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Take your pick of multiple wound-care dressings.

Santa Fe, N.M. -- Literally hundreds of wound-care dressings are available, but physicians would do well to choose a single favorite product from each category, Mark D.P. Davis, M.D., said at a dermatology conference sponsored by the Skin Disease Education Foundation. Then the decision comes down to knowing which category to use for which type of wound.

"The old principles apply," said Dr. Davis of the Mayo Clinic, Rochester, Minn. "We always laugh when we say this, but it's true: If it's dry, wet it, and if it's wet, dry it. If you have a dry wound, you want to provide a moist environment. If you have an overexudative wound, you want to dry it out because it causes maceration and delay in wound healing."

The properties of each category and the characteristics of the patient's wound help determine product choice, he said. For dry wounds, hydrocolloids, hydrogels, transparent films, and collagen dressings are best. For exudative wounds, the alginates and foams are best. And for wounds that are infected or are likely to become so, dermatologists can choose from among a number of topicals that can be combined with other dressings, as well as the relatively new silver dressings.

* Gauze dressings can work for both wet and dry wounds and in combination with many other products. When dampened, they provide a moist environment for the wound. As they turn from wet to moist, they assist with debridement. Gauzes can wick exudate from a wound and can be packed into tunnels. But if they become too dry, gauzes can traumatize the wound.

* Hydrocolloids can be useful for dry wounds if the wounds are surrounded by healthy skin. Otherwise, they tend to adhere to the edge of the wound, where they can cause trauma and skin breakdown. Dr. Davis said that he rarely uses hydrocolloids.

* Hydrogels can be combined with many other products and provide a moist environment that promotes healing.

* Transparent films make it possible to see the wound without removing the dressing. However, their popularity has diminished over time because, as with hydrocolloids, they adhere to the surrounding skin.

* Collagen dressings were developed based on the theory that since collagen is critical in the natural process of wound healing, why not sprinkle collagen on the wound? "This sounds a little bit crazy, but anecdotally a lot of people swear this makes a large difference," Dr. Davis said.

* Alginates are derived from seaweed and can absorb up to 10-15 times their volume in water. They're particularly useful in exudative wounds.

* Foams are also highly absorptive, but generally less so than alginates, although there is some overlap.

* A variety of topical treatments can be useful in wounds that are infected or likely to become so. These include 0.9% normal saline with gauze; a solution consisting of gentamicin, neomycin, and polymyxin; acetic acid solution, made from 4% white vinegar in distilled water; and Domeboro solution. Dr. Davis also recommended the use of Iodosorb gel, which contains timed-release iodine. Low concentrations of iodine delivered slowly are particularly effective for reducing bacterial load in streptococcus, pseudomonas, and staphylococcus.

* Silver dressings are the new "in" thing in wound care, Dr. Davis said, although the use of silver for wounds goes back to the time of Aristotle. Silver comes combined with many other types of dressings and is an excellent antimicrobial. "It's fantastic for preventing infection, and really seems to accelerate healing," he said.

The complexity of available dressings makes patient education vitally important. At the Mayo Clinic's wound-care center, each patient is allocated an hour to spend with the physician and the nurse, largely for this instruction. "The commonest reason [dressings] don't work is that they're not used properly," Dr. Davis said.

The SDEF and this newspaper are wholly owned subsidiaries of Elsevier.


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Title Annotation:Dermatology
Author:Finn, Robert
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jan 1, 2005
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