What are the possible wound barriers for wound care?

Wound Barriers for Wound Care

Wound barriers in wound care refer to physical dressings that protect the wound from external contamination while maintaining an optimal healing environment, though evidence shows standard dressings perform as well as advanced options for most wounds. 1

Primary Function of Wound Barriers

• Wound dressings act as a physical barrier to protect the wound from contamination from the external environment until it becomes impermeable to microorganisms. 1
• The traditional role is expanding beyond simple protection to actively supporting the wound healing process by providing a hospitable, moist environment where cells can thrive while allowing the wound to breathe and drain exudate. 2
• Dressings should maintain a moist wound environment with appropriate exudate control while avoiding tissue maceration. 3, 4

Evidence-Based Dressing Selection

Standard vs. Advanced Dressings

• Advanced dressings of any type should NOT be used for primarily closed surgical wounds for the purpose of preventing surgical site infections. 1
• Low-quality evidence from ten RCTs shows that advanced dressings applied on primarily closed incisional wounds do not significantly reduce SSI rates compared to standard wound dressings. 1
• No specific dressing type has proven superior for preventing infection or improving outcomes—simple gauze dressings perform as well as silver dressings, hydrogels, alginates, or foam dressings. 3

Selection Criteria

• Select dressings primarily based on exudate control, comfort, and cost rather than for antimicrobial properties. 4
• For wounds with moderate to high exudate, use absorbent dressings such as foam dressings or alginates that draw moisture away from the wound and periwound skin. 4
• The wound should be cleaned regularly with water or saline to remove debris from the wound surface. 4

Postoperative Wound Barrier Management

• The surgical wound dressing can be removed after a minimum of 48 hours post-surgery unless leakage occurs—there is no evidence that extending dressing time reduces SSIs. 1
• Postoperative care bundles recommend that surgical dressings be kept undisturbed for a minimum of 48 hours after surgery unless leakage occurs. 1
• Decision-makers may base decisions about how to dress a wound following surgery on dressing costs as well as patient preference, given the uncertain evidence for superiority of any particular dressing type. 1

Systematic Approach to Wound Barriers Using TIME Principles

The TIME framework identifies barriers to healing that wound barriers must address: 5

• Tissue (non-viable): Necrotic tissue must be removed before applying wound barriers, as it serves as a reservoir for pathogens. 4
• Infection/Inflammation: Wound barriers should allow monitoring for infection signs (increased exudate, odor, pain, surrounding erythema) at each dressing change. 4
• Moisture (imbalance): Barriers must control exudate while maintaining moist wound healing environment—failing to address underlying causes of excess exudate will result in continued problems despite appropriate dressing selection. 4
• Edge (non-advancing or undermining): Dress the wound in a manner that allows daily inspection and encourages a moist wound-healing environment. 4

Common Pitfalls to Avoid

• Avoid using dressings containing surface antimicrobial agents with the sole aim of accelerating healing—antibiotic dressings have shown no benefit. 1, 3
• Avoid occlusive dressings that can worsen maceration and potentially increase undermining. 4
• For infected wounds, systemic antibiotics should be administered if clinically indicated, rather than relying on antimicrobial dressings. 4
• Inadequate pressure offloading will prevent healing regardless of dressing choice for pressure-related wounds. 3

Special Considerations for Specific Wound Types

Venous Leg Ulcers

• Beyond debridement, wound exudate control and surface bacteria management are important goals, with topical dressings to control wound exudate and maintain moisture as well as skin protectants. 1
• Primary wound dressings should provide a topical barrier to maintain a moist, warm wound while avoiding topical antimicrobial dressings and anti-inflammatories. 1

Deep Tissue Injuries

• Maintain a moist wound environment with appropriate dressings that control any exudate while avoiding tissue maceration. 3
• Reassess the wound at least weekly to monitor healing progress and adjust treatment. 3