Gauze
Made of woven cotton
Plain or impregnated with gel, iodoform, xeroform, salt(s), or petrolatum
Ribbon or sheet forms; mesh or cotton filled sponges

Indications and advantages:
packing
works for mechanical debridement
good absorptive capacity
inexpensive

Contraindications and disadvantages:
nonselective; will debride normal tissue
painful
lint residue
not useful on dry wounds
needs solution or gel to maintain moist surface

Tips for use:
fiber must come in contact with wound surface
use with solution or gel in dry wounds
use dry in heavily exudating wounds
keep moist gauze off surrounding skin to prevent maceration
use as primary and secondary dressing
change TID during debridement then BID when wound bed has granulated
Use mesh form for debridement, and cotton filled form as secondary dressing.

Hydrocolloid
Sodium carboxymethylcellulose on a film or foam backing
May contain gelatin, pectin, and elastomers
Sheet or paste form

Indications and advantages:
Stage I-III dermal ulcer, superficial burn, abrasion, donor site
skin protection on high risk areas
moderate absorptive capacity
autolytic debridement
inexpensive
maintains moist surface and protects wound
waterproof and impermeable to bacteria
flexible, comfortable, and self-adhesive

Contraindications and disadvantages:
infected wounds
fragile surrounding skin
may traumatize wound surface when removed

Tips for usage:
apply to clean, dry area
dressing must extend 2cm beyond all wound borders; surrounding skin must be healthy
change every 3-5 days or when exudate strikethrough occurs
dressing breaks down into a yellow/tan residue which may remain in wound; remove this residue before assessing for s/s of infection
do not use as a secondary dressing

Transparent Film
Clear membrane with acrylic adhesive
Permeable to moisture vapor and oxygen
Impermeable to water and bacteria

Indications and advantages:
minor burns, abrasions, surgical incisions, stage I-II dermal ulcers, IV sites, dry wounds requiring debridement
autolytic debridement
inexpensive
permits visualization of wound
maintains moist surface

Contraindications and disadvantages:
no capacity for exudate absorption
some contain latex in packaging
stage III-IV pressure ulcers or full thickness wounds

Tips for usage:
must have good skin around lesion for dressing to adhere
very flexible and comfortable
may be used as a secondary dressing when primary dressing is changed only once a day or less

Hydrogel
Three-dimensional, water swollen, cross-linked, hydrophilic, homo- or copolymer
90% water. May have propylene glycol
Amorphous (tube) or fixed (sheet) forms

Indications and advantages:
stage II-IV dermal ulcers, burns, abrasions, head wounds, radiation wounds
autolytic debridement
conforms and fills dead space
maintains moist surface
evaporates slower than solution
nonadhesive and soothing

Contraindications and disadvantages:
no capacity for exudate absorption

Tips for usage:
requires a secondary dressing
may be difficult to secure
bacterial invasion in wound occurs when used alone

Alginate
Ca++ or Na+ salt of sugar acids. Gelling polysaccharide
Na+ in wound exchanges for Ca++ in dressing, promoting hemostasis
Rope or sheet form

Indications and advantages:
stage III-IV dermal ulcer, deep, heavily exudating wounds, donor sites, infected wounds, tracts
nonadherent
fills dead space
conforms and protects
maintains moist surface when it gelatinizes
huge absorptive capacity
promotes hemostasis

Contraindications and disadvantages:
dry wounds and wounds with eschar
minimal debridement capacity
expensive

Tips for usage:
requires a secondary dressing
remove with normal saline
change QD or BID based on exudate volume
do not pre-moisten

Enzymes
Cream, ointment, or spray containing one of the following enzymes: collagenase, fibrinolysin, trypsin, or papain

Indications and advantages:
wounds with eschar, fibrin, or keratin eschars
patients with bleeding disorders who could not tolerate sharp debridement
selective; will not work on normal skin and tissue
maintain moist surface

Contraindications and disadvantages:
slow
expensive
require specific pH to work properly

Tips for usage:
needs secondary dressing
crosshatch eschar prior to application
D/C enzymes when eschar is gone
choose the correct enzyme for the type of eschar
necrotic eschar--collagenase, papain, or trypsin
fibrin or blood--fibrinolysin
the use of enzymes varies--read package insert for appropriate application and removal instructions
enzymes interact with metals and some cleansers--read package insert for interaction precautions
follow instructions carefully