Gauze has been used as a wound dressing for centuries, and continues to be the most readily available wound dressing in use today. A wide variety of gauze dressings are available, with choices to be made between sterile and non-sterile types, gauzes with and without an adhesive border, and woven and non-woven gauze dressings. Woven gauzes are manufactured from cotton yam or threads and woven like fabric. Non-woven gauzes are usually manufactured from synthetic fibers, which are pressed together to give the appearance of a woven fabric. Gauze may be used as a primary or secondary wound dressing.
Gauze remains popular largely because of its cost-effectiveness in one-time or short-term use. However, as we shall see, gauze dressings have a number of drawbacks, and in most situations, a more effective alternative can usually be found.
Gauze dressings can be used dry, moist, or impregnated with petrolatum, antiseptics, or other agents. The choice of product requires careful wound assessment, with the application continually monitored as the patient’s condition changes.
Dry gauze dressings are often used as the primary dressing for heavily exuding, open wounds. In this situation, the gauze will wick away the exudate. Dry gauze dressings can also be used to protect a closed wound from additional trauma or infection.
Moist gauze dressings are used to help maintain a moist wound healing environment. When moist gauzes are applied to the wound and allowed to dry out, they become known as ‘wet-to-dry’ dressings. Wet-to-dry dressings are sometimes used for mechanical debridement. A moist gauze adheres to the necrotic tissue as it dries out, allowing the necrotic tissue to be removed when the dressing is removed. However, this method of debridement is not universally liked, for a number of reasons. It is non-selective, meaning that the gauze may remove granulation tissue as well as necrotic tissue. The gauze often becomes embedded in dried exudate, making dressing removal painful. Finally, fibers from the gauze may be left in the wound, prolonging wound healing or causing infection.
An impregnated gauze is infused with a substance that aids healing, such as an antiseptic, hydrogel or a hypertonic saline solution. This type of dressing is used as the wound contact layer and requires a secondary dressing. Antimicrobial-impregnated gauzes, such as silver-infused pads, are often used on burn victims to prevent bacterial infection. Hypertonic saline-impregnated dressings are infused with sodium chloride, which wicks moisture away from wounds with excessive exudate. As hypertonic saline dressings depend on wound moisture to moisten them, they are not appropriate for minimally draining wounds or wounds covered with dehydrated slough or eschar.
Gauze dressings can be used on both infected and non-infected wounds of any size, shape, depth, or etiology. If used on a non-draining or minimally-draining wound, a topical agent should be applied to the wound bed to help maintain a moist wound environment. Alternatively, the gauze may be pre-moistened with normal saline. If used on a highly- draining wound, by contrast, additional layers should be used to aid in absorption.
Impregnated-gauze dressings may be used as a contact layer on granulating wounds. They may also help prevent exposed tendons from dehydrating or adhering to the primary dressing. Impregnated gauze dressing are usually comfortable and can be removed without causing pain, making them ideal for use on sensitive wounds and burns.
Despite the ongoing popularity of gauzes, these dressings have a number of significant drawbacks. Woven gauze may traumatize the wound bed on removal, or leave residue in the wound bed that may result in an inflammatory response, or the formation of a granuloma. Finally, as gauze is highly permeable and relatively non-occlusive, gauze dressings may promote desiccation in wounds with minimal exudate unless used in combination with another dressing or topical agent.
To learn more about these dressings and others, you may wish to consider becoming certified as a wound care specialist. The benefits of wound certification are immeasurable, both to your own career and to the standard of care that you can offer your patients. And, because Medicare and other organizations are now holding healthcare professionals responsible for outcomes in wound care, there has never been a better time to become a wound care specialist.
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