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Wound Dressings

Wound, whether it is a minor cut or a major incision, it is important to care for it properly, part of this process includes wound dressing. Dressing is designed to be in contact with the wound, which is different from a bandage that holds the dressing in place. Historically, wet-to-dry dressings have been used extensively for wounds requiring debridement. In 1600 BC, Linen strips soaked in oil or grease covered with plasters was used to occlude wounds. Clay tablets were used for the treatment of wounds by Mesopotamian origin from about 2500 BCE. They cleaned wounds with water or milk prior to dressing with honey or resin. Wine or vinegar usage for cleaning the wounds with honey, oil and wine as further treatment was followed by Hippocrates of ancient Greece in 460- 370 BCE. They used wool boiled in water or wine as a bandage. There was a major breakthrough in the antiseptic technique during the 19th century, antibiotics were introduced to control infections and decrease mortality. Modern wound dressing arrival was in 20th century.

When the wound is closed with dressing, such as transparent film dressing, they are continuously exposed to proteinases, chemotactic, complement & growth factors, which is lost in the wound exposed. So during late 20th century, production of occlusive dressing began to protect and provide moist environment to wound. These dressings helps in faster re-epithelialization, collagen synthesis, promotes angiogenesis by creating hypoxia to the wound bed and decreases wound bed pH which leads to decrease in the wound infection. Woven absorbent cotton gauze was used in 1891. Until the mid 1900’s, it was firmly believed that wounds healed more quickly if kept dry and uncovered whereas ‘closed wounds heal more quickly than open wound’ written in an Egyptian medical text -Edwin smith surgical papyrus in 1615 BC. Oscar Gilje in 1948 describes moist chamber effect for healing ulcers. In the mid 1980’s, the first modern wound dressing were introduced which delivered important characteristics providing moisture and absorbing fluids (e.g. polyurethane foams, hydrocolloids, iodine-containing gels). During the mid 1990’s, synthetic wound dressings expanded into various group of products which includes hydrogels, hydrocolloids, alginates, synthetic foam dressing, silicone meshes, tissue adhesives, vapor-permeable adhesive films and silver/collagen containing dressing.

Traditional wound dressing

Traditional wound dressing products including gauze, lint, plasters, bandages (natural or synthetic) and cotton wool are dry and used as primary or secondary dressings for protecting the wound from contaminations. Gauze dressings made out of woven and non woven fibres of cotton, rayon, polyesters afford some sort of protection against bacterial infection. Some sterile gauze pads are used for absorbing exudates and fluid in an open wound with the help of fibres in these dressings. These dressings require frequent changing to protect from maceration of healthy tissues. Gauze dressings are less cost effective. Due to excessive wound drainage, dressings, including foam dressing, become moistened and tend to become adherent to the wound making it painful when removing. Bandages made out of natural cotton wool and cellulose or synthetic bandages made out of polyamide materials perform different functions. For instance, cotton bandages are used for retention of light dressings with non woven dressing, high compression bandages and short stretch compression bandages provide sustained compression in case of venous ulcers. Xeroform™ (non-occlusive dressing) is petrolatum gauze with 3% of Bismuth tribromophenate used for non-exudating to slight exudating wounds. Tulle dressings such as Bactigras, Jelonet, Paratulle are some examples of tulle dressings commercially available as impregnated dressings with paraffin and suitable for superficial clean wound. Generally traditional dressings are indicated for the clean and dry wounds with mild exudate levels or used as secondary dressings. Since traditional dressings fail to provide moist environment to the wound they have been replaced by modern dressings with more advanced formulations.

Modern and advanced wound dressing

Modern wound dressing have been developed to facilitate the function of the wound rather than just to cover it. These dressings are focused to keep the wound from dehydration and promote healing. Based on the cause and type of wound, numerous products are available in the market, making the selection a very difficult task. Modern wound dressings, transparent dressing with absorbent pad, are usually based on synthetic polymers and are classified as passive, interactive and bioactive products. Passive products are non-occlusive, such as gauze and tulle dressings, used to cover the wound to restore its function underneath. Interactive dressings are semi-occlusive or occlusive, available in the forms of films, foam, hydrogel and hydrocolloids. These dressings act as a barrier against penetration of bacteria to the wound environment.

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