Wound Dressings

The purpose of a burn dressing is to absorb the exudate from the wound and to prevent the colonisation by pathogenic bacteria.

Characteristics of a good burn dressing:

• Maintains a moist wound environment
• Promotes autolytic debridement of non-viable tissue
• Contours easily
• Non-adherent to protect delicate skin
• Retains close contact with the wound bed
• Easy to apply and remove
• Painless on application and removal
• Protects against infection
• Cost effective

When treating non-complex burns, cleansing is recommended to remove foreign bodies, soluble debris, excess slough or necrotic tissue, which may become a focus for infection.

The choice of dressing will depend on the size, depth, exudate level and site of the injury. A simple non-adhesive wound contact layer with a secondary absorbent layer is effective for most non-complex superficial dermal burns. Commonly used non-adherent dressings include silicone wound contact layers and contact layers impregnated with lipocolloid or triglycerides. Polyurethane film and hydrocolloids are other options that can be used as a primary dressing.

The absorbency of a dressing will be dependent on the level of exudate and frequency of dressing change. Options include alginates and gelling fibres, foams (silicone foams can assist with atraumatic removal), and superabsorbent dressings. These can remain in place for a few days, allowing the wound bed to remain undisturbed. The secondary absorbent layer can be changed more often to manage exudate. (International Best Practice Guidelines, 2014; Jeschke et al., 2018; NICE, 2020)

Hydrogels may be used to assist with debridement/desloughing, maintaining a moist wound environment and cooling in non-complex burns. Likewise, they can aid in reducing pain. Hydrogels are available in both gel and sheet formats and with the addition of an antimicrobial agent. (Stoica et al., 2020)

Any non-complex burn wound that has not healed within two weeks should be referred to a burn specialist for further assessment, as possible excision and grafting may be necessary.

Treatment and dressings for complex burns depend upon the severity of the burn, which is determined by the amount of body surface area affected. Cleansing and debridement is the first approach, followed by the most suitable wound care product. Patients with complex burns are more susceptible to infection, and the use of an antimicrobial dressing is advised. Non-adherent dressings will support pain reduction at dressing change. More often, these types of injury will necessitate surgical intervention and skin grafting.