CHAPTER THIRTEEN: Wound Dressings

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

1. Define the function of primary and secondary dressings.

2. Describe the role of dressings in moist wound healing.

3. Select the appropriate primary dressing based on wound characteristics.

4. Select the appropriate secondary dressing based on patient function.

5. Determine when an antimicrobial dressing is needed for wound healing.

6. Describe the mechanism by which different antimicrobial dressings reduce bacterial burden.

WOUND DRESSINGS: A HISTORICAL PERSPECTIVE

Chronicles about the care and management of open wounds go back to early civilization’s use of natural remedies to treat injuries of unfathomable causes. One of the oldest medical manuscripts known to man is a clay tablet dated circa 2100 BC that contains a collection of prescriptions described as “three healing gestures,” which even in modern times is the basis for wound treatment.^1,2 These gestures were washing the wound, making plasters, and bandaging the wound.

The Ebers Papyrus, circa 1500 BC, detailed the use of lint, animal grease, and honey for the management of open wounds. The lint provided a fibrous base that promoted wound site closure, the animal grease provided a barrier to environmental pathogens, and the honey served as an antibiotic agent. The Egyptians believed that closing a wound preserved the soul and prevented the exposure of the spirit to “infernal beings,” as was noted in the Berlin papyrus. The Greeks, who had a similar perspective on the importance of wound closure, were the first to differentiate between acute and chronic wounds, calling them “fresh” and “nonhealing,” respectively. Galen of Pergamum, a Greek surgeon who served Roman gladiators circa AD 120 to 201, made many contributions to the field of wound care. The most important was acknowledgment of the importance of maintaining wound-site moisture to ensure successful wound closure.

There were limited advances that continued throughout the Middle Ages and the Renaissance, but the most profound advances, both technological and clinical, came with the development of microbiology and cellular pathology. In the 19th century, Pasteur advocated that wounds be covered and kept dry because he believed this would keep them “germ” free. The dressings developed at this time (made from cloth, cotton, and gauze) have dominated wound management in recent history, and in some countries, they continue to be the main products used.

The first manufactured dressings were probably Gamgee wadding and tulle gras. Gamgee discovered that degreased cotton wrapped in bleached lint would absorb fluids, and he introduced his first dressing in the 19th century. During the 1914-1918 war, Frenchman Lumiere developed cotton gauze that was impregnated with paraffin to prevent the dressing from sticking to the wound. Wound management technology did not progress significantly beyond these early developments until the 1960s when comparisons were made of wound healing in dry and moist environments.³

In 1962, Winter⁴ published ...