Does Gauze Have Cause? – Making a Case for Gauze Wound Dressings Protection Status
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by Aletha Tippett MD

With a theme this month of dressings, I think it is time to give gauze its rightful due. There are a number of wound care providers who would say that “gauze has no cause”. Of course, this is said because of the understanding that moist gauze dries out when on a wound, leading to “wet to dry”, which is a major no-no according to CMS. This wet-to-dry results in debridement of viable tissue. It is also because of the belief and practice that a gauze dressing needs to be changed daily, and with all the cost-consciousness, this makes it more expensive than a once-a-week higher end dressing. However, in real life, how often does a once-weekly dressing actually last the full week, especially on a sacral or buttock wound?

On behalf of gauze, allow me to say that it is inexpensive, versatile, readily available, and well known with almost intuitive use. A gauze square can be made into any shape needed to fit a wound—it can be laid flat, it can be fluffed up, it can be twisted and pulled into a rope. It can have anything added to it, including saline to moisten the dressing, various medications including lidocaine or antibiotic. Or gauze can be used dry for a wet wound. In some cases the wet-to-dry feature is desirable and can be used, if documented properly. For other dressing uses, it is the top dressing that determines whether the gauze will dry out or how frequently the gauze needs to be changed. Of course, heavily draining wounds may need to be changed daily because of saturating exudate. When one considers a sacral pressure ulcer, for example, the most common wound seen by wound care providers, fluffed gauze with an added hydrogel or medications is ideal to fill the wound space. One just needs to consider the top dressing.

Speaking of top dressings, my very favorite is plain old plastic wrap, with zinc oxide ointment used to hold in place. How often is a dressing removed from a wound, only to tear the skin or leave marks from the dressing adhesive? This is especially true for wounds on the buttocks. Applying zinc oxide ointment around the wound not only protects the peri-wound from moisture, it also provides a sealant to hold the plastic wrap in place. Inexpensive plastic wrap works best, adheres as well as a thin film adhesive, and is easy to remove and replace. It is non-traumatic to the skin. There is also no wicking of stool into the dressing on a sacral wound.

Used properly, gauze has great cause, and to my thinking, when one initially encounters a wound, should be the first dressing considered. If the gauze really is not appropriate for the wound, a different dressing can be selected and used.

For more education and training on creative use of gauze for wounds, especially in palliative care, attend the 3rd Annual Palliative Wound Conference May 17-19, 2012 in Skamania, Washington. For information on registration go online to , or call (513) 891-3698 or email

About the Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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I would like to offer some supportive and possibly contradictive comments to a few statements made in Dr. Tippett's fine article.

1. I believe "gauze does have cause".... if used correctly. I disagree that a proper wet-to-dry (WTD) dressing debrides much viable tissue. I teach that a simple saline wet-to-dry dressing should appear early in any practitioner’s wound care algorithm, while a more definitive treatment plan is pending.

2. One reason many WTD dressings fail to debride is that too often nurses, in an attempt to avoid pain, will soak off the dressing prior to removal, thus totally defeating the purpose of the WTD dressing. Better pain management education of the staff is required here.

3. Not all gauze is created equal! The weave and fiber of the gauze fabric is critical to is efficacy. In the 1990s, Johnson & Johnson made a wonderful 4x4 gauze which was designed to selectively debride necrotic tissue, while sparing new granulation. The brand name was Nu-Brede. It works wonderfully. Fortunately, I stockpiled a large supply as I am uncertain where to find it today.

4. I cringe anytime I hear of staff applying any dressing which is to be left in place for days at a time, let alone a full week as noted by Dr. Tippett. A wound demands inspection at least daily. Often I suspect unscrupulous staff relish the notion of a once-a-week dressing change as it allows them a 7-day vacation from messy dressing changes, all the while believing they are still performing diligent wound care. In my experience, the most common offender of this is the dressing, Duoderm. To keep a wound covered and out of sight for a week is below the standard of care, in my opinion. While on the subject of Duoderm, I do believe it has one legitimate use in wound care.....

5. ....The author makes mention of the fear of repeated dressings tearing the skin from adhesives. Here's two tricks to avoid this, of which some may be unaware: a) Surround the wound with strips of Duoderm and tape directly to the Duoderm, rather than the skin. OR b) Don't forget good-old Montgomery straps.

6. Cost containment should always be on our mind, however it should never take precedence over what is most effective in achieving wound healing.

John Baeke, M.D.
Plastic Surgery

I have definitely had patients that this would have been great for. Thank you for an outside of the box solution to a not uncommon problem.

All Gauze Dressings are NOT Created Equal

Nonwoven gauze is actually custom manufactured from a fenestrated form of a very versatile fabric with numerous medical, food, and commercial applications.

Nonwoven fabrics can be manufactured with multiple features including excellent absorbency, air permeability, and flexibility. They are used in medical applications (including wound care, bandages, ostomy, face masks and disposable surgical apparel, etc.), food & beverage, household products, commercial wipes, industrial wipes, filters, and many other applications.

Unique characteristics of “melt-blown” nonwoven fabrics:
1. Manufactured with rayon, polypropylene, polyester and polyamide fibers as well as with elastomeric polymers of polystyrene, polyurethane, polyester and polyolefin in elastic versions.
2. Melt-blown technology provides consistency and uniformity.
3. Fine and soft texture by incorporating ultra-fine fiber materials.
4. Whiteness and air permeability customization through control over fiber diameter.
5. Heat-seal performance and biodegradability.
6. Hydrophilic/hydrophobic finish, dyeing and/or resin finish treatment possibilities.

Nonwoven gauze dressings continue to evolve and the technology is limited only to the available polymers blended to provide the desired characteristics. A nonwoven gauze dressing is not equivalent or comparable in composition and function to the familiar woven cotton, abrasive, loose-thread, fish-net “sponge” that has been used in every medical setting for the last 50 years.

With the proper blend of fibers, an impregnated nonwoven gauze can have an extended wear time of 3-7 days, which would not be possible utilizing the woven cotton fish-net gauze sponge. It can also be manufactured with non-adherent benefits to minimize trauma and pain reduction.

One should not underestimate the potential value in the evolving fiber/polymer technology behind nonwoven gauze.

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