- Bandages and Dressings
Bandages and dressings are both used in wound management. A bandage is a
piece of cloth or other material used to bind or wrap a diseased or
injured part of the body. Usually shaped as a strip or pad, bandages are
either placed directly against the wound or used to bind a dressing to the
wound. A dressing can consist of a wide range of materials, sometimes
containing medication, placed directly against the wound.
The purposes served by dressings include protecting wounds; promoting
healing; and providing, retaining, or removing moisture. Bandages can be
used to hold dressings in place, to relieve pain, and generally to make
the patient comfortable. Elastic bandages are useful to provide ongoing
pressure on wounds such as varicose veins, fractured ribs, and swollen
In recent years, there have been tremendous advances in the design and
composition of bandages and dressings. The field is becoming increasingly
complex, and there are
numerous reports of health care workers applying inappropriate products.
Wound-care materials come in a wide variety of product classes, including
Alginate dressings. These are derived from brown seaweed and contain
calcium alginate, which turns into a sodium alginate gel when it comes
in contact with wound fluid. They are available as pads or ropes.
Biosynthetic dressings. These are composites of biological (often
animal-derived) and synthetic materials such as polymers.
Collagen dressings. These are made from collagen, a protein obtained
from cowhide, cattle tendons, or birds. They are available as particles
Composite dressings. These are similar to plastic adhesive strips and
include an adhesive border, a non-adhesive or semi-adhesive surface that
is applied to the wound, an absorbent layer, and a bacterial barrier.
Contact layers. A low-adherent layer of perforated or woven polymer
material designed to stop a secondary absorbent dressing from sticking
to the surface of a wound.
Gauze. This woven fabric of absorbent cotton is available in a number of
formats and materials, including cotton or synthetic, non-impregnated,
and impregnated with water, saline, or other substances. Gauze is sold
as surgical swabs, sheets, rolls, pads, sponges, and ribbon.
Growth factors. These short-chain proteins affect specific target cells.
They exist naturally in humans, and can be transplanted from one part of
the body to another or manufactured outside the body.
Hydrocolloid dressings. Used for leg ulcers, minor burns, pressure sores
and traumatic injuries, these self-adhesive dressings form a gel as they
absorb fluid from the wound. They consist of materials such as sodium
carboxymethylcellulose (an absorbent), pectin, and gelatin that are
attached to a foam sheet or a thin polyurethane film.
Hydrofibers. Similar in appearance to cotton, carboxymethylcellulose
fibers turn into a gel when they come into contact with wound fluid.
They are available as ribbons or pads and are highly absorbent.
Hydrogels. These are sold as sheets and in gel form, and are primarily
used to supply moisture to wounds. Depending on the state of the tissue,
they can either absorb fluid or moisten the wound. An electrically
conductive aloe vera gel is available to provide electrotherapy to
Hydropolymers. These foamed-gel products consist of multiple layers. The
surface layer is designed to expand to fill the contours of a wound and,
at the same time, draw away fluids.
Leg compression/wrapping products. These are designed to apply external
pressure to improve blood flow and resolve chronic edema in the feet and
legs. They are available in a broad range of formats, including
stockings, compression bandages, or pneumatic pump.
Polyurethane foam dressings. These are sheets of foamed polymer
solutions with small open chambers that draw fluids away from the wound.
Some of these foam products offer adhesive surfaces. They are available
as sheets and rolls, as well as in various other formats suitable for
Skin substitutes. Also known as allografts or skin equivalents, these
are obtained from human cells cultured and expanded in vitro from
Superabsorbents. These are particles, hydropolymers, or foams that act
like the material inside diapers, with a high capacity for rapid
Transparent films. These consist of a thin, clear polyurethane sheet
that, on one side, has a special adhesive that does not stick to moist
surfaces like those found on a wound. They prevent bacteria and fluids
from entering the wound through the dressing, but allow limited
circulation of oxygen.
Wound fillers. These can be bought as powders or pastes, or in strands
or beads. They are used to fill wounds and also absorb wound fluid.
Wound pouches. Equipped with a special collection system for wounds that
have a high flow of secretion, they are designed to contain odors and to
be easily drained.
Other assorted wound-care products. These include adhesive bandages,
surgical tapes, adhesive skin closures, surgical swabs, paste bandages,
specialty absorptive dressings, support bandages, retention bandages,
elasticized tubular bandages, lightweight elasticized tubular bandages,
foam-padded elasticized tubular bandages, and plain stockinettes.
Just as there is a large selection of bandage and dressing products to
choose from, there is also a broad range of applications for these
Alginate dressings are used on wounds that exude moderate to heavy
amounts of fluid. They are useful for packing wounds, although
strip-packing gauze may be preferable for deeper wounds because it is
easier to retrieve. Common applications of alginate dressings include
treatment of acute surgical wounds, leg ulcers, sinuses, and pressure
sores. These dressings should not be used on third-degree burns. Neither
are they advisable for wounds that are dry or are secreting only small
amounts of fluid, because their powerful absorbing capability may dry
out the wound. These are primary dressings that need be covered by a
Biosynthetic dressings are used on burns and other wounds. Another
application is as a temporary dressing for skin autograft sites. Some
persons may be allergic to these dressing materials.
Collagen dressings are believed to hasten wound repair and are often
used on stubborn wounds. They are most effective on wounds that contain
no dead tissue. Collagen dressings should not be used in dry wounds,
third-degree burns, or on any patient who is sensitive to bovine (cow)
Composite dressings are sometimes used alone, sometimes in combination
with other dressings. Deep wounds should first be packed with
wound-filler material. These dressings should not be cut, and are not
recommended for use on third-degree burns.
Contact layers are designed for use in clean wounds that contain no dead
tissue. They are not recommended for infected, shallow, dry, or infected
wounds, or on third-degree burns.
Gauze is used to pack wounds, and also for
and wicking. It is especially desirable for packing deep wounds. When
using gauze to pack wounds, a loose packing technique is preferred.
Growth factors. These have highly specific applications against such
conditions as diabetic foot ulcers involving disease of the peripheral
nerves. Growth factors are heat sensitive and often require
refrigeration. These are not recommended for persons with benign or
Hydrocolloid dressings are used for leg ulcers, minor burns, pressure
sores, and traumatic injuries. Because they are not painful to remove,
hydrocolloid dressings are often employed in pediatric wound management.
Because of their absorbent capabilities, they are used on wounds that
are secreting light to moderate amounts of fluid.
Hydrofibers are highly absorbent, so they are particularly useful for
wounds that are draining heavily. For this reason, they are not
recommended for dry wounds or wounds with little secretion, because they
may result in dehydration. Hydrofibers should not be used as surgical
sponges or on third-degree burns.
Hydrogels are often used on wounds that contain dead tissue, on infected
surgical wounds, and on painful wounds. They should not be used on
wounds with moderate to heavy secretions. As with all dressings, it is
important to check and follow the directions of the manufacturer. In the
case of hydrogels, directions on some products indicate they are not to
be used on third-degree burns.
Hydropolymers are typically used on wounds with minimal to moderate
drainage. They are not indicated for dry wounds or third-degree burns.
Leg compression/wrapping products are used to increase blood flow and
reduce edema in the lower extremities of the body. A medical doctor
should be consulted before using these products on people with edema. In
many cases, topical dressings are used under these products.
Polyurethane foam dressings are very absorbent and are typically used on
wounds with moderate to heavy secretions. They should not be used on
third-degree burns or on wounds that are not draining or that have
sinuses or tunneling.
Skin substitutes are a relatively new product category, approved for
treating venous leg ulcers. It is often advisable to cut slits in the
artificial skin, so that wound secretions underneath do not lift the
newly applied skin.
Superabsorbents are employed on wounds that are secreting heavily, or in
applications requiring extended wear. A packing material is commonly
employed under this product. Superabsorbents should not be used on
third-degree burns or wounds that are either dry or have minimal
Transparent films are often employed as a secondary cover for another,
primary dressing. They are used on superficial wounds and on intact skin
at risk of infection. It is important to remove transparent films very
carefully to avoid damaging fragile skin.
Wound fillers are primary dressings that are usually used in conjunction
with other, secondary dressings. Wound fillers are considered
appropriate for shallow wounds with little or moderate secretions. They
appropriate for use in third-degree burns or in dry wounds. They are
similarly not recommended for wounds with tunnels or sinuses.
Wound pouches are useful in treating wounds with high volumes of
secretion. They are not suitable for dry wounds.
Recommended intervals between dressing changes vary widely among product
classes. The materials used in some dressings require that they be changed
several times a day. Others can remain in place for one week.
Manufacturer's directions should be consulted and followed.
Wounds require appropriate cleaning, debridement, closure, and medication
before bandages and dressings are applied.
Determining the cause of wounds is often very important, especially the
cause of chronic wounds such as skin ulcers. A physician should be advised
of any signs of infection or other changes in a wound.
Wound-care nursing is a rapidly advancing field that requires considerable
training, clinical experience, and judgment, causing some observers to
predict that it will eventually develop into an advanced practice nursing
or a specialty-based practice. Increasingly, the demands on wound-care
nurses are expected to require that they undertake graduate studies. For
all nurses working in the field, ongoing education is a must to keep up
with new knowledge, technologies, and techniques. Numerous organizations
and institutions offer continuing education courses in
Wounds that receive appropriate and timely care are most likely to heal in
an acceptable manner.
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American Academy of Family Physicians. 11400 Tomahawk Creek Parkway,
Leawood, KS 66211-2672. (913) 906-6000. E-mail:
American College of Physicians. 190 N. Independence Mall West,
Philadelphia, PA 19106-1572. (800) 523-1546, x2600, or (215) 351-2600.
American Medical Association. 515 N. State Street, Chicago, IL 60610.
American Nurses Association. 600 Maryland Avenue, SW, Suite 100 West,
Washington, DC 20024. (800) 274-4262.
American Red Cross National Headquarters. 2025 E Street, NW, Washington DC
International Federation of Red Cross and Red Crescent Societies. PO Box
372, CH-1211 Geneva 19, Switzerland. +41 22 730 42 22. Email:
Search and Rescue Society of British Columbia. PO Box 1146, Victoria, BC
V8W 2T6. (250)384-6696. Email:sarbc.org.
Wound, Ostomy, and Continence Nurses Society. 1550 South Coast Highway,
Suite #201, Laguna Beach, CA 92651. (888) 224-9626.
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L. Fleming Fallon, Jr, MD, DrPH