What is the treatment for a wound with drainage?

From the Guidelines

Wound drainage treatment should prioritize thorough irrigation with running tap water or sterile saline solutions, and the use of absorbent dressings to manage exudate while maintaining a moist wound environment, as recommended by the most recent guidelines. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, superficial wounds and abrasions should be thoroughly irrigated until there is no obvious debris or foreign matter in the wound. For wounds with moderate to heavy drainage, an absorbent dressing like an alginate, foam, or hydrofiber dressing can be used to manage the exudate. It is also reasonable to cover clean superficial wounds and abrasions with an occlusive dressing to promote wound healing, as stated in the guidelines 1.

Key Considerations for Wound Drainage Treatment

• Wash hands thoroughly and put on clean gloves before treating the wound
• Gently clean the wound with saline solution or mild soap and water, removing any debris
• Pat the area dry with a clean gauze
• Use an absorbent dressing to manage exudate and maintain a moist wound environment
• Change the dressing when it becomes saturated or at least daily
• Apply a secondary dressing or tape to secure the primary dressing in place
• Monitor the wound for signs of infection, such as increasing drainage, color changes, foul odor, increased pain, redness, warmth, or swelling

Monitoring for Infection

It is crucial to monitor the wound for signs of infection, as stated in the guidelines 1. If signs of infection appear, such as redness, swelling, foul-smelling wound drainage, increased pain, or fever, it is reasonable to remove the dressing, inspect the wound, and obtain medical care. Additionally, maintaining good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand gel is essential, particularly after touching infected skin or an item that has directly contacted a draining wound 1.

Dressing Changes and Wound Care

Proper wound drainage management is crucial because it removes harmful bacteria and debris while promoting tissue healing. The moist environment created by appropriate dressings helps facilitate cell migration and prevents scab formation that can impede healing. According to the guidelines, it is reasonable to use running tap water or sterile saline solutions for wound irrigation instead of antiseptic agents such as povidone-iodine 1. Negative pressure wound therapy (NPWT) may also be considered for certain types of wounds, as it appears to stimulate granulation tissue formation and contraction of the wound 1. However, the most recent and highest quality study recommends prioritizing thorough irrigation and the use of absorbent dressings 1.

From the Research

Wound with Drainage Treatment

• The main purpose of wound dressing is to provide a temporary protective physical barrier, absorb wound drainage, and provide the moisture necessary to optimize re-epithelialization 2
• A moist wound environment has several benefits that result in faster and better quality of healing, including facilitating autolytic debridement, reducing pain, and activating collagen synthesis 3
• Wound dressings can be utilized to create, maintain, and control a moist environment for healing, and can be divided into films, foams, hydrocolloids, hydrogels, and alginates 3
• Negative pressure wound therapy (NPWT) is a treatment that uses negative pressure to create suction, which drains the wound of exudate and influences the shape and growth of the surface tissues in a way that helps healing 4
• NPWT may be used for patients with chronic and acute wounds, subacute wounds, chronic diabetic wounds or pressure ulcers, meshed grafts, or flaps, but should not be used for patients with fistulae to organs/body cavities, necrotic tissue that has not been debrided, untreated osteomyelitis, wound malignancy, or wounds that require hemostasis 4

Types of Wound Dressings

• Moist wound dressings, such as foams, hydrocolloids, and hydrogels, can provide a moist environment and have an optimal water vapor transmission rate (WVTR) and absorptive capacity 3
• Negative pressure wound therapy systems can also be used to create a moist environment and promote wound healing 3, 4
• A new reticulated open-cell foam dressing with through holes (ROCF-CC) has been introduced to assist with wound cleansing by removing thick wound exudate and infectious materials during negative pressure wound therapy with instillation 5

Clinical Experience and Recommendations

• A multidisciplinary expert panel of clinicians has developed recommendations for the use of ROCF-CC dressings with NPWTi-d, including goals for using the dressings, appropriate wound and patient characteristics, application settings, and clinical techniques to optimize outcomes 5
• The panel recommended that NPWTi-d with ROCF-CC dressings may be an appropriate adjunct therapy for wound cleansing, especially in cases when sharp excisional debridement is not available or appropriate 5
• Further controlled clinical and scientific studies of NPWTi-d with ROCF-CC are needed to further elucidate best practices and effectiveness in various wound types 5