Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 40

40

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Table 3. Selection of Wound Care Dressing
Dressing Category
and Definition

Indications

Advantages

Disadvantages

Considerations, Usage,
and Precautions

PA S S IVE W OUND CARE PRODUCTS/ THERAPI ES

Composites
Composed of
impermeable barrier, an
absorptive layer other
than an alginate, foam,
hydrocolloid or
hydrogel, a semiadherent or
nonadherent property
for covering the wound
and an adhesive border.

* Primary or secondary
dressing
* Partial- and shallow
full-thickness wounds
* Minimal exudate
(dressing dependent
and when used in
combination with
another dressing such
as an alginate)
* Healthy granulation
tissue, or necrotic
tissue (slough or moist
eschar), or mixed
wounds with granular
and necrotic base

* Easy to use -
application and removal
* Combines the
advantages from more
than one dressing group
to address the
characteristics of the
wound
* Molds well
* May be used on
infected wounds
* Includes an adhesive
border

* Requires a border of
intact skin for anchoring
the dressing
* Dependent upon the
type of composite
dressing. Read the
package labeling for
specific information, and
proper use based on
wound bed
characteristics

* A paper-backing liner
is removed and the
dressing is applied to the
wound
* Usual composite
dressing change is up to
3 times per week, one
wound cover per
dressing change

Contact Layers
A single layer,
nonadherent, woven
polyamide net that is
placed in contact with
the wound base. It
allows the passage of
wound exudate to a
secondary dressing,
usually a gauze or foam
dressing.

* Primary dressing for
partial- and fullthickness wounds
* Wounds with minimal,
moderate, and heavy
exudate
* In combination with
negative pressure
wound therapy

* Protects wound base
from trauma during
dressing changes
* For use with large or
deep wounds
* Antimicrobials may be
applied under the
dressing

* Not recommended
for use in shallow or
dry wounds in the
presence of viscous
exudate
* Not recommended
for wounds covered
with eschar
* Requires a secondary
dressing

* Applied to a wound
base with a secondary
absorbent dressing
cover (e.g., gauze or
foam)
* Contact layer stays in
place up to 7 days
while the absorbent
layers are changed as
needed

Wound Fillers
Absorbent materials
composed of starch
copolymers in paste,
powder or bead form.
It requires a secondary
dressing.

* Partial and shallow
full-thickness wounds
* Minimal to moderate
exudate
* Necrotic wounds with
moisture
* Infected wounds

* Absorbent filling
material
* May be combined
with other dressings to
extend wear time

* Not recommended for
dry wounds, wounds
covered with eschar,
deep wounds, or those
with tunneling

* Apply to fill a shallow
defect in a wound
* Apply a secondary
dressing
* Change dressing up to
once per day

Wound Pouches
Adapted from ostomy
care with anintegrated
skin barrier and a
drainage spout that can
be connected to a
straight drainage.
Odor proof pouch film

* Highly exudative
wound
* Malodorous exudate

* Pouch wear time 4-7
days
* Skin protection from
wafer
* Ease of use

* Pouching system is
expensive and requires
extensive education of
caregiver to minimize
application errors

* Apply in similar
fashion as an ostomy
pouch
* Educate caregiver
* Dressing change is up
to 3 times per week
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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