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Wound dressings

Vanessa Jones,1Joseph E Grey, and Keith G Harding1Vanessa Jones is senior lecturer at the Wound Healing Research Unit, Cardiff University!his article has "een cited "yother articles in #$C

%ther &ections'

!raditionally (et)to)dry gau*e has "een used to dress (ounds +ressings that create and

aintain a oist environent, ho(ever, are no( considered to provide the optial conditions

for (ound healing $oisture under occlusive dressings not only increases the rate of

epithelialisation "ut also prootes healing through oisture itself and the presence initially of alo( o-ygen tension .prooting the inflaatory phase/ Gau*e does not e-hi"it these

properties0 it ay "e disruptive to the healing (ound as it dries and cause tissue daage (hen it

is reoved t is not no( (idely used in the United KingdoKingdo

Figure 1

2eft3 Healthy venous leg ulcer suita"le for dressing (ith lo(

adherent dressing Right3 Wound suita"le for dressing (ithseiperea"le fil

Table 1

Characteristics of the ideal dressing

%cclusive dressings are thought to increase cell proliferation and activity "y retaining an

optiu level of (ound e-udate, (hich contains vital proteins and cyto4ines produced in

response to in5ury !hese facilitate autolytic de"rideent of the (ound and proote healingConcerns of increased ris4 of infection under occlusive dressings have not "een su"stantiated in

clinical trials !his article descri"es (ound dressings currently availa"le in the UKUK

Figure 2

Venous leg ulcer suita"le for dressing (ith hydrocolloid

Table 2

Low adherent dressingssuitable for use on flat, shallow

wounds with low exudates

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl1/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/citedby/

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2o( adherent dressings

2o( adherent dressings are cheap and (idely availa"le !heir a5or function is to allo( e-udate

to pass through into a secondary dressing (hile aintaining a oist (ound "ed$ost are anufactured in the for of tulles, (hich are open (eave cloth soa4ed in soft paraffin

or chlorhe-idine0 te-tiles0 or ultilayered or perforated plastic fils

!hey are designed to reduce adherence at the (ound "ed and are particularly useful for patients(ith sensitive or fragile s4in

%ther &ections'

&eiperea"le fils

&eiperea"le fils (ere one of the first a5or advances in (ound anageent and heralded aa5or change in the (ay (ounds (ere anaged !hey consist of sterile plastic sheets of

polyurethane coated (ith hypoallergenic acrylic adhesive and are used ainly as a transparent

priary (ound cover6lthough they are iperea"le to fluids and "acteria, they are perea"le to air and (ater

vapour, the control of (hich is dependent on the oisture and vapour transission rate, (hich

varies depending on the "rand t is through this echanis that this dressing creates a oist(ound environent

7ils are very fle-i"le and are good for (ounds on 8difficult9 anatoical sites:for e-aple,

over 5oints !hey are una"le to cope (ith large aounts of e-udate, ho(ever, and ay cause

aceration of the s4in surrounding the (ound "ed if they are used in5udiciouslyin5udiciously

Table 3

Semipermeable films

%ther &ections'

Hydrocolloids

This is the ninth in a series of 12 articles

odern dressing technolog! is based on the principle of creating and maintaining a moist

wound en"ironment

&odiu car"o-yethylcellulose, gelatin, pectin, elastoers, and adhesives are "onded to acarrier of seiperea"le fil or a foa sheet to produce a flat, occlusive, adhesive dressing that

fors a gel on the (ound surface, prooting oist (ound healing Cross lin4age of the

aterials used influences the viscosity of the gel under the dressing !his gel, (hich ay "e

yello( and alodorous, ay "e ista4en for infection "y the un(ary Hydrocolloids arevirtually iperea"le to (ater vapour and air and can "e used to rehydrate dry necrotic eschar

and proote autolytic de"rideent !hey are reported to reduce (ound pain, and their "arrier

properties allo( the patient to "athe or sho(er and continue (ith noral daily activities (ithoutdistur"ing or ris4ing containation of the (ound Caution should "e e-ercised (hen using

hydrocolloids for (ounds that re;uire fre;uent inspection:for e-aple, for dia"etic foot ulcers

ulcers

Figure 3

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/

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7oot (ound coplicated "y heterotopic calcification suita"le for

dressing (ith hydrofi"res

Table #

$!drocolloid dressings %including h!drofibres&

Hydrocolloid fi"res are no( availa"le in the for of a hydrophilic, non)(oven flat sheet,

referred to as hydrofi"re dressings %n contact (ith e-udate, fi"res are converted fro a drydressing to a soft coherent gel sheet, a4ing the suita"le for (ounds (ith a large aount of

e-udatee-udate

Figure #

+ry, sloughy leg (ound suita"le for dressing (ith hydrogel

Table '

$!drogels

%ther &ections'

Hydrogels

Hydrogels consist of a atri- of insolu"le polyers (ith up to (ater content ena"ling theto donate (ater olecules to the (ound surface and to aintain a oist environent at the

(ound "ed 6s the polyers are only partially hydrated, hydrogels have the a"ility to a"sor" a

degree of (ound e-udate, the aount varying "et(een different "rands !hey transit oisture

vapour and o-ygen, "ut their "acterial and fluid perea"ility is dependent on the type ofsecondary dressing usedused

Figure '

+ia"etic foot ulcer (ith aceration to surrounding s4in suita"le for dressing(ith alginate

Hydrogels proote (ound de"rideent "y rehydration of non)via"le tissue, thus facilitating the

process of natural autolysis 6orphous hydrogels are the ost coonly used and are thic4,viscous gels

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig3/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig4/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig5/

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Hydrogels are considered to "e a standard for of anageent for sloughy or necrotic (ounds

!hey are not indicated for (ounds producing high levels of e-udate or (here there is evidence of

gangrenous tissue, (hich should "e 4ept dry to reduce the ris4 of infection

%ther &ections'

6lginates6lginates are produced fro the naturally occurring calciu and sodiu salts of alginic acidfound in a faily of "ro(n sea(eed .#haeophyceae/ !hey generally fall into one of t(o 4inds3

those containing 1??> calciu alginate or those that contain a co"ination of calciu (ith

sodiu alginate, usually in a ratio of @?3A?

6lginates are rich in either annuronic acid or guluronic acid, the relative aount of eachinfluencing the aount of e-udate a"sor"ed and the shape the dressing (ill retain 6lginates

partly dissolve on contact (ith (ound fluid to for a hydrophilic gel as a result of the e-change

of sodiu ions in (ound fluid for calciu ions in the dressing !hose high in annuronic acid.such as Kaltostat/ can "e (ashed off the (ound easily (ith saline, "ut those high in guluronic

acid .such as &or"san/ tend to retain their "asic structure and should "e reoved fro the (ound

"ed in one piecepiece Table (

)lginates

$!drocolloid fibres %h!drofibres& are often used on wounds where, traditionall!, alginates

ha"e been used

6lginates can a"sor" 1B to A? ties their (eight of fluid, a4ing the suita"le for highly

e-uding (ounds !hey should not "e used, ho(ever, on (ounds (ith little or no e-udate as they(ill adhere to the healing (ound surface, causing pain and daaging healthy tissue on reoval

reoval

Figure (

Venous leg ulceration in "ac4ground of chronic oedea suita"le for dressing

(ith foa

%ther &ections'

7oa dressings

7oa dressings are anufactured as either a polyurethane or silicone foa !hey transit

oisture vapour and o-ygen and provide theral insulation to the (ound "ed #olyurethanefoas consist of t(o or three layers, including a hydrophilic (ound contact surface and a

hydropho"ic "ac4ing, a4ing the highly a"sor"ent !hey facilitate unifor dispersion ofe-udate throughout the a"sor"ent layer and prevent e-terior lea4age .stri4e)through/ due to the

presence of a seiperea"le "ac4ing"ac4ing

Figure *

!op left3 &loughy, infected arterial ulcer suita"le for dressing

(ith copound antiicro"ial dressing .silver or iodine "ased/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/

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!op right3 Gangrenous foot suita"le for dressing (ith

antiicro"ial iodine ipregnated dressing 2eft3 $alodorous

alignant.ore /

Table *

Foam dressings

#olyurethane foa dressings are also availa"le as a cavity dressing:sall chips of hydrophilic

polyurethane foa enclosed in a e"rane of perforated polyeric fil, giving a loosely filled"ag"ag

Table +

)ntimicrobial dressings

&ilicone foas consist of a polyer of silicone elastoer derived fro t(o li;uids, (hich, (hen

i-ed together, for a foa (hile e-panding to fit the (ound shape foring a soft open)cell

foa dressing !he a5or advantage of foa is the a"ility to contain e-udate n addition,silicone foa dressings protect the area around the (ound fro further daage

%ther &ections'

6ntiicro"ial dressings

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl8/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl8/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl8/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/figure/fig7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl7/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl8/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/table/tbl8/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/

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&ilver, in ionic or nanocrystalline for, has for any years "een used as an antiicro"ial agent

particularly in the treatent of "urns .in the for of silver sulfadia*ine crea/ !he recent

developent of dressings ipregnated (ith silver has (idened its use for any other (oundtypes that are either colonised or infected

odine also has the a"ility to lo(er the icro"iological load in chronic (ounds Clinically it is

ainly used in one of t(o forats3 (a)as povidone)iodine .polyvinylpyrrolidone)iodinecople-/, an iodophor .a copound of iodine lin4ed to a non)ionic surfactant/, (hich is

produced as an ipregnated tulle0 and (b)as cade-oer iodine .a three diensional starch lattice

containing ? iodine/ Cade-oer iodine has good a"sorptive properties3 1 g of cade-oeriodine can a"sor" up to l of fluid 6s fluid is a"sor"ed, iodine is slo(ly released, reducing the

"acterial load and also de"riding the (ound of de"ris !his ode of action facilitates the delivery

of iodine over a prolonged period of tie:thus, in theory, aintaining a constant level of iodine

in the (ound "edCaution is re;uired in patients (ith a thyroid disease o(ing to possi"le systeic upta4e of

iodine 7or this reason, thyroid function should "e onitored in patients (ho are treated (ith

iodine dressings

$etronida*ole gel is often used for the control of odour caused "y anaero"ic "acteria !his isparticularly useful in the anageent of fungating alignant (ounds t ay "e used alone or as

an ad5unct to other dressings

%ther &ections'

Un(anted effects of dressings

$aceration of the s4in surrounding a (ound ay occur if a dressing (ith a lo( a"sorptive

capacity is used on a heavily e-uding (ound f the dressing is highly a"sorptive then orefre;uent dressing changes ay "e needed, in addition to investigation and anageent of the

cause of the e-udate .such as infection/

The ion exchange properties of some alginates mae them useful haemostatic agents, and as

such the! are particularl! useful for postoperati"e wound pacing-nappropriate use of dressings ma! lead to unwanted effects

!he s4in surrounding a highly e-uding (ound ay "e further protected through the use ofeollients .such as B?3B? i- of (hite soft paraffin and li;uid paraffin/ or the application of

"arrier fils .such as Cavilon/ Conversely, use of a highly a"sorptive dressing on a dry (ound

ay lead to disruption of healthy tissue on the (ound surface and cause pain (hen reoved

reoved

Figure +

6"doinoperineal resection (ound treated (ith vacuu assisted closure !he

s4in edges are protected (ith a "arrier crea to prevent aceration

6llergic reactions are not uncoon3 the dressing should "e avoided, and the allergy ay need

to "e treated (ith potent topical steroids !apes used to 4eep dressings in place are coon

causes of allergy $any dressings re;uire secondary dressings:for e-aple, padding on highlye-uding (ounds:(hich ay a4e the "ul4y &econdary dressings should not "e too tight,

especially on patients (ith peripheral vascular diseasedisease

Figure .

2eft3 6llergy to dressing used to treat arterial leg ulceration Dote erytheatous

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s4in (ith sharply dearcated edges corresponding to the shape of the offending

dressing Right3 Ulceration over the anterior aspect of the an4le caused "y

inappropriately.ore /

DotesCopeting interests3 7or series editors copeting interests, see the first article in this series

!he 6FC of (ound healing is edited "y Joseph E Grey

.5osephgreycardiffandvale(alesnhsu4/, consultant physician, University Hospital of Wales,Cardiff and Vale DH& !rust, Cardiff, and honorary consultant in (ound healing at the Wound

Healing Research Unit, Cardiff University, and "y Keith G Harding, director of the Wound

Healing Research Unit, Cardiff University, and professor of reha"ilitation edicine .(ound

healing/ at Cardiff and Vale DH& !rust !he series (ill "e pu"lished as a "oo4 in suer A??=

%ther &ections'

7urther reading and resources

/ Choucair $, #hillips ! 6 revie( of (ound healing and dressings aterial &4in and

6ging 1

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6rti4el ini telah di4utip oleh arti4el lain dala #$C

M Fagian 2ainnya '

Fasah tradisional cenderung 4ering 4asa telah diguna4an untu4 "erpa4aian lu4a +ressing yang

encipta4an dan eelihara ling4ungan yang le"a", naun, se4arang dianggap untu4

enyedia4an 4ondisi optial untu4 penye"uhan lu4a Kele"a"an di "a(ah dressing o4lusiftida4 hanya ening4at4an la5u epithelialisation tetapi 5uga ening4at4an penye"uhan elalui

4ele"a"an itu sendiri dan 4ehadiran a(alnya dari te4anan o4sigen rendah .eproosi4an

fase inflaasi/ Kasa tida4 enun5u44an sifat ini, ung4in engganggu untu4 penye"uhanlu4a 4arena engering dan enye"a"4an 4erusa4an 5aringan "ila dihapus Hal ini tida4 se4arang

"anya4 diguna4an di KingdoKingdo &eri4at

Ga"ar 1Kiri3 ul4us vena tung4ai &ehat coco4 untu4 "erpa4aian dengan dressing ele4at rendah Kanan3

2u4a coco4 untu4 "erpa4aian dengan fil seiperea"el!a"el 1

Kara4teristi4 rias yang ideal

+ressing o4lusif diper4ira4an ening4at4an proliferasi sel dan a4tivitas denganepertahan4an ting4at optial dari e4sudat lu4a, yang engandung protein penting dan

sito4in diprodu4si dala enanggapi cedera ni efasilitasi autolytic de"rideent lu4a dan

epercepat penye"uhan Ke4ha(atiran pening4atan risi4o infe4si di "a(ah dressing o4lusif

"elu di"u4ti4an dala u5i 4linis 6rti4el ini en5elas4an pe"alut lu4a saat ini tersedia diUKUK

Ga"ar A

Ul4us vena 4a4i yang coco4 untu4 ganti dengan hidro4oloid!a"el A

#atuh Rendah dressing)coco4 untu4 diguna4an pada datar, dang4al lu4a dengan e4sudat yang

rendah

Rendah patuh dressing+ressing patuh rendah urah dan "anya4 tersedia 7ungsi utaa ere4a adalah untu4

eung4in4an e4sudat ele(ati 4e dressing se4under tetap epertahan4an dasar lu4a

le"a"Ke"anya4an diprodu4si dala "entu4 tule, yang enenun 4ain direnda dala parafin ter"u4a

le"ut atau 4lorhe4sidin, te4stil, atau fil plasti4 "erlapis)lapis atau "erlu"ang

$ere4a dirancang untu4 engurangi 4epatuhan pada dasar lu4a dan sangat "erguna untu4 pasiendengan 4ulit sensitif atau rapuh

M Fagian 2ainnya '

&eiperea"el fil

7il seiperea"el adalah salah satu 4ea5uan "esar pertaa dala ana5een lu4a dan

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dige"ar)ge"or4an peru"ahan "esar dala cara lu4a di4elola $ere4a terdiri dari le"aran

plasti4 steril dari polyurethane dilapisi dengan pere4at a4rili4 hypoallergenic dan diguna4an

terutaa se"agai penutup lu4a transparan prier$es4ipun ere4a 4edap cairan dan "a4teri, ere4a perea"el terhadap udara dan uap air,

4ontrol yang tergantung pada 4ele"a"an dan la5u transisi uap, yang "ervariasi tergantung

pada ere4 $elalui e4anise ini "ah(a saus ini encipta4an ling4ungan lu4a yang le"a"7il yang sangat fle4si"el dan sangat "ai4 untu4 lu4a pada NsulitN situs)untu4 anatoi isalnya,

le"ih dari sendi $ere4a apu engatasi dengan 5ulah "esar e4sudat, "agaianapun, dan

dapat enye"a"4an aserasi 4ulit se4itar dasar lu4a 5i4a ere4a diguna4anin5udiciouslyin5udiciously

!a"el

&eiperea"el fil

M Fagian 2ainnya 'Hydrocolloids

ni adalah 4ese"ilan dala serang4aian 1A arti4el

!e4nologi "erpa4aian odern didasar4an pada prinsip encipta4an dan eelihara ling4ungan

lu4a le"a"Datriu 4ar"o4sietilselulosa, gelatin, pe4tin, elastoer, dan pere4at teri4at pe"a(a fil

seiperea"el atau le"ar "usa untu4 enghasil4an, datar o4lusif, ganti pere4at yange"entu4 gel pada peru4aan lu4a, eproosi4an penye"uhan lu4a le"a" Hu"ungan

silang dari "ahan yang diguna4an epengaruhi vis4ositas gel "a(ah saus ni gel, yang

ung4in 4uning dan "er"au "usu4, ung4in 4eliru untu4 infe4si oleh (aspada Hydrocolloidshapir 4edap uap air dan udara dan dapat diguna4an untu4 rehydrate eschar ne4roti4 4ering dan

eproosi4an de"rideent autolytic $ere4a dilapor4an untu4 engurangi rasa sa4it lu4a,

dan sifat penghalang ere4a eung4in4an pasien untu4 andi atau andi dan elan5ut4an

dengan 4egiatan noral sehari)hari tanpa engganggu atau epertaruh4an 4ontainasi lu4a#erhatian harus dila4u4an 4eti4a engguna4an hydrocolloids untu4 lu4a yang eerlu4an

peeri4saan untu4 sering)contoh, untu4 ulcersulcers 4a4i dia"eti4

Ga"ar Ka4i lu4a ruit dengan 4alsifi4asi heterotopic coco4 untu4 ganti dengan hydrofi"res

!a"el I

Hidro4oloid dressing .terasu4 hydrofi"res/

&erat hidro4oloid se4arang tersedia dala "entu4 le"aran, hidrofili4 non)(oven datar, dise"utse"agai dressing hydrofi"re #ada 4onta4 dengan e4sudat, serat di4onversi dari pe"alut 4ering

untu4 le"ar soft gel yang 4oheren, e"uat ere4a coco4 untu4 lu4a dengan 5ulah "esar

e-udatee-udate

Ga"ar I

Kering, 4a4i "erlupur lu4a coco4 untu4 ganti dengan hidrogel

!a"el B

Hidrogel

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M Fagian 2ainnya '

Hidrogel

Hidrogel terdiri dari atri4s polier larut sapai dengan 4adar air eung4in4an ere4auntu4 enyu"ang4an ole4ul air 4e peru4aan lu4a dan epertahan4an ling4ungan yang

le"a" pada dasar lu4a &e"agai polier hanya se"agian terhidrasi, hidrogel eili4i

4eapuan untu4 enyerap e4sudat lu4a dera5at, 5ulah "ervariasi antara ere4 yang "er"eda$ere4a engiri4an 4ele"a"an uap dan o4sigen, tetapi ere4a perea"ilitas "a4teri dan

cairan tergantung pada 5enis rias se4under usedused

Ga"ar B

Ka4i dia"etes ul4us dengan aserasi pada 4ulit di se4itarnya coco4 untu4 ganti dengan alginatHidrogel eproosi4an de"rideent lu4a oleh rehidrasi non)laya4 5aringan, sehingga

eudah4an proses autolisis alai Hidrogel aorf yang paling sering diguna4an dan te"al, gel

4ental

Hidrogel adalah dianggap se"agai "entu4 standar ana5een untu4 lu4a "eca4 atau ne4roti4$ere4a tida4 diindi4asi4an untu4 lu4a enghasil4an ting4at tinggi e4sudat atau di ana ada

"u4ti 5aringan gangren, yang harus tetap 4ering untu4 engurangi risi4o infe4siM Fagian 2ainnya '

6lginat

6lginat yang dihasil4an dari gara 4alsiu dan sodiu alai asa alginat diteu4an dala4eluarga ruput laut co4lat .#haeophyceae/ $ere4a uunya 5atuh 4e dala salah satu dari

dua 5enis3 yang engandung 1??> alginat 4alsiu atau yang engandung 4o"inasi 4alsiu

dengan natriu alginat, "iasanya dala rasio @?3A?

6lginat 4aya "ai4 dala asa annuronic atau asa guluronic, 5ulah relatif asing)asingepengaruhi 5ulah e4sudat diserap dan "entu4 ganti a4an epertahan4an 6lginat se"agian

larut pada 4onta4 dengan cairan lu4a untu4 e"entu4 gel hidrofili4 se"agai hasil dari

pertu4aran ion natriu dala cairan lu4a untu4 ion 4alsiu di ganti $ere4a yang tinggi dalaasa annuronic .seperti Kaltostat/ dapat di"ersih4an dengan udah lu4a dengan gara, tetapi

ere4a yang tinggi dala asa guluronic .seperti &or"san/ cenderung untu4 epertahan4an

stru4tur dasar ere4a dan harus dihapus dari dasar lu4a dala satu piecepiece !a"el =

6lginat

Hidro4oloid serat .hydrofi"res/ yang sering diguna4an pada lu4a di ana, secara tradisional,

alginat telah diguna4an6lginat dapat enyerap 1B sapai A? 4ali "erat "adan ere4a cairan, e"uat ere4a coco4

untu4 yang sangat eancar4an lu4a $ere4a tida4 harus diguna4an, "agaianapun, pada lu4a

dengan e4sudat sedi4it atau tida4 4arena ere4a a4an eatuhi peru4aan penye"uhan lu4a,enye"a"4an rasa sa4it dan erusa4 5aringan sehat di reovalreoval

Ga"ar =

Vena 4a4i ulserasi di latar "ela4ang edea 4ronis coco4 untu4 "erpa4aian dengan "usa

M Fagian 2ainnya '

8/10/2019 Wound Dressings Vanessa

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Fusa dressing

+ressing "usa poliuretan di"uat se"agai "ai4 atau "usa sili4on $ere4a engiri4an

4ele"a"an uap dan o4sigen dan e"eri4an insulasi teral untu4 tepat tidur lu4a Fusapoliuretan terdiri dari dua atau tiga lapisan, terasu4 4onta4 peru4aan lu4a hidrofili4 dan

hidrofo"i4 du4ungan, e"uat ere4a sangat penyerap $ere4a efasilitasi dispersi seraga

e4sudat seluruh lapisan penyerap dan encegah 4e"ocoran e4sterior .peogo4an)elalui/4arena adanya "ac4ing"ac4ing seiperea"el

Ga"ar

Kiri atas3 "eca4, ul4us arteri terinfe4si coco4 untu4 "erpa4aian dengan saus senya(a

antii4ro"a .pera4 atau yodiu "er"asis/ 6tas 4anan3 4a4i gangren coco4 untu4 "erpa4aiandengan saus yodiu antii4ro"a diresapi Kiri3 "er"au "usu4 ganas .ore /

!a"el

Fusa dressing

+ressing foa poliuretan 5uga tersedia se"agai chip rongga rias 4ecil dari "usa poliuretanhidrofili4 tertutup dala e"ran fil polier yang "erlu"ang, e"eri4an "ag"ag longgar

diisi

!a"el @

6ntiicro"ial dressingFusa sili4on terdiri dari polier elastoer sili4on "erasal dari dua cairan, yang "ila dicapur

"ersaa)saa, e"entu4 "usa seentara eperluas agar sesuai dengan "entu4 lu4a ter"u4a

e"entu4 ganti)sel "usa yang le"ut Keuntungan utaa dari "usa adalah 4eapuan untu4engandung e4sudat &elain itu, sili4on dressing foa elindungi daerah se4itar lu4a dari

4erusa4an le"ih lan5ut

M Fagian 2ainnya '6ntiicro"ial dressing

#era4, dala "entu4 ioni4 atau nano4ristalin, telah "ertahun)tahun telah diguna4an se"agai agen

antii4ro"a terutaa dala pengo"atan lu4a "a4ar .dala "entu4 4ri sulfadia*in pera4/

#er4e"angan ter"aru dressing diresapi dengan pera4 telah ele"ar diguna4an untu4 "anya45enis lu4a lainnya yang "ai4 ter5a5ah atau terinfe4si

Lodiu 5uga eili4i 4eapuan untu4 enurun4an "e"an i4ro"iologi di lu4a 4ronis &ecara

4linis hal ini terutaa diguna4an dala salah satu dari dua forat3 .a/ seperti povidone)iodine.yodiu polivinilpirolidon)4ople4s/, se"uah iodophor .suatu senya(a yodiu ter4ait dengan

surfa4tan non)ioni4/, yang diprodu4si se"agai tulle diresapi, dan ."/ se"agai yodiu cade-oer

.4isi)4isi tiga diensi yang engandung pati yodiu ?,/ Lodiu Cade-oer eili4i sifatserap yang "ai43 1 g iodin cade-oer dapat enyerap hingga l cairan &eperti cairan diserap,

yodiu perlahan)lahan dilepas4an, engurangi "e"an "a4teri dan 5uga de"riding lu4a dari

4otoran ni odus tinda4an efasilitasi pengirian yodiu selaa 5ang4a (a4tu laa)

dengan dei4ian, dala teori, epertahan4an ting4at 4onstan yodiu dala dasar lu4a

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#erhatian di"utuh4an pada pasien dengan penya4it tiroid 4arena penyerapan sistei4

4eung4inan yodiu Untu4 alasan ini, fungsi tiroid harus dipantau pada pasien yang dio"ati

dengan yodiu dressing$etronida*ole gel sering diguna4an untu4 engontrol "au dise"a"4an oleh "a4teri anaero" Hal

ini sangat "erguna dala pengelolaan fungating lu4a ganas ni dapat diguna4an sendiri atau

se"agai ta"ahan 4e dressing lainnyaM Fagian 2ainnya '

+iingin4an efe4 dressing

$aserasi dari 4ulit di se4itarnya lu4a dapat ter5adi 5i4a ganti dengan daya serap rendahdiguna4an pada lu4a "erat eancar4an Ji4a dressing sangat serap 4eudian "eru"ah saus

le"ih sering ung4in diperlu4an, selain penyelidi4an dan pengelolaan penye"a" e4sudat .seperti

infe4si/

&ifat)sifat pertu4aran ion dari "e"erapa alginat e"uat ere4a agen heostati4 yang "erguna,dan 4arena itu ere4a sangat "erguna untu4 lu4a pascaoperasi 4easan

#enggunaan yang tida4 tepat dressing dapat enye"a"4an efe4 yang tida4 diingin4an

Kulit di se4itarnya lu4a yang sangat eancar4an selan5utnya dapat dilindungi elalui

penggunaan eolien .seperti capuran parafin luna4 B?3B? putih dan parafin cair/ ataupenerapan fil penghalang .seperti Cavilon/ &e"ali4nya, penggunaan saus sangat serap pada

lu4a 4ering dapat enye"a"4an terganggunya 5aringan sehat pada peru4aan lu4a danenye"a"4an nyeri "ila reovedreoved

Ga"ar @

6"doinoperineal resection lu4a dio"ati dengan penutupan va4u di"antu !epi 4ulit dilindungi

dengan 4ri penghalang untu4 encegah aserasiRea4si alergi yang tida4 "iasa3 rias harus dihindari, dan alergi ung4in perlu dio"ati dengan

steroid topi4al poten Kaset diguna4an untu4 enyipan dressing di tepat adalah penye"a"

uu alergi Fanya4 dressing eerlu4an se4under dressing)isalnya, padding pada sangateancar4an lu4a)yang ung4in e"uat ere4a "esar +ressing se4under tida4 "oleh terlalu

4etat, terutaa pada pasien dengan diseasedisease pe"uluh darah perifer

Ga"ar