Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.
By the WoundSource Editors
Occlusive dressings are used for sealing particular types of wounds and their surrounding tissue off from air, fluids and harmful contaminants, such as viruses and bacteria, in a trauma or first aid situation. They are often utilized as an immediate means of controlling the cleanliness of a wound as well as the loss of blood until surgery can be used for long-term treatment. Although no wound dressing can provide complete seal, the waxy, non-absorbent nature of occlusive dressings are often enough. The quality of the provided seal often depends on factors such as the skill of the person dressing the wound, the nature of the wound and the condition of the area around the wound. Health care professionals are trained in the application of this kind of dressing, but the task is sometimes taken on by a patient's long-term caregiver.
Design and Application
Occlusive dressings come in a wide variety of shapes and formulations, and while some are available at drugstores, high quality dressings can be ordered via medical supply catalogs. They are commonly manufactured in flat sheets which may be cut to size if appropriate. Medicated occlusive dressings are also available and are used for the application of antibacterial creams or steroids.
Application involves adapting the bandage to the appropriate size, applying it to the wound then using a medical adhesive to tape off on all sides to create a complete seal. One side of the bandage may be left untaped to create a make-shift valve or flapper. As with any wound dressing, occlusive bandages must be checked regularly and changed when necessary to avoid infections.
Indications and Contraindications for Occlusive Dressings
Indications for the necessity of an occlusive dressing include:
- Pressure and bleeding are two of the major concerns when managing any wound, they can often be immediately addressed with the application of an occlusive dressing.
- Atopical ointments benefit from the application of an occlusive dressing. The dressing allows for ointments to thoroughly penetrate wounds by preventing evaporation. Occlusive dressings also press the ointment into the wound, rather than absorbing it like other dressings.
- Allergy tests sometime require the use of an occlusive dressing as well. The dressing will be applied to seal off the wound when testing for suspected or potential allergens. The controlled exposure will prevent the allergen from evaporating, being absorbed into a normal bandage or being washed away.
- Sucking chest wounds (open pnuemothorax) are holes in a patient's chest (such as punctures via knife or gun shot) which have created new pathways for air. Occlusive wounds can be utilized to block and treat the puncture.
- Partial evisceration may require the application of an occlusive dressing to contain the bowels until surgery.
- Wound Moisture Maintenance can be achieved by combining an occlusive dressing with a gauze or sponge, which can be soaked in a medicine such as antibiotics, hydrogels and other antibacterial creams utilized for the treatment of the wound.
- Minor wounds and skin conditions can also benefit from an occlusive dressing, which provide protection from contaminants, can help to expedite the healing process and reduce scar tissue. New tattoos are sometimes covered with an occlusive dressing to promote healing, prevent infection and preserve the aesthetics of the tattoo.
Contraindications for the application of an occlusive dressing include:
- Pre-existing pathogens in the affected area may create complications when sealed into a wound by an occlusive dressing. Occlusive dressings made from polyethylene film have been known to promote the growth of undesirable skin flora in some patients.1
- Skin maceration becomes a concern with long term use of occlusive dressings. With this condition the tissue surrounding the wound is affected by the tape and sealing method utilized in the application of the dressing. When this occurs the skin becomes tender, often feeling moist and looking whiter than usual. In this weakened state, the skin becomes susceptible to bacteria and infections, which could compromise the health of the wound itself.
An occlusive dressing addresses the need to control the environment around a wound to block out pathogens, prevent further trauma and promote optimal healing conditions. They have very particular uses which all require the need for a thorough analysis of the patient's circumstances. Indications and contraindications will lead to the appropriate application of occlusive bandages, and regular inspection enables the health care professional or caregiver the ability to avoid potential complications.
1. Rheinecker SB. Wound Management: The Occlusive Dressing. J Athl Train. 1995;30(2):143-6.