What are the instructions for applying compression wraps with Zinc oxide (ZnO) to a wound?

Instructions for Applying Compression Wraps with Zinc Oxide

Apply zinc oxide-based skin protectants directly to the peristomal skin when gastric leakage occurs, and use zinc oxide paste bandages (Unna boot) for venous leg ulcers to protect inflamed peri-ulcer skin while promoting wound healing. 1, 2

Application for Peristomal Leakage (Gastrostomy/Feeding Tube Sites)

When to Apply

• Use zinc oxide-based skin protectants when gastric contents leak at the stoma site, causing skin breakdown 1
• Apply when there is moisture-related skin damage around the tube insertion site 1

Application Technique

• Clean the area first: Use soap and water of drinking quality to cleanse the peristomal site 1
• Dry thoroughly: Gently and completely dry the skin before application 1
• Apply zinc oxide barrier: Use as a powdered absorbing agent, barrier film, paste, or cream containing zinc oxide directly to the affected skin 1
• Consider foam dressings: Apply foam dressings rather than gauze over the zinc oxide to lift drainage away from skin and prevent maceration 1

Maintenance Schedule

• Change dressings once or twice weekly after initial stoma healing 1
• Reapply zinc oxide barrier as needed when leakage persists 1
• Monitor for proper tension between internal and external bolsters to prevent ongoing leakage 1

Application for Venous Leg Ulcers

Zinc Oxide Paste Bandages (Unna Boot)

• Use zinc oxide in paste bandage form to protect and soothe inflamed peri-ulcer skin 2
• This formulation provides sustained release of zinc ions that stimulates epithelialization 2
• Zinc is transported through the skin from these formulations, though systemic effects are minimal 2

Clinical Benefits

• Promotes cleansing and re-epithelialization of leg ulcers, particularly in patients with low serum zinc levels 3
• Reduces infections and ulcer deterioration compared to non-zinc treatments 3
• Enhances local defense systems through anti-infective action and autodebridement 2, 3

Mechanism of Action

Why Zinc Oxide Works

• Topical zinc is superior to oral therapy for wound healing due to direct local effects 2
• Reduces superinfections and necrotic material through enhanced local defense systems 2
• Stimulates collagenolytic activity for autodebridement 2, 3
• Decreases inflammation in treated wounds 3
• Provides sustained zinc ion release that promotes epithelialization even in patients with normal zinc status 2, 4

Absorption Characteristics

• Zinc oxide is slowly but continuously solubilized when applied to open wounds, maintaining constant therapeutic levels 3
• Absorption occurs through wound beds into epidermis, interstitial fluid, and dermis 3
• This sustained release pattern is more effective than zinc sulfate formulations 3

Important Caveats

What NOT to Do

• Do not use compression wraps for acute joint injuries: Evidence shows no benefit for pain reduction, swelling, or range of motion in ankle sprains or other closed joint injuries 1
• Avoid confusing zinc oxide skin protectants with compression bandaging for musculoskeletal injuries 1

When Zinc Oxide is Most Effective

• Most beneficial for open wounds with moisture damage or leakage 1
• Particularly effective for venous leg ulcers with inflamed peri-ulcer skin 2, 3
• Works best when applied to clean, dry skin before dressing application 1, 3

Monitoring

• Assess for signs of infection despite zinc oxide use (though infections are less common with treatment) 3
• Check for adequate wound cleansing and re-epithelialization progress 3
• Verify that compression (if used separately for venous insufficiency) does not compromise circulation 5