Introduction
Surgical dressings play a pivotal role in wound management, facilitating healing, preventing infection, and ensuring patient comfort. As a nursing student, understanding the evidence behind selecting appropriate dressings is essential for delivering effective care. This essay explores the rationale for choosing surgical dressings, focusing on skin dressings, cavity dressings, and specialist dressings. It examines evidence from clinical guidelines and research to discuss their application in diverse wound scenarios. The discussion will highlight key considerations in dressing selection, such as wound type, exudate levels, and patient needs, while acknowledging some limitations in the evidence base.
Evidence for Selecting Skin Dressings
Skin dressings are commonly used for superficial wounds, such as surgical incisions or abrasions. Evidence from clinical guidelines, such as those by the National Institute for Health and Care Excellence (NICE), suggests that the choice of dressing should align with the wound’s characteristics, including moisture balance and infection risk (NICE, 2016). For instance, hydrocolloid dressings are often recommended for low-exudate wounds as they maintain a moist environment conducive to healing (Dealey, 2012). However, for wounds with higher exudate, alginate or foam dressings are preferred due to their superior absorbency, reducing the risk of maceration (Weller and Team, 2019).
Furthermore, studies indicate that transparent film dressings are effective for protecting surgical sites with minimal drainage, as they allow for wound monitoring without frequent changes (Dumville et al., 2014). Despite this, there is limited consensus on the superiority of one dressing type over others, highlighting the need for individualised assessment in nursing practice. Arguably, the evidence underscores the importance of balancing cost-effectiveness with clinical outcomes when selecting skin dressings.
Application of Cavity Dressings
Cavity dressings are designed for deeper wounds, such as those resulting from surgical debridement or abscesses. The evidence supports the use of materials like alginate ropes or hydrofiber dressings, which conform to the wound shape and manage moderate to high exudate levels effectively (Jones and Milton, 2000). According to Dealey (2012), these dressings also aid in preventing dead space, which could otherwise harbour infection.
In practice, nurses must ensure that cavity dressings are neither overpacked nor underpacked, as this could impede healing or cause tissue trauma. While the evidence base is robust regarding exudate management, there is less clarity on optimal dressing change frequency, suggesting a reliance on clinical judgement. Typically, such dressings are used in hospital settings under close monitoring, reflecting their specialised application.
Role of Specialist Dressings
Specialist dressings, including those with antimicrobial properties or negative pressure wound therapy (NPWT) systems, are reserved for complex or chronic wounds. Research by Dumville et al. (2014) supports the use of silver-impregnated dressings for infected wounds, as they reduce bacterial load. However, overuse can lead to resistance, a limitation noted in recent literature (Weller and Team, 2019). NPWT, on the other hand, is evidenced to accelerate healing in large surgical wounds by promoting tissue regeneration (NICE, 2016).
Nevertheless, the high cost and training requirements for NPWT limit its applicability in resource-constrained settings. Therefore, nurses must weigh clinical benefits against practical constraints, often reserving specialist dressings for cases where standard options fail.
Conclusion
In summary, the selection of surgical dressings is guided by robust evidence concerning wound type, exudate levels, and infection risk. Skin dressings like hydrocolloids and foams cater to superficial wounds, while cavity dressings address deeper defects with effective exudate control. Specialist dressings, though highly effective for complex cases, come with limitations regarding cost and accessibility. The implications for nursing practice include the need for ongoing assessment and adaptation to patient-specific needs. Indeed, while the evidence provides a sound foundation, gaps in consensus on certain aspects, such as dressing change frequency, call for further research and clinical discretion to optimise patient outcomes.
References
- Dealey, C. (2012) The Care of Wounds: A Guide for Nurses. 4th ed. Wiley-Blackwell.
- Dumville, J.C., Gray, T.A., Walter, C.J., Sharp, C.A. and Page, T. (2014) Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews, (9), CD003091.
- Jones, V. and Milton, T. (2000) When and how to use dressings with an antimicrobial agent. British Journal of Nursing, 9(19), pp. S4-S10.
- NICE (2016) Surgical site infections: prevention and treatment. National Institute for Health and Care Excellence.
- Weller, C.D. and Team, V. (2019) Interactive dressings and their role in moist wound management. Wound Practice & Research: Journal of the Australian Wound Management Association, 27(2), pp. 85-92.
