Table, Classification of dressings suitable for use on primarily closed incisions* - Global Guidelines for the Prevention of Surgical Site Infection

From: Web Appendix 26, Summary of a systematic review on advanced dressings

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Contents

I. Basic wound contact dressings
Ia. Absorbent dressings and surgical absorbents	Absorbent dressings are applied directly to the wound. Surgical absorbents may be used as secondary absorbent layers in the management of heavily-exuding wounds.
Ib. Low-adherent wound contact layers	Low-adherent wound contact layers consist mainly of a fine mesh gauze impregnated with moisturizing, antibacterial or bactericidal compounds. They are either non-medicated (for example, paraffin gauze dressing) or medicated (for example, containing povidone iodine or chlorhexidine). These dressings are widely used primarily as interface layers between the wound surface and a secondary absorbent dressing, usually made of cotton gauze, to prevent it from adhering to the wound surface and causing trauma upon removal. As the dressing dries, fibrin from the wound bed causes temporary bonding of the dressing to the wound, thus permitting healing beneath it.
II. Advanced dressings
IIa. Vapour-permeable films	Vapour-permeable films are permeable to water vapour and oxygen, but not to water or microorganisms. They are normally transparent.
IIb. Hydrocolloid dressings	Hydrocolloid dressings vary significantly in their composition and physical properties. In general, they consist of a self-adhesive gel-forming mass applied to a carrier, such as a thin polyurethane film or a foam sheet. They contain colloidal particles, such as quar, karaya, gelatic, sodium carboxymethylcellulose, gelatin and pectin, in an adhesive mass usually made of polyisobutylene. In their intact state, hydrocolloids are virtually impermeable to water vapour and thus they facilitate wound hydration and promote moist wound healing. By trapping wound exudates, hydrocolloids create a moist environment that softens and lifts dry eschars or causes their autolytic debridement and proteolytic digestion. They favour also granulation tissue formation and re-epithelialization.
IIc. Hydrogels or fibrous hydrocolloid dressing	Hydrogels consist of 80–90% water and insoluble cross-linked polymers, such as polyethyleneoxide, polyvinyl pyrollidone, acrylamide or carboxymethylcellulose, with hydrophilic sites that interact with aqueous solutions, absorbing and retaining significant volumes of water.
IId. Polyurethane matrix hydrocolloid dressing	Polyurethane matrix hydrocolloid dressings consist of two layers: a polyurethane gel matrix and a waterproof polyurethane top film designed to act as a bacterial barrier.
III. Antimicrobial dressings
IIIa. Polyhexametylene biguanide (PHMB) dressing	A commonly used antiseptic. It is used in a variety of products, including wound care dressings, contact lens cleaning solutions, perioperative cleansing products and swimming pool cleaners.
IIIb. Silver-impregnated dressing	The extensive coverage that silver provides against bacteria, fungi and viruses, including nosocomial pathogens and methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), make it a valuable adjunct in the prevention and treatment of infection. Silver has both bactericidal effects via oxidation of the cell membrane and bacteriostatic effects by inhibiting bacterial replication through damage to DNA.
IV. Negative-pressure dressings	Primarily designed to prevent exudate collection while simultaneously preventing desiccation of the wound. It has been also claimed that these dressings increase oxygen tension in the wound, decrease bacterial count, increase granulation formation and prevent shear force on the wound surface.

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Global Guidelines for the Prevention of Surgical Site Infection.

TableClassification of dressings suitable for use on primarily closed incisions^*

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