What is the proper method for dressing a blister wound?

Proper Method for Dressing a Blister Wound

For blister wounds, drain painful or likely-to-rupture blisters by lancing at the lowest point, keeping the roof intact as a natural protective covering, then apply a non-adherent dressing. 1

Assessment and Decision Algorithm

1. Assess the blister condition:
   • Uncomplicated blister without pain: Leave intact
   • Painful blister or likely to rupture: Drain while preserving roof
   • Already ruptured blister without infection: Keep remaining roof
   • Ruptured blister with signs of infection: Remove blister roof
   • Burn blisters (2nd degree or higher): Remove blister roof 2

Proper Blister Drainage Technique

When drainage is indicated:

• Clean the area and blister with sterile saline or antimicrobial solution 1
• Lance the blister at its lowest point using a sterile needle or scissors 1
• Allow fluid to drain by gravity while keeping the blister roof intact 1
• Use gauze or absorbent material to wick away fluid 1

Wound Dressing Procedure

1. Cleansing:

   • Gently irrigate the wound area with warmed sterile water, saline, or dilute antimicrobial solution (e.g., chlorhexidine 1/5000) 3, 1
   • Avoid hydrogen peroxide or other cytotoxic solutions 4

2. Application of emollient:

   • Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the area 3, 1
   • Consider using aerosolized formulations to minimize shearing forces 1

3. Antimicrobial application (if needed):

   • Apply topical antimicrobial only to sloughy areas 3
   • For adults and children over 2 years: apply a small amount (equal to fingertip surface area) 1-3 times daily 5
   • For children under 2 years: consult a doctor 5

4. Dressing application:

   • Apply non-adherent dressings to denuded dermis (suitable options include Mepitel™ or Telfa™) 3
   • Use a secondary foam or burn dressing to collect exudate (e.g., Exu-Dry™) 3
   • May cover with a sterile bandage 5

Monitoring and Follow-up

• Monitor for signs of infection: increasing redness, warmth, pain, pus, or red streaks 1
• If infection develops, consider oral antibiotics such as:
  • Dicloxacillin: 250 mg four times daily
  • Cephalexin: 250 mg four times daily
  • Clindamycin: 300-400 mg three times daily (if penicillin allergic)
  • Amoxicillin/clavulanate: 875/125 mg twice daily 1

Special Considerations

• For extensive blisters: Consider antiseptic baths or soaks with potassium permanganate 1
• For recurrent blisters: Evaluate foot biomechanics and consider custom orthotics 1
• For pain management: Provide appropriate analgesia during wound care 1

Common Pitfalls to Avoid

• Avoid using adhesive dressings directly on the wound bed as they can damage new epithelial cells 1
• Don't remove intact blister roofs unnecessarily as they serve as natural protective coverings 1, 6
• Avoid home remedies or applying substances that may introduce infection 1
• Don't use antibiotics prophylactically - only when signs of infection are present 6
• Avoid tetracyclines in children under 8 years of age 1

Studies show that blister wounds treated with appropriate dressings and topical antimicrobials heal significantly faster (mean nine days) than untreated wounds or those treated with antiseptics alone 7.