT, WCC, CLT 

Heidi Thielen, RNC, WOCN

Wound Bed Preparation 

� Four Major Components 

1. Tissue Management 

2. Inflammation and Infection 

control 

3. Moisture Balance 

4. Epithelial Edge Advancement

Tissue Management 

� Cleansing with mechanical force 

– Normal saline 

– Commercial cleansers 

– Lactated ringers 

– Tap water 

Debridement 

– Mechanical 

– Sharp 

– Autolytic 

– Enzymatic

Infection Control 

� Choosing to cleanse with an antiseptic 

� Topical Antiseptics (Cleansing) 

– Betadine – gram +/- 

– Dakins solution – gram +/-; pseudomonas 

– Acetic acid – gram +/-; pseudomonas 

– Hydrogen peroxide


� Topical Antibacterial 

Dressings 

– Iodoform 

– Aquacel Ag; 

Maxsorb Ag 

– Silvadene 

– Silverlon 

– Acticoat 

– Optifoam Ag 

- Silver Polymem 

- Mepilex Ag 

- Xeroform


� Topical Antibiotics – used for a limited time 

period when clinical infection is present 

– Muprirocin (Bactroban): MRSA, gram + 

– Polymyxin: gram -; pseudomonas 

– Bacitracin: wide spectrum gram + and – 

+ Oral and IV Antibiotics: vancomyicin; 

levaquin; sulfonamides (bactrim)

Epithelial Edge 

Advancement 

� Open wound edges 

– If epibole present, no healing will take place 

– Silver nitrate 

� Pack Dead Space 

– Promotes healing from the bottom up 

– Fill depth of wound with packing material 

– Do not pack tightly 

– Ex: wound fillers; gauze; alginates 

– To determine what you use: do you want to 

absorb exudate or hydrate the wound bed – this 

determines dressing choice

Dressings 

� Primary 

– The therapeutic or protective covering 

applied directly to the wound base 

� Secondary 

– Materials that serve as therapeutic or 

protective function and are used to 

secure the primary dressing i.e. keeps 

the dressing in place

Product Categories 

� Alginates – primary dressing 

– Derived from brown seaweed 

– Rope or flat dressing 

– Sometimes impregnated with Ag 

– Absorbs 333% its weight in fluid 

– Becomes gel like when mixes with wound 

exudate 

– Ex: Kaltostat, Kalginate, Sorbsan, Curasorb, 

Aquacel, Maxsorb


� Collagens – primary dressing 

– Freeze dried sheets of collagen, pastes, 

or gels usually derived from cowhide 

– Encourages deposition/organization of 

new collagen & granulation 

– Only use in proliferative phase 

– Ex: Fibercol, Won’dres, Nu gel, Medfil 

Pads, hyCure


� Composites – primary or secondary dressing 

– Combination of 2 or more different products 

– Provides multiple functions – autolytic 

debridement and vapor exchange 

– Sometimes provides an absorptive function 

– Ex: Covaderm, Alldress, Telfa Island, 

Stratasorb; Optifoam adhesive


� Contact Layers – primary dressing 

– Thin, non-adherent sheets placed in wound bed 

to protect against contact from other agents 

– Provides protection 

– Porous to allow fluid exchange 

– Often used with fillers or topical medications 

– Always used when bone or tendon is exposed 

– Can leave in wound bed up to 7 days 

– Ex: Tegapore, Dermanet, Mepitel, Telpha Clear, 

Curity Nonadherent, Vaseline Impregnated 

Gauze


� Foams – primary dressing 

– Semi-permeable polyurethane foam, nonadherent; 

waterproof outer layer 

– Provides moist wound environment 

– Best for maintaining temperature of wound bed 

– Used on minimal to moderate drainage 

– Ex: Allevyn, Curafoam, Flexzan, Hudrasorb, 

LYOfoam, Mitraflex, Polymem, Tielle, Mepilex, 

Biatain, 3M Heel Foam, Comfeel Ulcer Dressing, 

Optifoam


� Hydrocolloids – primary dressing 

– Contain hydrophilic colloidal particles in an 

adhesive compound laminated onto a flexible 

outer layer; is occlusive 

– Can protect intact skin or newly healed wounds 

– Cause autolytic debridement 

– Use only on non-infected wounds 

– Is somewhat absorptive of drainage 

– Ex: Exuderm, Duoderm


� Hydrogels – primary dressing 

– Generally contain a 90% water gel base 

– Comes in gel or sheets 

– Donates moisture to a wound 

– Ex: Wound gel filler: Curasol, Curafil, Intrasite, 

Solosite, Carrasyn, Normigel, Amerigel, Saf-gel Gel 

Sheets: Dermagel, Curagel, Kendall Island, NDM 

Island, MPM Med Gel Pad, Elastogel, Vigilon, 

Tenderwet Impregnated Gauze: CarraGauze, 

Transigel, Curasol, Dermagran Gauze


� Specialty Absorptives – primary or 

secondary dressing 

– Multilayered dressings consisting of highly 

absorptive layers 

– Often made of cellulose, cotton, or rayon 

– Use with heavy exudate 

– Ex: Aquacel, Combiderm, Exu-Dry, 

Softsorb, Tendersorb Wet-Pruf pads, ABD 

pads


� Transparent Films – primary or 

secondary dressing 

– Transparent sheets with adhesive back 

– Occlusive 

– Cause autolytic debridement 

– Use only on non-infected wounds 

– Has no absorptive properties 

– Ex: Tegaderm, Opsite, Polyskin, Mefilm


� Wound fillers – primary dressing 

– Agents that come in a variety of forms: 

thick paste, granules, powders, and 

beads 

– Provide moist environment yet absorb 

some exudate 

– Can be used on infected wounds 

– Ex: Flexigel, Gold Dust Wound Filler, 

Iodoflex pads, Multidex

Tapes 

� Used to secure 

dressings 

� Types 

– Foam 

– Non woven cloth 

– Fabric 

– Paper 

– Plastic 

– Cloth 

– Silk

Gauze Dressings 

� Commonly known as 4x4’s, 2x2’s, 

packing strip, kerlix, conform, kling. 

� Made of woven and non-woven fibers 

of cotton, rayon, polyester, or 

combination 

� Moderately absorptive

Gauze Dressings 

� Some are impregnated 

– Mesalt: intended for heavily draining infected wounds 

– Idoform: iodine impregnated gauze packing strip 

– Xeroform: fine mesh gauze impregnated with 

petrolatum and 3% bismuth; deodorizes 

– Vaseline: fine mesh gauze impregnated with vaseline 

– Adaptic: fine mesh coated with light oil emulsion 

– Kerlix AMD: coated with polyhexamethylene biguanide 

(bacteria killing polymer); extracts bacteria from wound

Skin Sealants 

� Liquid skin protectors that provide a 

plastic type film over skin 

� Protects from moisture and tape 

damage 

� Ex: Skin prep, NO-STING skin prep, 

Cavilon Barrier Film, Hollister Skin gel, 

Sure prep, Benzoin spray or sticks

Prescription Products 

� Accuzyme Papain-Urea Ointment 

– Provides enzymatic debridement 

– Does not harm viable tissue 

– Digests nonviable protein necrosis 

– 1 st choice until necrosis is


� Panafil Ointment 

– Provides enzymatic debridement 

– Does not harm viable tissue 

– Digests nonviable protein necrosis 

– Use when there is


� Other less common 

– Regranex 

– Xenaderm 

– Optase Gel 

– Granulex Spray 

– Biafine

Wound Types 

Pressure, Venous, Arterial, 

Diabetic, Acute, Unusual

Pressure Ulcers 

� Rounded 

� Crater like 

� Regular edges 

� Take on shape that caused the 

pressure 

� The deeper the less likely they bleed 

� Often peri-wound is non-blanchable 

erythema

Arterial Ulcers 

� Location 

– Between toes or tips of toes 

– Over phalangeal heads 

– Around lateral malleolus 

– Areas subjected to trauma/rubbing footwear 

� Other skin characteristics 

– Thin, shiny, dry skin - cyanosis 

- Hairless - abnormal ABI 

– Thick toenails - poor/absent pulses 

– Dependent rubor - decreased skin temp 

– Pallor on elevation

Arterial Ulcers 

Continued… 

� Characteristics 

– Even wound margins 

– Punched out 

appearance 

– Pale, deep, wound 

bed 

– Blanched peri-wound 

tissue 

– Extreme pain 

– Cellulitis 

– Gangrene/necrosis 

� Dry gangrene 

– black non-viable 

tissue 

– Exclusive to the 

extremities 

– Tx: paint with 

betadine or 

alcohol and 

dress with dry 

gauze 

� Unstable gangrene 

– Amputation 

required

Diabetic Ulcers 


– Painless 

– Even wound margins 

– Rounded/oblong shape over bony 

prominence 

– Deep 

– Surrounding callous 

– Cellulitis/underlying osteomyelitis

Venous Ulcers 


– Irregular wound margins 

– Superficial 

– Lumpy granulation tissue 

– Generally painless 

– Exudate is moderate to heavy initially 

– Surrounding skin can be weepy 

– Dermatitis vs. cellulitis

Venous Ulcers 

Continued… 

� Treatment: 

– Cleanse and choose dressings for wound 

– Compress 

– Optimize contributing factors 

– Elevate 

– Establish a maintenance plan

Venous Ulcers 

Continued… 

� Options for treatment 

– Unna boot 

– Duke boot 

– Circ-Aid 

– Multilayer compression bandage 

� Can get manufactured in a premade kit 

– Dressing and compression wraps 

(dependent on pt mobility/independence)

Venous Ulcers 

Continued… 

� Options for maintenance 

– Compression garments 

� Ted hose are NOT compression garments 

� 20-30mmHg (recommended for arms) 

� 30-40mmHg (recommended for legs) 

� 40-50mmHg (recommended for severe 

swelling in legs) 

– Compression pumps

Treatment Considerations 

� Other considerations… 

– Dry stable eschar: leave intact 

– Unstable necrotic tissue: aggressive debridement 

– Granulating wound bed: appropriate moist 

wound healing 

– Infected wound: silver products; cadexomer 

iodine; use precaution with occlusive dressings 

– Adjunctive therapies: Regranex (spendy); 

anodyne

� Thank you! 

Questions?

Wound Cleansing and Dressing Selection

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