Chapter 21: Table of Contents
Open Wound Management
Open wound management (for wounds that do not penetrate a cavity), typically involves daily bandage changes, repeated layered wound debridement, and lavage performed using sterile technique. Initial wound debridement is typically performed using surgical instruments. This is often followed by use of an adherent primary bandage layer such as a wet-to-dry bandage to provide further mechanical debridement. Wet-to dry bandages bandages are applied wet and removed when dry. They consist of applying a slightly humidified gauze dressing (thin layer) directly onto the wound bed and allowing it to dry by covering with a thick absorptive layer of bandage material. Upon removal embedded necrotic tissue and debris is mechanically separated from wound bed. Because they adhere to the wound as they dry, removal of the bandage results in removal of dead tissue or foreign material. Adherent bandages should only be used in the initial debridement phase of wound healing (3-5 days). Once granulation tissue enters the wound, a non-adherent bandage such as a petroleum impregnated gauze bandage or silver dressing (see below) should replace the adherent layer to prevent damaging the newly formed granulation tissue. Wet-to-dry bandages have gone out of favour in recent years due to their drying effect on the wound. The author typically uses sugar as the initial debridement bandage.