What is the recommended protocol for wet to dry (WTD) dressing?

Wet to Dry Dressings: Current Recommendations

Wet to dry dressings are no longer recommended for wound care as they can cause tissue damage, increase pain, and delay healing compared to modern wound dressing options. 1

Current Evidence on Wet to Dry Dressings

The 2015 International Consensus on First Aid Science with Treatment Recommendations specifically evaluated wet versus dry dressings for wounds and found insufficient evidence to support the use of wet to dry dressings 1. The consensus statement noted:

• There are no studies directly evaluating wet versus dry dressings in the first aid context
• All available studies were performed in healthcare professional settings
• No recommendation could be made due to insufficient evidence showing benefits of wet compared with dry dressings applied to thermal burns in the prehospital setting

Modern Wound Care Principles

Moist Wound Healing Approach

Current evidence supports maintaining a moist wound environment rather than the traditional wet to dry approach:

• Moist wound healing results in less necrosis and faster, better quality healing in the formation of newly regenerated epidermis 2
• Moist environments facilitate autolytic debridement, reduce pain, reduce scarring, activate collagen synthesis, and promote keratinocyte migration 3

Appropriate Dressing Selection

The 2012 Infectious Diseases Society of America guidelines for wound care recommend selecting dressings based on the wound characteristics 1:

• Dry or necrotic wounds: Continuously moistened saline gauze or hydrogels
• Exudative wounds: Alginates, foams, or hydrocolloids
• Moistening dry wounds: Films (occlusive or semiocclusive)

Alternative to Wet to Dry Dressings

Instead of wet to dry dressings, the following approach is recommended:

1. For wounds requiring debridement: Use modern autolytic debridement methods with hydrogels or enzymatic agents rather than mechanical debridement with wet to dry dressings 1

2. For burn wounds: Apply non-adherent dressings for denuded areas (e.g., Mepitel™ or Telfa™), and consider silver-containing products for sloughy areas only 4

3. For clean wounds: Early dressing removal (within 48 hours) appears to have no detrimental effect on outcomes and may result in shorter hospital stays and reduced costs 5

Specific Wound Types Approach

For specific wound types, follow this algorithm:

1. Dry wounds: Apply a moist dressing (hydrogel, moistened saline gauze) 6
2. Wet/exudative wounds: Apply a dry, absorbent dressing (foam, alginate, hydrocolloid) 6
3. Infected/odorous wounds: Use an antibacterial dressing 6
4. High exudate wounds: Use a superabsorbent dressing 6
5. Healing wounds: Use a foam dressing as primary or secondary coverage 6

Common Pitfalls to Avoid

• Mechanical trauma: Wet to dry dressings can cause mechanical trauma when removed, as they adhere to the wound bed and may remove healthy tissue along with debris 7
• Pain: The removal of wet to dry dressings that have dried can cause significant pain to patients 7
• Bacterial contamination: Frequent dressing changes increase the risk of introducing bacteria into the wound 7
• Cost inefficiency: Wet to dry dressings typically require more frequent changes (2-3 times daily), increasing nursing time and supply costs compared to modern dressings that may remain in place for several days 7

By using appropriate modern dressings based on wound characteristics, clinicians can promote optimal wound healing while minimizing pain, reducing the risk of infection, and improving patient outcomes.