Gauze. Woven gauze is generally not recommended as a packing material for open wounds. The use of wet-to-dry dressings, although still commonly used, will not adequately contribute to exudate absorption; in fact, it may cause local trauma and pain at the wound site. With that said, a bulky cotton gauze roll may be loosely packed into larger spaces as a temporizing measure until other dressings are available or other procedures (such as surgery) are considered. Packing ribbons, either plain or impregnated with iodophor or hypertonic saline, may be useful in packing narrow tunnels or tracts to facilitate movement of exudate into the secondary dressing. Care should be taken to extend the packing ribbon well beyond the packed area in order to enable complete removal and prevent loss of the material into the depths of the wound.
Calcium alginates. Calcium alginates are composed of calcium/sodium salts of alginic acid. Alginates are derived from a variety of seaweed sources. They form a moist gel through a process of ion exchange with the wound exudate. They are primary dressings placed in contact with the wound bed and are indicated for pressure, arterial, and venous wounds; diabetic ulcers; and postoperative and trauma wounds. They conform to the wound surface, creating a moist wound environment, and can be used to tuck, pack, or fill uneven surfaces, tunnels, and undermining. Alginates support autolytic debridement and are painlessly removed when moist, or can be remoistened with saline irrigation, should they dry out. Alginates require a secondary absorptive dressing to soak up drainage not absorbed by the alginate, to hold the dressing against the wound bed, and to protect the wound from outside contaminants. They are available in various sizes and conformations such as sheets, pads, and ropes. Alginates have hemostatic properties and may assist in stopping punctate bleeding. Alginate dressings are contraindicated for wounds that are dry or have minimal exudate or for third-degree burns.
Gelling fiber dressings. Similar in function to calcium alginate dressings, gelling fiber dressings are absorbent wound covers that are typically composed of sodium carboxymethyl cellulose, strengthening cellulose fibers, and other blended superabsorbent materials. As wound fluid is absorbed into the dressing, a gel forms, which assists in maintaining a moist environment and protecting the periwound skin. These dressings vary among manufacturers and may include additives such as chitosan, which enhances hemostasis. These dressings are available in a variety of sizes and in pads and ropes. They also require a secondary dressing.
Foams. Foams are versatile dressings that are indicated for absorbing moderate to copious amounts of fluids on partial- and full-thickness wounds; they also are now commonly used as prophylactic protection over bony prominences. These dressings are generally polyurethane or polyvinyl alcohol foam and may be used as primary or secondary dressings. The dressings feature small, open cells capable of wicking drainage away from the wound through their hydrophilic properties, retaining exudate in the upper layers of the dressing or allowing it to pass through to another absorbent pad to protect the wound bed and the periwound skin. Foam dressings may be adhesive or nonadherent, with or without borders, and many are available with silicone adhesion. Some advanced foams may be used in wounds with higher levels of exudate; these dressings have absorbent particles suspended within the dressing, multiple layers, larger pores at the wound interface to absorb more viscous exudate, and additional cuts to enhance comformability and increase surface area for absorption. One specialized foam dressing also releases surface active agents onto the wound bed to facilitate cleansing.
Superabsorbent and specialty absorbent dressings. A growing category of dressings, superabsorbents are just what their name implies — dressings made from a variety of different layers of fibers, particles, cellulose, and other materials that rapidly wick and hold higher amounts of wound exudate and lock it into the dressing or pass it through to a secondary dressing. They may be made from fibrous materials or foam combinations, enabling longer wear time and reducing the frequency of dressing changes.