What type of dressing is recommended for a patient with a wound, considering factors like medical history and wound location, if tricot (wound dressing material) is being used?

Tricot Wound Dressing: Evidence-Based Recommendations

For wounds requiring tricot dressing material, use it as a non-adherent contact layer beneath an absorbent secondary dressing, selecting the secondary dressing based on wound exudate level and location-specific contamination risk.

Understanding Tricot as a Dressing Material

Tricot is a knitted fabric material used as a non-adherent contact layer in wound care. It functions similarly to other atraumatic dressings by preventing the secondary dressing from adhering to the wound bed while allowing exudate to pass through to an absorbent outer layer 1.

Dressing Selection Algorithm

Step 1: Assess Wound Characteristics

• Exudate level: Minimal, moderate, or heavy drainage 2
• Location: Consider contamination risk (e.g., proximity to perineum/anus requires barrier protection) 2
• Infection status: Presence of redness, warmth, swelling, purulence, or fever 3
• Wound bed condition: Presence of necrotic tissue requiring debridement 4, 3

Step 2: Apply Tricot as Contact Layer

• Place tricot directly on the wound bed as the primary non-adherent interface 1
• Ensure adequate coverage extending slightly beyond wound margins 2
• The tricot prevents trauma during dressing changes while maintaining moisture balance 1

Step 3: Select Secondary Dressing Based on Exudate

For minimal to moderate exudate:

• Apply hydrocolloid dressing over the tricot layer to absorb exudate, facilitate autolysis, and maintain moist wound healing 2
• Hydrocolloid dressings demonstrate superior wound size reduction compared to gauze 2

For moderate to heavy exudate:

• Apply foam dressing over the tricot layer for enhanced absorption capacity 2
• Foam dressings lift drainage away from skin, reducing maceration risk 1

For high contamination risk areas (perineal/perianal):

• Use foam dressings preferentially as they provide better barrier protection 1, 2
• Change dressings based on contamination risk, not just exudate saturation 2

Wound Cleansing Protocol

• Clean with running tap water or sterile saline before applying tricot and secondary dressing 3, 2
• Avoid antiseptic agents (povidone-iodine, chlorhexidine) for routine wound irrigation as they provide no healing benefit 2
• Debride devitalized tissue frequently—this is essential and cannot be substituted by dressing selection 3

Critical Pitfalls to Avoid

Do NOT Use Topical Antimicrobials for Uninfected Wounds

• Antimicrobial dressings (silver, iodine) show no benefit for improving wound healing outcomes in uninfected wounds 4, 3, 2
• Simple gauze or petroleum-based dressings perform equally well as silver dressings, hydrogels, and alginates for clean wounds 3
• Topical antimicrobials have higher hypersensitivity reaction rates and promote antimicrobial resistance more readily than systemic agents 3

Do NOT Use Collagen or Alginate as Primary Treatment

• Strong evidence against collagen or alginate dressings for diabetic foot ulcers, with 9 of 12 studies showing no difference in healing 1
• These should not be used for the purpose of wound healing in most wound types 1

Do NOT Use Honey Products

• Strong recommendation against honey or bee-related products for wound healing, particularly in diabetic foot ulcers 1
• Evidence quality is very low and any positive results should be treated with caution 1

When to Escalate Treatment

Indications for Systemic Antibiotics (NOT Topical)

• Clinical infection present: redness, warmth, swelling, purulence, increasing pain, or fever 3
• Gross contamination with soil or debris 3
• Human or animal bite wounds 3

Consider Advanced Therapies

• Negative pressure wound therapy (NPWT) for refractory wounds after ensuring complete debridement of necrotic tissue 1, 2
• NPWT increases blood supply, removes exudate and bacteria, and promotes granulation tissue formation 1
• Growth factors or cellular products for wounds not responding to standard care 4

Special Considerations by Location

For coccyx/sacral wounds:

• High fecal contamination risk requires foam dressings over tricot for barrier protection 2
• Change dressings more frequently based on contamination, not just saturation 2

For extremity wounds:

• Standard hydrocolloid or foam over tricot is appropriate 2
• Ensure proper offloading if lower extremity 1

For abdominal/trunk wounds:

• Consider NPWT if wound is complex or post-surgical 1
• Incisional NPWT on closed incisions reduces wound complications including dehiscence 1

Dressing Change Frequency

• Change dressings at least daily for most wounds 3
• More frequent changes needed for high contamination risk areas 2
• Monitor for signs of infection requiring systemic antibiotic therapy 3