WOUND MANAGEMENT

Wound cleansing is undertaken by mechanical and fluid means. The goals are to:

• Remove visible debris and dead tissue
• Remove any dressing residue
• Remove excessive or dry crusting exudates

Principles

Clean the wound with minimal trauma to the wound bed, using saline or water. Avoid use of damaging soaps or alcohol-based solutions. Any other solution used should be non-toxic and pH neutral. Antiseptic should be used only in initial stages of decontamination.

Method
Irrigation is the preferred method for cleansing open wounds. Gauze swabs and cotton wool should be used with care to prevent mechanical damage to new tissue and the shedding of fibres into the wound which then slow healing.

Choice of dressing

A wound will require different dressing types over its healing process; no one dressing is suitable for all wounds.
Considerations when choosing dressing products:

• Maintain a moist environment without allowing maceration
• Sterile
• Have an ability to remove excess exudates
• Protect the wound from bacteria
• Have good adhesion to surrounding skin
• Be non-stick to the wound, shed fibres into or cause trauma to the wound or surrounding tissue on removal
• Aid debridement where necrotic or sloughy tissue exists
• Be conformable to body parts maintaining body function

Some examples of dressing choice:

Dry Wound	Minimal Exudate	Moderate Exudate	Heavy Exudate
Non Adherent Island Dressing	Hydrogel	Calcium Alginate	Hydrofibre
Hydrocolloid	Hydrocolloid	Hydrofibre	Foam
Films Semi Permeable	Silicone Absorbent	Foam	Absorbent Dressing
		Negative Pressure Wound Therapy	Negative Pressure Wound Therapy
		Hydrocolloid paste/power	Ostomy Bags

 Dressings can be categorised into four types:

1. Primary dressing: is one that comes directly in contact with the wound bed.
2. Secondary dressing: this is used to cover a primary dressing when the primary dressing does not protect the wound from contamination.
3. Occlusive dressing: this covers a wound from the outside environment and keeps nearly all wound vapors at the wound site.
4. Semi-occlusive dressing: this allows some oxygen and moisture vapour to evaporate.