Preparing the Wound Bed – Debridement, Bacterial Balance, and ...

Recommendation 11
Select Appropriate Dressing for Local Moisture
Balance to Stimulate Granulation Tissue and
Re-epithelialization
Compared to dry wounds, a moist wound environment
accelerates wound healing by as much as 50%, often with
more rapid epithelialization. 41 Using clinical judgment to
select a type of moist wound dressing suitable for an ulcer is
important. Seven dressing recommendations have been put
forward since the Agency for Health Care Policy and
Research guidelines came out in 1994. 42 They were published
in Ostomy/Wound Management by Liza Ovington in
1999, 43 and are discussed below:
1. Use a dressing that will keep the wound bed continuously
moist. Wet-to-dry saline dressings are not considered continuously
moist and should be used only for debridement.
Kim 44 reported that occlusive hydrocolloid dressings for the
treatment of Stage I and II pressure ulcers were less timeconsuming
and less expensive, compared to saline-soaked
gauze dressings. Colwell’s trial showed that a hydrocolloid
dressing increased healing rate and was less costly than moist
gauze dressings. 45 If saline-soaked gauze is used, it must be
moist with frequent dressing changes or harm may result.
2. Use clinical judgment to select a type of moist wound
dressing suitable for an ulcer. Studies of different types of
moist wound dressings showed no differences in pressure
ulcer healing outcomes. Mulder 46 looked at three types of
dressings, all providing moist wound healing, and found no
statistical differences with wound healing.
3. Choose a dressing that keeps the surrounding peri-ulcer
skin dry while keeping the ulcer bed moist.
4. Choose a dressing that controls exudate but does not
desiccate the ulcer bed. If the exudate is not controlled, it
will come in contact with the surrounding peri-ulcer skin
and cause maceration, which could lead to breakdown and
further deterioration of the wound. There must be a balance
in choosing a dressing to avoid drying of the wound surface.
Continuous assessment of the wound and changes in the
dressing material used is needed to achieve optimal moisture
balance. Maceration may be controlled by certain dressing
materials that provide a vertical wicking and trap the wound
fluid in the matrix of the dressing (ie, calcium alginate
ropes, hydrofibers).
5. Consider caregiver time when selecting a dressing. A
dressing that is easier to apply and does not require frequent
changes decreases the healthcare provider’s workload and the
financial burden to the patient, family, and society. 6.
30 OstomyWound Management