Dr.

MUHIBULLAH BANGASH
PG-1 Resident
Surgical-E Unit
KTH, Peshawar
 Definitions
 History of Surgical Dressings
 Properties of Ideal wound Dressings
 Types of Surgical Dressings
 Commonly used Surgical Dressings
 Miscellaneous Dressings
 Conclusion
 Videos
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.
 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.
 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%.
 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.
 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.
 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
 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
 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
CLASSIFICATION:
 Dry dressings
 Moisture-keeping dressings
 Bioactive Dressings
 Skin Substitutes
 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
 Nonadherent to the wound
 Heals faster
 Do not break granulation tissue on removal
 Comparatively less painful
EXAMPLES:
 Pastes, creams and ointments
 Nonpermeable, semipermeable membranes
or foils,
 Hydrocolloids
 Hydrogels
 Combination products.
They play a significant active role in wound
healing because

 enhance granulation tissue formation

 Reduce slough formation
 Inhibits bacteria
 Some provide growth factors
EXAMPLES:
 Antimicrobial dressings
 Interactive dressings
 Single-component biologic dressings
 Combination products
 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.
EXAMPLES:
 Epidermal substitutes
(autologous or allogenic)
 Acellular skin (dermis) substitutes
(allogenic or xenogenic)
 Autologous and Allogenic skin
 Skin substitutes containing living cells.
 Gauzes  Enzymatic dressings
 Foams  Bead dressings
 Polymeric films  Silicone dressings
(Opsite)  Human Amniotic
 Tissue adhesives Membrane
 Tulles  Porcine skin
 Hydrocolloids
 Hydrogels
 Debriding agents
 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.
 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.
 Semipermeable film dressings
 Primary adhesive
 transparent
 Waterproof
 Impermeable to bacteria
 Breathable
 Ultra thin & high elasticity
Examples:
 Opsite
 Bioclusive
 Tegaderm
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

 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
 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
 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
 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.
 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.
 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.
 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!!
 Brand: DueDERM®
 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
 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®
 GEL FORM

SHEET FORM
 Provide acidic environment
 Enhance healing via debriding action
 Only used in Necrotic sloughing skin ulcers

EXAMPLE:
 Benoxyl-benzoic acid
 Activate fibrinolysis and liquefy pus on
CHRONIC SKIN ULCERS

Example:
 Varidase-streptokinase/streptodornase
 Remove bacteria and excess moisture by
CAPILLARY ACTION
 Useful in Deep Granulating Wounds

EXAMPLES:
 Debrisan®
 Iodosorb®

 Available as Sheeths & Pastes

 May reduce Hypertrophic scarring and
Keloid formation
 Work as Antiadhesives
 useful in covering split-skin donor sites or
fresh meshgrafts
 MAKING THE SCARS MORE COSMETICALLY
ACCEPTABLE via:
 flattening of scarring tissue
 increasing elasticity
 reducing discoloration
 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
BRANDS:
 Kaltostat®
 Sorbsan®
 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
 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.
 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
 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
 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 Nonhealing Wounds
 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
 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
 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
 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