End the Nightmare of Dressing Changes: Understanding the Selection and Application of Modern Wound Dressings
Update Date：2025/12/05，
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Orthopedic Surgeon Dr. Qiao Hao-Yu
"Doctor, I have to change my dressing again tomorrow, just thinking about it scares me..." For many patients with long-term wound care, the words "dressing change" are often associated with pain, fear, and even a nightmare. Traditional gauze dressings, while inexpensive and easy to obtain, tend to dry out, stick to the wound, and cause secondary injury during the change. This not only causes significant discomfort for the patient but may also delay the healing process.
However, this nightmare has been put to rest in modern medicine. With advancements in material science, we have entered the era of "functional dressings." These "modern dressings" are no longer just passive coverings; they can actively participate in and regulate the environment of wound healing.
Saying Goodbye to Old Concepts: From "Keep It Dry" to "Maintain Moisture"
In the past, elders often advised us to "keep the wound dry and let it scab," thinking that this would help it heal faster. However, as early as the 1960s, Dr. George Winter's research confirmed that skin cells (epidermal cells) migrate twice as fast in a "moist" environment compared to a dry, scab-forming environment.
This is the golden principle of "Moist Wound Healing." The core task of modern dressings is to strike a precise balance between "not too wet" (to prevent excessive exudation) and "not too dry" (to avoid wound desiccation).
The Treasure Chest of Wound Dressings: Understanding the T.I.M.E. Principle
How do surgeons choose among the wide variety of dressings available? When assessing a wound, orthopedic surgeons often use the internationally recognized
"T.I.M.E." principle, which also guides the selection of dressings:
• T (Tissue): What is the tissue type of the wound bed? Is it yellow necrotic tissue or black eschar (necrotic), or healthy red granulation tissue?
• I (Infection/Inflammation): Does the wound show signs of infection or inflammation, such as redness, swelling, pain, abnormal discharge, or biofilm?
• M (Moisture): Is the wound too dry, just right, or excessively moist?
• E (Edge): Are the edges of the wound healthy, and is there evidence of epithelialization (wound closure)?
Based on the T.I.M.E. assessment, the physician selects the most suitable dressing from the following "treasure chest":
1. Hydrocolloids
- Characteristics: Jelly-like, absorb moderate to low exudate, waterproof, self-adhesive.
- Applications: Commonly used for pressure ulcers and chronic ulcers. They lock exudate into the dressing to form a gel, providing a moist environment without sticking when changed.
2. Foams
- Characteristics: Soft, highly absorbent, provides cushioning and pressure reduction.
- Applications: For wounds with moderate to heavy exudate, such as diabetic foot ulcers and venous leg ulcers. Many foam dressings (like Mepilex) are coated with silicone, which adheres only to the skin and not the wound, reducing pain during removal. This is a key player in "ending the dressing change nightmare."
3. Alginates
- Characteristics: Derived from natural seaweed, in fiber form, highly absorbent (up to 15-20 times its weight), and has mild hemostatic properties.
- Applications: For wounds with heavy exudate, unpleasant odors, or deep "cavity" wounds. After absorbing exudate, the dressing forms a gel-like substance that can be easily removed without leaving residues.
4. Hydrogels
- Characteristics: High water content (80-99%), can donate moisture to the wound, softens eschar.
- Applications: For wounds that are dry on the surface and lack moisture, or for debridement of black or yellow necrotic tissue. It helps soften dead tissue for easier removal.
5. Silver/Antimicrobial Dressings
- Characteristics: Contains silver ions or other antimicrobial agents (such as PHMB).
- Applications: For confirmed or highly likely infected wounds, such as burns or wounds in immunocompromised patients. Silver ions inhibit bacterial growth and control inflammation in the wound.
Conclusion
Wound care is a dynamic art. During the different stages of healing, the T.I.M.E. status of the wound will change, and the dressing must be adjusted accordingly. The advancement of modern dressings is not only an innovation in materials but also a revolution in medical concepts—we no longer just care for the wound, but for the "person with the wound."
If you are suffering from dressing changes, remember, you don't have to endure it. Actively discuss with your orthopedic surgeon whether there is a more suitable modern dressing for you. Say goodbye to painful dressing changes, and let advanced dressings accompany you comfortably and safely toward the end of healing. End the pain and embrace recovery.