By the WoundSource Editors
Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.
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 www.hopeofhealing.org , or call (513) 891-3698 or email firstname.lastname@example.org.
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.