Dressing a burn wound
In the treatment plan, choose the most suitable dressing strategy for the patient based on their specific wound(s) and the treatment setting.
How to dress a burn wound
- Prepare the patient with adequate pain management.
- Ensure that all materials are ready before starting to dress the wound.
- Work in the most sterile manner possible, using clean gloves that must be changed in between patients.
- For each patient, use a new basic dressing pack.
- Cover all parts of the burn wound completely to prevent the edges of the wound from drying out.
- Select a dressing technique that enables the patient to exercise.
The frequency of dressing changes depends on the type of burn wound and type of topical agent used. Redress contaminated wounds daily. When removing dressings, take care to do so gently, otherwise newly formed tissue will be damaged. If the dressing is adherent to the wound, soak it with water and wash the burn wound gently after removing the dressing.
Dressing materials
The basis for burn dressings is usually a Vaseline gauze or palm tree oil-impregnated gauze. A second layer with normal gauzes is recommend to protect the Vaseline gauze layer. You can fix the gauze using a bandage or strapping.
Many other dressing materials can be used according to local protocols. Some of the options are listed below.
Hydrocolloid dressings
Occlusive wound therapy provides a moist wound environment. When the inner layer of the dressing comes into contact with exudate, a gel forms. This facilitates autolytic debridement of the wound.
Use
These dressings are used for superficial and deep dermal partial thickness burns.
Application
Apply the adhesive sheet directly to the wound and leave it in place for several days, depending on the amount of wound exudate.
Example
Duoderm®
Polyurethane film dressings
These are semi-permeable dressings, permeable to water vapor, oxygen and carbon dioxide, but impermeable to liquid water and bacteria.
Use
These dressings are only suitable for small, superficial dermal, lightly exudative wounds.
Application
Apply the adhesive sheet directly to the wound. You can leave this in place for several days, depending on the amount of wound exudate. Only change these dressings when the edges are coming loose.
Examples
Tegaderm®
OpSite®
Hydrogel dressings
These are high water content gel dressings that facilitate autolytic debridement of the wound and assist with maintaining a moist wound environment.
Use
These dressings are suitable for high levels of wound exudate.
Application
Leave these dressings in place for several days, depending on the amount of wound exudate.
Example
IntraSite®
Aqua clear®
Nu-gel®
Silicon-coated nylon dressings
These dressings function as a non-adherent, silicone net dressing layer, therefore reducing damage caused by dressing changes. These dressings have a meshed structure that allows exudate to drain.
Application
Apply the dressing to the wound and change every two to three days, depending on amount of exudate.
Examples
Mepitel®
Biosynthetic skin substitute dressings
These dressings mimic the function of the skin, by replacing the epidermis, dermis, or both. Therefore they allow re-epithelialization to occur. They should only be used when there is extensive experience in the burn center.
Use
These dressings are used for superficial and deep dermal partial thickness burns.
Application
Leave these dressings in place until the wound has healed.
Examples
Biobrane®
TransCyte®
Fiber dressings
These calcium alginate dressings are absorbent, biodegradable and derived from seaweed. They maintain a moist wound environment that stimulates healing, while limiting wound secretions and minimizing bacterial contamination.
Use
These dressings are suitable for moderate to high levels of wound exudate. They are useful for large abdominal or upper torso scald burns, or to cover a donor site.
Application
When changing dressings, remove any loose material. If any dressing material is stuck to the wound, apply a topical ointment (e.g. oil, Vaseline or even SSD) to limit interference with the healing process. Using this method, the dressing can be easily removed after one or two days.
Example
Kaltostat®
Aquacel®
Antimicrobial dressings
These dressings are thought to reduce the risk of invasive infection.
Application
Aquacel Ag® may be kept in place until the burn has healed. Replace the dressing when it is soaked.
Examples
Aquacel Ag® (fiber dressing with silver)
Contreet® (hydrocolloid with silver)