What are occlusive dressings?

Occlusive Dressings: Types, Uses, and Clinical Applications

Occlusive dressings are wound coverings that create a sealed, moisture-retaining environment over a wound to promote faster healing by preventing wound desiccation and enhancing reepithelialization.

Types of Occlusive Dressings

Several types of occlusive dressings are available for clinical use:

• Films: Transparent, adhesive sheets that are permeable to oxygen but impermeable to water and bacteria
• Hydrocolloids: Adhesive, waterproof wafers containing gel-forming agents
• Hydrogels: Water-based, non-adhesive dressings that provide moisture to dry wounds
• Foams: Absorbent, non-adherent dressings that manage moderate to heavy exudate
• Semipermeable polyurethane dressings: Effective barriers to vaccinia and recombinant vaccinia viruses 1

Mechanism of Action

Occlusive dressings work through several mechanisms:

• Create a moist wound environment that prevents desiccation
• Prevent eschar formation
• Enhance reepithelialization
• Increase the speed of healing 2
• Reduce wound pain 3

Clinical Applications

Recommended Uses:

• Clean superficial wounds and abrasions: The 2024 American Heart Association and American Red Cross guidelines recommend covering clean superficial wounds with occlusive dressings to promote wound healing 1
• Laser skin resurfacing: Occlusive dressings may promote reepithelialization and improve wound healing by creating a moist environment 1
• Athletic injuries: Can increase patient comfort, increase compliance, decrease infection risk, and decrease overall healing time 4

Contraindicated Uses:

• PEG (percutaneous endoscopic gastrostomy) exit sites: Occlusive dressings should be avoided as they promote a moist wound environment and can lead to skin maceration 1
• Open chest wounds: The 2015 International Consensus on First Aid Science recommends against applying occlusive dressings to open chest wounds due to the risk of tension pneumothorax 1
• Vaccination sites: Occlusive bandages should not be routinely used for smallpox vaccination sites because maceration of the site might occur 1

Benefits of Occlusive Dressings

• Enhanced healing: Increase the speed of reepithelialization in acute wounds 3
• Pain reduction: Reduce or eliminate wound pain 3
• Infection control: Despite concerns about bacterial proliferation, clinical infection rates are generally lower under occlusion than with non-occlusive dressings 5
• Debridement: Stimulate debridement and healing of chronic ulcers 3
• Barrier function: Help prevent infection by presenting a barrier to potential pathogens 5

Potential Complications

• Skin maceration: Prolonged moisture can lead to maceration of surrounding skin 1, 6
• Fluid accumulation: During the first 10-14 days, a large amount of fluid may accumulate under the dressing 3
• Tension pneumothorax: When used on open chest wounds, occlusive dressings may lead to tension pneumothorax 1

Best Practices for Application

1. Clean the wound thoroughly with running tap water or sterile saline solution 1
2. Assess wound type to determine if occlusive dressing is appropriate
3. Select appropriate dressing based on wound characteristics (size, depth, exudate)
4. Apply dressing according to manufacturer's instructions
5. Monitor for signs of infection (redness, swelling, foul-smelling drainage, increased pain, fever) 1
6. Change dressing when saturated or according to recommended schedule

When to Remove or Replace

• If signs of infection develop (redness, swelling, foul-smelling drainage, increased pain, fever) 1
• When the dressing becomes saturated with exudate
• According to the manufacturer's recommended wear time

Special Considerations

• For primarily closed surgical wounds, a standard dressing should be used for a minimum of 48 hours after surgery 6
• For wounds with heavy exudate, consider more absorbent occlusive dressings like foams or hydrocolloids
• For dry wounds, hydrogels may be more appropriate to provide moisture

Occlusive dressings represent a significant advancement in wound care that can improve healing outcomes when used appropriately. However, proper selection based on wound type and careful monitoring are essential to prevent complications and ensure optimal results.