ABSTRACT
With any wound-dened as a breach in the integrity of the skin-the objectives of clinical management should include healing wherever possible, as it is reepithelialization that restores full barrier function and the exclusion of potential pathogens. In chronic wounds, so called because of factors that delay or compromise healing, a necessary part of management is the control of bioburden. All wounds healing by secondary intent will be contaminated or colonized with microorganisms. This does not necessarily lead to infection, and does not prevent healing. The clinical skill
Introduction ............................................................................................................ 329 Wound Dressings ................................................................................................... 330 Generic Dressing Classes ....................................................................................... 331
Hydrocolloids .................................................................................................... 331 Alginate Dressings ............................................................................................ 331
Negative Pressure Wound Therapy ........................................................................ 332 Biosurgery .............................................................................................................. 332 Honey ..................................................................................................................... 333 Hyperbaric Oxygen ................................................................................................ 334 Sequestration .......................................................................................................... 334 Control of Bacterial Virulence Determinants ......................................................... 335 Dressing Leakage and Strike-Through .................................................................. 336 The Microbiological Barrier Properties of Dressings ............................................ 336 The Value of Close Association of Dressing with the Wound Bed ........................ 336 Fluid Handling Properties: Absorption/Retention, Lateral Wicking, Sequestration .......................................................................................................... 337 Conclusions ............................................................................................................ 338 References .............................................................................................................. 338
of management is to ensure that the bioburden does not overwhelm host defenses and delay healing or cause infection. Although clinicians will, by necessity, have to resort to antimicrobial agents to control bioburden in some cases, not all chronic wounds will require such interventions. This chapter outlines how modern dressings and other topical treatments can help in this respect-without recourse to antimicrobial therapy. Where antimicrobial dressings are mentioned, it is in the context of the performance characteristics of the base dressing, or “carrier,” as this technology is recognized as an important adjunct to the overall clinical performance.1
