Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 41

CLINICAL PRACTICE GUIDELINE

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

Indications

Advantages

Disadvantages

Considerations, Usage,
and Precautions

A CT IVE WOUND CARE PRODUCTS/ THERAPI ES

Antimicrobial
Topical wound care
product derived from
agents such as silver,
iodine, and
polyhexethylene
biguanide. Delivers
antimicrobial or
antibacterial action to
the wound (e.g., silver
dressing or iodine).
Available as ointments,
impregnated gauzes,
pads, island dressings,
and gels.

* Primary Dressing for
effective barrier to
bacterial penetration
* Primary or secondary
dressing
* Provides sustained
release of antiseptic
agent at the wound
surface for longlasting antimicrobial
action
* Acute and chronic
wounds
* To reduce infection
and manage wounds
with moderate to
heavy exudates in
partial- and fullthickness wounds

* Provides broad range
of antimicrobial or
antibacterial activity
* Reduces and prevents
infection
* Alters
metalloproteinases
(MMP) within wounds

* Not indicated to
control heavy bleeding
* Not indicated for
patients with known
sensitivity to silver
* Not indicated for use
on patients during
MRI examination
* Incompatible with oilbased products such as
petrolatum
* May cause staining on
wound and intact skin
with silver dressings

* Must be removed
before start of longterm radiation
treatment with x-rays,
ultrasound, diathermy,
or microwaves
* When using silver or
iodine dressings, do
not apply or combine
with collagenase
enzymatic debrider
because silver and
iodine will inhibit the
enzymatic activity

Collagen
Derived from bovine,
porcine, or avian
sources.
Non adherent pouches
or vials, gels loaded
into syringes, pads,
powders, and freezedried sheets.
Requires a secondary
dressing.

* Primary dressings for
partial- and fullthickness wounds
* Contaminated and
Infected wounds,
tunneling wounds
* Minimal to moderate
exudate

* Accelerates wound
repair
* Nonadherent to
wound
* Some forms may
be left in wound
for 7 days
* May be used in
combination with
topical agents
* Conforms well to
wound bed
* Easy to apply
and remove

* Not recommended for
patients with
sensitivity to bovine
materials
* Requires a secondary
dressing

* Refer to package
insert. Each form
of collagen dressing
has specific usage
instructions

Enzymatic Debriding
Agents
Proteolytic enzymes,
fibrinolytic enzymes,
collagenase applied to
wound to digest
necrotic tissue.

* Partial - and fullthickness wounds
* Eschar or necrotic
tissue in wound bed

* Conservative
debriding agent
* Easy to understand
* May be used in many
care settings

* Use with caution in
patients with
coagulation disorders

* Use gauze as a
secondary dressing
* When granulation
tissue is present, may
discontinue product
use unless
maintenance
debridement
is planned

Negative Pressure
Wound Therapy
Open cell reticulated
foam or gauze dressing
placed into the wound,
sealed with semiocclusive drape and
attached to
subatmospheric
pressure through an
evacuation tube
connected to a
computerized pump
device.

* Acute and chronic
open wounds with
depth
* Partial- and fullthickness wounds

* Control for fluid
and isolation of the
wound is provided
while dressing is
in place
* Suction provides
wound contraction
to promote wound
closure

* Use with caution in
patients with active
bleeding, clotting
disorders, and those
on anticoagulants

* Follow strict protocol
* Dressing changes
varies based on
wound usually every
24 up to 72 hours

41
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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