This document summarizes the history and types of surgical dressings. It discusses how dressings have evolved from simple cloths to advanced engineered skin substitutes. The key types of dressings covered are dry dressings, moisture-keeping dressings, bioactive dressings, and skin substitutes. Examples of commonly used dressings like gauze, foams, hydrocolloids, and alginates are provided along with their characteristics and uses.
3. Definitions
History of Surgical Dressings
Properties of Ideal wound Dressings
Types of Surgical Dressings
Commonly used Surgical Dressings
Miscellaneous Dressings
Conclusion
Videos
4. SURGICAL DRESSING:
A dressing is a sterile pad or compress applied
to a wound to promote healing and prevent
further harm.
BANDAGE:
A bandage is a piece of material used either to
support a medical device such as a dressing or
splint, or on its own to provide support to the
body.
5. Historically, a dressing was usually a piece of
material, sometimes cloth, but the use of
cobwebs, dung, leaves and honey have also
been described.
Previously, the accepted wisdom was that to
prevent infection of a wound, the wound
should be kept as dry as possible.
6. 1860, English surgeon, Joseph Lister, began
treating his surgical gauze with carbolic acid,
known today as phenol, and subsequently
dropped his surgical team's mortality rate by
45%.
7. 1870, Robert Wood Johnson, co-founder of
“Johnson & Johnson”, began producing
gauze and wound dressings treated with
iodine.
1960, George Winter published his
controversial research on moist healing. He
demonstrated that wounds kept moist
healed faster.
8. 1990, the surgical dressings expanded into the
well-recognized groups of products, such as
vapor-permeable adhesive films, hydrogels,
hydrocolloids, alginates, and synthetic foam
dressings. Additionally, new groups of products,
such as antiadhesive, mostly silicone meshes;
tissue adhesives; barrier films; and silver- or
collagen-containing dressings, were introduced.
Finally, combination products and engineered
skin substitutes were developed.
9. Primary Dressing: A dressing that touches the
wound
Secondary Dressing (Bandage): Keeps the
primary dressing in site
Some dressings function as primary dressing
only. However some could function both as
primary as well as secondary dressing
10. Provide mechanical and bacterial protection
Maintain a moist environment at the
wound/dressing interface
Allow gaseous and fluid exchange
Remain nonadherent to the wound
Nontoxic, nonsensitizing, and nonallergic
Well acceptable to the patient (e.g., providing
PAIN RELIEF and not influencing movement)
Cost effective
11. Highly absorbable (for exuding wounds)
Absorb wound odor
Sterile
Easy to use (can be applied by medical
personnel or the patient)
Require infrequent changing
Available in a suitable range of forms and
sizes
13. Most commonly available dressings
Tend to absorb wound moisture.
Tightly Adherent to granulation Tissue – will
break upon removal
EXAMPLES:
Gauze and bandages
Membranes and foils
Foams
Tissue adhesives
14. Nonadherent to the wound
Heals faster
Do not break granulation tissue on removal
Comparatively less painful
15. EXAMPLES:
Pastes, creams and ointments
Nonpermeable, semipermeable membranes
or foils,
Hydrocolloids
Hydrogels
Combination products.
16. They play a significant active role in wound
healing because
enhance granulation tissue formation
Reduce slough formation
Inhibits bacteria
Some provide growth factors
18. Skin substitutes are heterogeneous group of
wound coverage materials that aid in would
closure and replace the functions of the skin,
either temporarily or permanently, depending
on the product characteristics.
19. EXAMPLES:
Epidermal substitutes
(autologous or allogenic)
Acellular skin (dermis) substitutes
(allogenic or xenogenic)
Autologous and Allogenic skin
Skin substitutes containing living cells.
21. Most readily available simple wound dressings
Non-adherent coating
Absorbs exudate
Promote desiccation in wounds
Can be used as a primary or secondary dressing
Inexpensive
Highly permeable
Relatively non-occlusive
FORMS: squares, sheets, rolls, and packing strips.
22.
23. polyurethane porous sponges or polyurethane
foam films
Light-to-medium exuding wounds (Absorbent)
Left on the wound surface for up to 7 days,
depending on exudate volume.
Not recommended for any kind of dry
wounds!!
Can be shaped to fit deep cavities and
granulating wounds.
26. Uses:
General wound care
Skin biopsies
Donor sites
Superficial partial thickness burns
Surgical incisions
Securing of peripheral IV lines
central venous catheters
Contraindicted in highly exudative wounds
27.
28. contain CYANOACRYLATE which polymerize in
an exothermic reaction on contact with either
a fluid or a basic substance
Used for SIMPLE LACERATIONS, which
otherwise might require the use of fine
sutures, staples, or skin strips
cosmetic results similar/better than traditional
suturing
29. Needleless & Painless method of wound
repair
Does not require follow-up visits for suture
removal
Strength of healed tissue seen at 7 days
Ensure that wound edges are appropriately
adapted and that no adhesive passes
between wound borders
30.
31. Tulle: A light, thin type of cloth that is like a
net
They comprise a gauze cloth impregnated
with paraffin for non-traumatic removal
Antiseptics/Antibiotics are added for
prevention or treatment of infection.
Does not stick to wound surface
Suitable for flat, shallow wound
Useful in patient with sensitive skin
Require a secondary dressing
32.
33. Soft paraffin dressing
Contains chlorhexidine which is an ANTISEPTIC
Allows the wound to drain freely into an
absorbent secondary dressing
Used for covering wounds such as superficial
burns, lacerations, abrasions, graft sites and leg
ulcers.
34. It consists of a cotton fabric, impregnated
with a base composed of white soft paraffin,
anhydrous lanolin, and 1.0% Framycetin
Sulphate
Framycetin is an antibiotic of the
aminoglycoside group
It is used for Infected wounds, combining low
adherence with antimicrobial activity.
35. Hydrocolloids slowly absorb fluids, leading to a
change in the physical state of the dressing &
the formation of gel covering the wound.
Thus, they are called interactive dressings
Provide moist wound environment
Promote the formation of granulation tissue
Provide PAIN RELIEF by covering nerve endings
with both gel and exudate.
Constituents are methylcellulose, pectin,
gelatin, and polyisobutylene.
36. USES:
Both acute wounds and chronic wounds
Desloughing purpose
For different stages of light-to-heavily exuding
wounds
Initially, dressings need to be changed daily,
but once the exudate has diminished, dressings
may be left for up to 7 days
Do not use on infected wounds!!
39. Contain WATER i.e., > 70-90%
They have some important characteristics of an
IDEAL DRESSING
Cool the surface of the wound, resulting in
MARKED PAIN REDUCTION
Maintain the moist wound environment
For use on dry or necrotic wounds or on
lightly exuding wounds
Can be used at all stages of wound healing
except for infected or heavily exuding wounds
40. May MACERATE the healthy skin (mostly
wound border areas), decreasing the
keratinocyte reepithelialization ratio or
leading to over wetting of split-skin donor
sites.
Available as sheet dressings or gels.
Brands: Tegagel®, Intrasite®
42. Provide acidic environment
Enhance healing via debriding action
Only used in Necrotic sloughing skin ulcers
EXAMPLE:
Benoxyl-benzoic acid
43. Activate fibrinolysis and liquefy pus on
CHRONIC SKIN ULCERS
Example:
Varidase-streptokinase/streptodornase
44. Remove bacteria and excess moisture by
CAPILLARY ACTION
Useful in Deep Granulating Wounds
EXAMPLES:
Debrisan®
Iodosorb®
Available as Sheeths & Pastes
45. May reduce Hypertrophic scarring and
Keloid formation
Work as Antiadhesives
useful in covering split-skin donor sites or
fresh meshgrafts
46. MAKING THE SCARS MORE COSMETICALLY
ACCEPTABLE via:
flattening of scarring tissue
increasing elasticity
reducing discoloration
47.
48. An ALGINATE dressing is a natural wound
dressing derived from different types of algae
and seaweeds.
Best used on wounds that have a LARGE
AMOUNT OF EXUDATE
Can absorb Exudate upto 20 times their own
weight
Available as Sheaths and Ropes
50. Obtained from the placenta after delivery
To cover burn wounds.
Can be prepared relatively inexpensively
CHARACTERISTICS OF AN IDEAL SKIN SUBSTITUTE:
Excellent adherence to the wound
Very low immunogenicity
Decrease of pain
Bacterial control
Stimulation of healing
51. It is translucent, allowing inspection of the
wound.
Can be applied on superficial second-degree
burns, deep second-degree burns after early
debridement and donor sites
To cover 1:3 meshed autografts
Extremely effective in sterilizing contaminated
wounds and cleaning burns of bacteria within
3-5 days.
52. Have to be changed DAILY
Need to be covered with gauze to prevent
desiccation
Can be kept refrigerated for 6 weeks
They can be frozen for longer storage
53. Porcine skin is the most common source of
xenograft because of its high similarity to
human skin.
Well-suited temporary dressing for the
coverage of second-degree burns, especially
after early excision.
It usually promotes scar-free healing
Average healing period of about 10 days.
suitable overlay to cover widely meshed (1:8
to 1:12) autografts
54. Promote the deposit of newly formed collagen
in the wound bed
These dressings chemically bind to Matrix
Metalloproteinases (MMPS) found in the
extracellular fluid of wounds. MMPs normally
attack and break down collagen, so dressings
containing collagen give MMPs an alternative
collagen source, leaving the body’s natural
collagen available for normal wound healing.
Mainly used for Chronic NonhealingWounds
55.
56. Bilayer Skin Substitute
Constructed of a Silicon Film with a Nylon
fabric partially imbedded into the film to
which Collagen has been chemically bound
and cross-linked
Used in Severe burns and Donor sites
significantly reduce local wound pain
speed up the healing process
57. Tissue engineering is the use of a
combination of cells, engineering and
materials methods to improve or replace
biological functions
Engineered skin substitutes have been
developed to address the need for wound
coverage and tissue repair as conventional
wound dressings have significant limitations
for skin regeneration
58. EXAMPLES:
TransCyte® was the first human-based,
bioengineered, temporary skin substitute for the
treatment of Full and Partial thickness burns
Integra® serves to prepare the wound bed in
preparation for transplantation with autologous
split-thickness skin three weeks later
Currently, NO engineered skin substitute can
replace all of the functions of intact human skin
59. Determine and address cause of wound
Establish plan of care that includes dressings
that will address principles of moist wound
healing
Keep dressings as simple as possible
Assure Pain is addressed