Advanced Wound Dressings

Several innovative wound dressings have been developed to assist in healing diabetic ulcers and similar difficult skin problems. Many were originally prescription items or hospital supplies but most are now available over the counter at the local pharmacy. Many of these products have proven to be suitable for protecting fragile skin contained within an orthosis or prosthesis.

The first type of dressing is the thin and clear semi-occlusive membrane that permits oxygen and vapor exchange but keep dirt and fluids out of the wound. These items are typically made from ultra-thin polyurethane with a self-stick acrylic adhesive that is designed to be skin-friendly. They conform nicely to rounded surfaces and can be left in place for several consecutive days.

In addition to protecting the wound itself, they also act as a shear barrier within a prosthesis or orthosis. I often recommend these dressings to cover areas of adherent scarring or similar shear-intolerant skin. They can be used in the present of a mild abrasion or prophylactically in areas of high skin stress. These are basically a high tech version of the old method for shear relief of the transtibial residuum: application of a plastic baggie between two nylon sheaths.

Clear PU film dressings, available in the wound care section of your local pharmacy, can protect fragile skin within a prosthesis or orthosis. These ultra-thin self-stick membranes do not increase pressure inside the device, and their clarity allows visual inspection of the skin to verify that it is healing.
Clear PU film dressings, available in the wound care section of your local pharmacy, can protect fragile skin within a prosthesis or orthosis. These ultra-thin self-stick membranes do not increase pressure inside the device, and their clarity allows visual inspection of the skin to verify that it is healing.

The two brands I have used most often are Bioclusive by Johnson & Johnson, and Opsite , which is distributed by Smith & Nephew. Both can be easily trimmed with scissors to cover irregular areas. If the skin has been broken, or the suture line is fragile, the patient can gently push the margins of the wound together while the dressing is applied. If done properly, this relieves tension across the skin edges, similar to butterfly strips.

In addition, these dressings are crystal clear so the wound progress can be visually inspected without removing them. And, they are as thin as kitchen "cling wrap", so they do not significantly increase the pressure over the area within the orthosis or prosthesis. Highly active amputees sometimes apply these dressings in areas where they know from experience their skin is likely to chafe, such as the groin region or the popliteal area.

There are a related group of hydrocolloidal dressings that have a more limited role in managing the skin contained within a prosthesis or orthosis. A number of manufacturers make these "water gel" bandages, which are designed to keep the area moist. Since moist skin increases the risk of maceration under pressure, these are not usually suitable for use in weight bearing or force application areas.

Hydrocolloidal dressings, which contain fairly thin gel membranes that are mostly water, are soothing when the skin is burned or sensitive but do not hold up well in areas where forces are being applied. They may offer comfort while sleeping or when the orthosis or prosthesis is not being worn.
Hydrocolloidal dressings, which contain fairly thin gel membranes that are mostly water, are soothing when the skin is burned or sensitive but do not hold up well in areas where forces are being applied. They may offer comfort while sleeping or when the orthosis or prosthesis is not being worn.

The original product was Spenco "Second Skin", now known as "Moist Burn Pads" . These items are small sheets about 0.5 millimeter thick that are primarily water in a gel matrix. They are soothing to burned skin or when the roof skin of a blister has been removed, but crumble under weight bearing or force application. 3M makes a version with a self-stick covering called Tegasorb THIN hydrocolloidal dressing. These come in an oval configuration, can be worn for up to seven days, and are sufficiently clear that the wound can be inspected through the dressing.

Curad Hydra Heal has been used inside an orthosis or prosthesis, but care must be taken to avoid increasing pressure due to the thickness of the pad. This bandage is reported to "retain the skin's natural moisture level".
Curad Hydra Heal has been used inside an orthosis or prosthesis, but care must be taken to avoid increasing pressure due to the thickness of the pad. This bandage is reported to "retain the skin's natural moisture level".

Curad makes a variation on the hydrocolloidal bandage that has a reinforced outer covering and is not as "wet" as the original type. Their Hydro Heal bandages have been worn successfully inside a prosthesis or orthosis, but care must be taken to insure that the thickness does not increase pressure in the problem area. One package contains an assortment of ten different sizes, which may be convenient to protect different skin regions.

Adding silver to various dressings is the latest fad in health care, reported to add a measure of natural antibacterial protection. Some of these bandages may be suitable for use within a prosthesis or orthosis in areas where minimal forces are being applied.
Adding silver to various dressings is the latest fad in health care, reported to add a measure of natural antibacterial protection. Some of these bandages may be suitable for use within a prosthesis or orthosis in areas where minimal forces are being applied.

There are two additional types of bandage that may be worth considering, but I have no personal experience using them. The first is one of the many "silver laced" dressings, such as Curad's Silver Gel. Adding small amounts of silver to various items that contact the skin is the latest fad in health care, purporting to add a "natural antibacterial" effect. At the moment this seems to be more marketing than science, but the practice appears to be harmless.

Spray-on dressings may be suitable for areas where flat bandages will not work well, but durability within a prosthesis or orthosis is unknown.
Spray-on dressings may be suitable for areas where flat bandages will not work well, but durability within a prosthesis or orthosis is unknown.

The final type of dressing that may have merit for our patients is the spray-on or paint-on skin covering. These are available from many suppliers, including 3M and Curad. It seems tempting to use a dressing that conforms perfectly to the tender area, but I don't know how well these products will hold up to the stresses inside an orthosis or prosthesis.

Readers are encouraged to share their experiences with skin protection items by posting a comment detailing what they have tried that worked well, or if it did not work well, what seemed to be the problem.

It is important to note that all of these dressings are best used only on an occasional basis to shield the skin from stresses that cannot be mitigated by adjusting the fit of the artificial limb or brace. They will hasten healing and may reduce the frequency of breakdown due to shear forces, but will do nothing to alter a pressure imbalance in the device. High tech dressings should be used in a prosthesis or orthosis the same way they should be used in athletic shoes: to hasten recovery from an abrupt increase in activity or to protect the skin during unusually stressful activities.



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