What is a Foam Dressing?

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foam wound dressing

Wound dressings can accelerate the healing process by protecting the injury or wound from bacteria and creating an environment which supports healthy healing. Foam dressings are an effective tool for moist wound healing and are particularly useful in preventing dressing-related trauma, managing exuding wounds, and minimizing dressing discomfort and pain.

Construction and Features of Foam Dressings

Made of semipermeable polyurethane, foam dressings contain foamed polymer solutions with small, open cells that can hold fluids. These cells may be layered with other materials. Their absorptiveness varies depending on the thickness of the dressing. The contact area of a foam dressing is nonadherent and nonlinting, so the dressing is easy to remove. The outer layer of the dressing is often hydrophobic or waterproof to keep out bacteria and other contaminants. Foam dressings come either with or without an adhesive border and in many sizes and shapes. Some foam dressings also include a bacterial barrier made from a transparent film. Additionally, some foam dressings are impregnated with an antimicrobial agent such as silver, Manuka honey, cadexomer iodine, antibiotics, or include surfactants as a vehicle for delivery of these substances to the wound bed.

A primary feature of foam dressings is that they help maintain a moist wound environment. Also important is that foam helps cushion the wound and periwound area from additional trauma, as well as providing thermal insulation for wounds. Easy to apply and remove, foam dressings don't cause wound trauma. Foam dressings can be used when there is an infection and during compression therapy. In addition, foam dressings are compatible with enzymatic debridment agents. Depending on the amount of exudate, foam dressings have a wear time of one to seven days.

Indications and Contraindications for Foam Dressing Use

Foam dressings are excellent for wounds which are exuding, whether minimally or heavily. Generally, foam dressings are meant for partial- or full-thickness wounds. Wounds which benefit from the use of foams dressings include:

  • leg ulcers
  • surgical wounds
  • skin grafts
  • minor burns
  • abrasions
  • infected wounds
  • lacerations
  • draining peristomal wounds
  • pressure ulcers/injuries (stages 2 to 4)
  • wounds needing negative pressure wound therapy (NPWT)
  • tracheotomy and gastrostomy tubes
  • wound cavities

Foam dressings can be used on wounds that have softened necrotic tissue. They are also flexible and can be cut to fit specific body parts like toes, fingers, or ears. Because of their thermal properties, foam dressings can be used on a wound which needs insulation to keep it warm. Additionally, foam dressings can be helpful in protecting the skin on top of bony prominences or high friction areas on the skin.

Non-draining wounds and third-degree burns are generally not good candidates for foam dressings. These dressings are also not effective on wounds which have dry eschar because with no exudate, the wound bed may be too dry for a moist wound healing environment (though in these cases foam dressings can be used to keep the eschar dry and protect it from accidental removal). Excessive exudate can be a contraindication if the foam is being soaked through quickly, possibly allowing external bacteria to enter the wound. In addition, excessive exudate can require too many dressing changes and cause maceration of the periwound area. In such cases, a more absorbent foam or another dressing type is indicated.

Proper Foam Dressing Application Instructions

The procedure for applying a foam dressing is as follows:

  1. Put on gloves.
  2. Clean the wound area with saline solution.
  3. Dry the skin around the wound with sterile gauze.
  4. Apply a foam dressing which extends a minimum of one inch beyond the edges of the wound.
  5. If the dressing does not have an adhesive border, you may need to apply a secondary dressing or use wrap or tape to hold it in place.
  6. When changing the dressing, peel off the foam dressing carefully, clean the wound and apply a new foam dressing.

The flexibility of foam dressings allows for a wide variety of clinical applications with wounds that have from moderate to heavy exudate. Because they are easy to use and can be easily cut to fit irregular wound areas, they are a good dressing choice for many situations.

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

Comments

This is an excellent, thorough discussion of foam dressings that highlights the dilemma of classifying wound products by their reimbursement codes. In 2007, Bolton wrote, "The approach of choosing wound dressings on the basis of evidence that they perform clinically needed MWH functions... is an important first step in focusing attention on meeting clinically assessed functional patient and wound needs rather than focusing on the material from which a dressing is made."(1)

PolyMem, while reimbursed as a foam, belongs to an innovative class of multifunctional wound dressings generically called polymeric membrane dressings (PMDs). Researchers and clinicians familiar with PolyMem distinguish between PMDs and conventional foam dressings because although PMDs provide all of the benefits of foam dressings mentioned in this article, they are qualitatively different. PMDs are used differently from any other dressings, and they provide additional benefits. Various configurations of PMDs (more or less absorbent, shaped like finger-cots or reinforced rope, etc.) are appropriate for use on all wound types at all stages of healing, including closed tissue injuries, dry eschar (if the goal is to atraumatically debride it), and the most heavily exudating wounds.

The key to PMDs' success is not any one component, but rather, its synergy: the way all of PolyMem’s many components work with each other and work with each patient’s body to speed healing, increase comfort, and streamline patient care. PMDs are made up of an extremely flexible stretchy foam substrate, a superabsorbent starch (baby-diaper technology) that is locked into the dressing, glycerol (a simple sugar with special properties that make it especially suitable for wounds), and a carefully chosen nontoxic, non-ionic, healing tissue-friendly surfactant. Some other dressings are impregnated with additives, as this article describes. In contrast, all of these components of PolyMem are incorporated into the dressing, not added later. PolyMem secondary dressings also contain a semi-permeable outer film covering that protects from microbial contamination while allowing gaseous exchange and adjusting the evaporation rate to help keep wounds optimally moist.

PMDs are known as the drug-free pain relieving, inflammation-limiting dressings because they are proven to alter the nociceptor (pain-sensing nerve) response at the site of application. In addition to decreasing the need for pain medications, this capability improves healing directly as it decreases the secondary inflammation that causes circulation-limiting swelling.

Instructions for use for PMDs can be the same as for conventional foam dressings initially (steps 1 - 5 in the article). However, because of PolyMem's continuous wound cleansing system, it is not necessary to cleanse or even routinely rinse at dressing changes (step 6 in the article). Rinsing at dressing changes cools the wound, removes nutrients from the wound bed, and can damage fragile new tissue. All of this is avoided with PMDs. Also, PolyMem is an indicator dressing - rather than changing on a rigid schedule, change the dressings when a darker color, visible through the backing, indicates that the area of saturation is reaching a wound edge. When PMDs are first used, they often recruit large amounts of nutrient-rich fluid from the body, which flushes out the chronic wound fluid and helps clean the wound. During this time, the dressings will need to be changed more frequently. After the continuously cleansing system has done its job, the quantity of exudate will decrease and the dressing may be left in place longer - up to 7 days - as the wound heals.

Sincerely,
Linda Benskin, PhD, RN, SRN (Ghana), CWCN, DAPWCA
Independent Nurse Researcher, and Clinical Research and
Education Liaison, & Charity Liaison for Ferris Mfg. Corp.

(1) Bolton L. Operational definition of moist wound healing. J Wound Ostomy Continence Nurs. 2007 Feb;34(1):23–9.
(2) For clinical studies to support the claims for PMDs, see the tables of evidence in the appendices of this article:
Benskin LL. Polymeric Membrane Dressings for Topical Wound Management of Patients With Infected Wounds in a Challenging Environment: A Protocol With 3 Case Examples. Ostomy Wound Manage. 2016 Jun;62(6):42–50. http://www.polymem.com/articles/Benskin-PMD-OWM_June2016.pdf

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