TOPICAL WOUND TREATMENTS

133

Box 3.1.

Dressing Selection for Promotion of Healing During Different Phases of Repair

Infl ammatory/Cellular Debridement Phase

1.

Occlusive dressings: Use for clean or contaminated non-infected wounds until healthy granulation tissue

forms.
• Exceptions are Vulketan® and silicone gels, which can be used throughout the entire healing period.
• Occlusive dressings promote autolytic wound debridement.

2.

Adherent, hydrophilic, and antimicrobial dressings: Use for heavily contaminated/infected exudative

wounds.
• Discontinue when a healthy bed of granulation tissue is formed.
• Gauze roll or strips can be used for packing tunneled and undermined wounds; the dressing fi lls in

the dead space and provides drainage.

3.

Alginate dressings: Use to “kick start” healing in chronic slow/non-healing wounds.

• Hydrate dressing for dry wounds.

4.

Acemannan-containing dressings: Use to promote granulation tissue formation in wounds over exposed

bone.
• Discontinue when a healthy bed of granulation tissue is formed.

5.

Protein-free dialysate of calf blood dressings: Use to promote granulation tissue and contraction in deep

wounds.
• Discontinue at the fi rst signs of epithelialization.

6.

Oxidized regenerated cellulose/collagen: Use to promote healing in a chronic wound.

• Inactivates matrix metalloproteinases and binds growth factors, releasing them back into the wound

in an active form as the gel is slowly broken down.

Repair Phase

1.

Semi-occlusive dressings: Use once granulation tissue develops.

• Sometimes used for the entire healing period in clean, non-infected wounds.
• Not good for autolytic debridement.

2.

Vulketan® and silicone gels: Use to promote moist healing.

• Prevents the formation of exuberant granulation tissue.

All Phases

1.

Vulketan® and silicone gels: Use to promote moist healing.

• Suppresses the formation of exuberant granulation tissue and the development of infection in the distal

extremities.

2.

Liquid adhesives: Provide protective barrier for small (

<10 cm in diameter), clean limb wounds.

3.

Biologic dressings: Use to stimulate healing.

• ECM dressings provide constructive remodeling of clean large avulsive wounds and tendon defi cits
• Some biologic dressings include autologous and homologous platelet-rich plasma gels.

recommended. Heavily contaminated or infected wounds are best treated with adherent dressings or hydro-
philic or antimicrobial dressings until a healthy bed of granulation tissue develops, at which time a semi-
occlusive dressing is selected for the repair phase. Although reports on biologic bioactive dressings are limited,
and in some cases confl icting, these represent an important category of dressings that will undoubtedly achieve
more use in the future.

References

1. Turner TD: The development of wound management products. In D Krasner, G Rodeheaver, and G Sibbald, editors.

Chronic wound care: a clinical source book for healthcare professionals (3rd edition) Wayne, PA: HMP communications, 2001,
p.293