This chapter provides an overview of wound dressings developed for the management of chronic wounds as well as a discussion of products commonly known as skin substitutes. At first glance, it may seem incongruous to cover wound dressings and skin substitutes in one chapter; however, if one seeks to generally define these two classes of products, the similarity becomes apparent. Wound dressings are a predominantly synthetic and heterogeneous group of medical devices that aid in the topical management of a wide variety of wound types and conditions and that vary greatly in their materials of composition as well as their purported mechanisms of action. Skin substitutes are a predominantly biological and heterogeneous group of substances that aid in the temporary or permanent closure of a wide variety of wound types and that may also vary greatly in their materials of composition and purported mechanisms of action. The differences between the two categories are specifically their materials of composition and proposed mechanisms of action. One might actually view skin substitutes as a natural progression of dressing technology. In clinical practice, these two categories of products are often used simultaneously and or sequentially in the course of wound management.
We begin this discussion with an examination of wound dressing categories and skin substitutes by looking at a description of the various materials of composition and their functions and mechanisms of action in the wound environment. This is followed by a discussion of the existing evidence for efficacy and utility in the health-care environment. It is not intended that this chapter be a discussion of individual wound care products. A listing of several manufacturers and some of their more common products is presented in Chapter Appendix 1.
Currently, there are over 400 different dressings commercially available for wound management in the United States.1 (Table 12.1) Dressings for wound care are categorized by the Center for Medicare Services for reimbursement according to their composition, their dimensions, and whether they include a circumferential adhesive border. These reimbursement categories are shown in Table 12.2. More practically, dressings are categorized by health-care professionals based on their function in the wound environment, that is, what they do to facilitate the healing process. (Table 12.3).
Table 12•1Commercially Available Wound Dressing Types |Favorite Table|Download (.pdf) Table 12•1 Commercially Available Wound Dressing Types
|Dressing Material and Format ||Number of Brands∗ |
|Alginate dressings ||25 |
|Collagen dressings ||10 |
|Composite dressings ||28 |
|Contact layers ||13 |
|Foam dressings ||76 |
|Gauze, nonimpregnated ||44 |
|Gauze, impregnated ||23 |
|Hydrocolloid dressings ||46 |
|Hydrogel dressing, gauze-impregnated form ||18 |
|Hydrogel dressings, sheet form ||23 |
|Hydrogel dressing, amorphous form ||40 |
|Specialty absorptive dressings ||19 |
|Transparent films ||27 |
|Wound fillers ||10 |
|Antimicrobial dressings ||60 |