CARING FOR AN OPEN WOUND: ADVICE FROM AN OSTOMY NURSE
While complicated wounds may require skilled nursing care or a wound clinic setting, many wounds can be easily managed at home. You just have to know what products are available and how to use them…
First, let’s review what types of wound cleansers and dressings are available and discuss their differences.
Wound Cleansers are saline-based liquid cleansers in a bottle that can be sprayed into a wound bed, on to dressings, or around the wound for gentle cleansing. SIMPLY SALINE is saline in a convenient can, while ADAPT WOUND CLEANSER has some gentle organic ingredients to enhance cleansing and healing. No need to rinse after using either of these products! Simply dress the wound after using the cleanser.
Non Stick Contact Layers are used to prevent gauze layers from sticking to an open wound and can stay in place on the wound bed for a number of days. These absorbent dressings can be changed as needed without disturbing the wound. VASELINE GAUZE, ADAPTIC OIL EMULSION DRESSING and XEROFORM dressings are all examples of a non sticking contact layer and can be cut to fit any size wound.
Transparent Dressings like TEGADERM are great for superficial scrapes, shallow wounds, cuts or blisters. They are a breathable “plastic” like dressing that will adhere to intact skin but not to a wound bed. Transparent dressings allow oxygen in and moisture out while maintaining a healing environment over the wounded area like skin. They are also “see through” so the wound is visible for signs of infection. Transparent dressings can also be used to reinforce an insulin pump or a transdermal drug patch. Some people do perspire under the dressing and a rash can result, so it is important to watch for skin irritation.
Island Dressings are a nonstick dressing with a tape border around the perimeter and are usually used over a stapled or sutured incision line, but can be used over a slightly open wound to hold packing in place. Most common uses are over a knee or hip replacement or a closed abdominal staple line. They are available in multiple sizes and with either a cloth-like paper tape border or a water resistant border. They are meant to serve as a primary dressing but can be used to secure some other type of dressing over a wound area. PRIMAPORE AND TELFA ISLAND DRESSINGS are available.
Silicone Coated Foam Dressings can provide high absorbency over a very wet, weepy wound like “road rash”. The foam soaks up the fluid released by the wound and remains moist but not dripping so the wound is protected and much more comfortable. Foam dressings can also provide cushion over a boney area, a blister or between the toes. Foam dressings like MEPILEX AND PROXIMEL are available with or without an adhesive border to secure it and come in various sizes and specialty shapes (by special order). The non-bordered foam can be cut as needed and the silicone surface resists sticking to drier wounds. These dressings are also available with SILVER added for chronic or infected wounds. Usually a physician or wound nurse will recommend the use of a silver dressing, if it is necessary.
Hydrocolloid Dressings like DUODERM, are a flexible, almost skin-like material used to cover blisters, shallow pressure sores and abrasions. It is available in a few different thicknesses, but the most popular is the extra thin version, as it is very pliable and can form fit over a boney area or fold into a crease. Hydrocolliods can be cut to fit, are mildly absorbent and are waterproof. They can be left in place up to 5 days.
An Alginate Dressing is a seaweed based absorbent fiber for wet wounds like open surgical incisions and large abrasions. KALTOSTAT can be cut or comes as a “rope” for packing a deep hole. It becomes jelly-like as it absorbs drainage and is easily removed. Alginates do require a secondary dressing, like gauze, placed over them and are available with silver.
A Hydrogel Dressing is a clear gel used to provide moisture to a dry wound. SOLOSITE can be applied to an open wound or to a dressing and tucked into a wound. A dry wound can be slow to heal so adding moisture aids with cell growth to promote healing. Hydrogel dressings require a secondary dressing like gauze or foam dressing if cushioning is indicated.
So how does one choose a dressing to use? Here are some common wounds we hear about at Medical West Healthcare Center and how we help clients make a choice.
Simple Burns, Abrasions, Skin Tears and “Road Rash” Injuries: Always cleanse any wound with saline or a wound cleanser (SIMPLY SALINE or ADAPT WOUND CLEANSER) to remove any debris or dirt. A non-adhering contact layer (VASELINE GAUZE OR ADAPTIC) or a hydrogel jelly (SOLOSITE) may be applied to the wound bed and a transparent dressing (TEGADERM), a foam dressing (MEPILEX) or a simple gauze/tape dressing may be used depending on the injury. The idea is to keep the wound bed undisturbed and moist for optimal healing. Change the dressing if it is leaking or every 48-72 hours to inspect the area. DO NOT POP ANY BLISTERS.
Abraisons, Shallow Pressure Sore (Bed Sore), Weeping Leg Ulcer: Cleanse any wound with saline or a wound cleanser (SIMPLY SALINE or ADAPT WOUND CLEANSER). These injuries may need a bit more absorption and/or cushioning for protection. A foam dressing (MEPILEX or MEPILEX BORDER) is a good choice for both absorbency and cushioning. A hydrocolliod (DUODERM) may also work well providing some absorption and waterproof coverage if the wound is on the dryer side. A hydrocolliod will capture the natural fluid from the wound and keep it bathed for faster healing.
Closed, Stapled, Sutured, Post-Op Knee/Hip or Abdominal Incision Line: A staple line or sutured incision line that is not oozing or just minimally draining is a good candidate for the island dressings. These come in various sizes to accommodate various lengths of incisions. (TELFA ISLAND DRESSING HAS A CLOTH TAPE SURROUND, PRIMAPORE HAS A WATER RESISTANT SURROUND).
Open Abdominal or Surgical Wounds, Weeping Leg Ulcer: Some wounds require more products for absorption of drainage and to allow the wound to heal from the bottom up. A combination of products may be the best choice. An alginate (KALTOSTAT) may be used to pack/absorb drainage in an open wound. If drainage is excessive, a foam (MEPILEX) may be added for even more absorption, cutting down on “nursing” time. Depending on wound size, a bordered dressing may be used (ISLAND DRESSING or MEPILEX BORDER). Otherwise gauze products with hypoallergenic tapes (MEDIPORE, MICROPORE) can be used as a cover dressing.
At Medical West Healthcare Center, we have knowledgeable staff available to help assist you in finding the right wound dressing. Give us a call or visit one of our locations to talk with an expert.
Author: Zoe Shepard, COCN
Zoe, our Certified Ostomy Care Nurse, has over 40 years experience and has become a trusted community resource. She is available for consult by appointment.