Choice of dressing is best informed by the assessment of the burn wound, as this determines the wound management goals. Factors to consider include:
Amount of Exudate
Exudate needs to be carefully managed to create a moisture balance at the wound interface and optimise its benefits for wound healing. Too much can cause maceration and wound breakdown and too little can inhibit natural debridement, slow epithelial migration and delay wound healing. Visit the Exudate Management tab for more information regarding wound moisture.
Protect healthy tissue/Debride non-viable tissue
The type of tissue at the base of the wound will determine whether you need to simply protect the wound or whether you need to debride the wound to facilitate the normal wound healing process
Burn Wound Depth
If the burn is superficial, a standard dressing without antimicrobial properties is suitable as a dressing, however if the burn is deep, an antimicrobial or silver dressing will be necessary and a referral to a surgeon.
Contamination and Infection
If the wound is potentially contaminated or clinically infected, an antimicrobial dressing will be required. See below for more information on when to use Silver and anti-microbial dressings.
The patient’s situation will affect dressing choice. It is important to discuss the patient’s environment and identify factors which can affect healing and dressing requirements. For example, if the patient’s work environment represents a high risk of acquiring an infection, a silver dressing maybe necessary to negate this risk. Similarly, a dressing product which can last several days would be the best choice for patients that are unable to attend the clinic & have the burn dressing performed more frequently.
Burn Size & Location
The burn size and location will influence the choice of dressing. The dressing should be large enough to cover the burn completely to provide a barrier, and reduce the risk of infection. In circumstances where it is necessary to overlap dressing products, the dressing products should be secured together with tape to reduce slippage and exposure of the wound bed to secondary dressings which can be painful on removal.
Burn location also influences dressing choices, for example, non-bulky dressing products are the preferred choices for hand and finger burns to allow for maximum range of motion and functional activity. Whilst foams can be secured adequately to limb burns, they can be challenging to secure on torso burns to avoid slippage especially on active patients. An understanding of the different dressing product properties will help to guide best choices.
Ease of Application & Contour
Ease of application and removal with minimal pain should also be considered when selecting dressing. Dressing that stick to the wound bed can cause retrauma to healthy tissue on removal.
Consideration should also be given to the location of the burn and the dressings ability to contour to that area. For example, foam dressings can be difficult to secure to the abdomen in a mobile patient or be too bulky to apply to multiple fingers.
Silver & Anti-microbial Dressings – When its needed and when its not…
There is insufficient evidence to decide whether silver-based products improve outcomes for minor burns treated in emergency settings. (24) Furthermore other research has raised concern regarding the effects on wound healing with in-vitro studies demonstrating silver to be toxic to keratinocytes and fibroblasts. Despite this, there is an increasing multitude of dressing types to which silver has been added. For the vast majority of minor superficial burns in which healing should occur without complication, consideration should be made as to whether silver is required as it will also add to the expense of a dressing. Silver based and antimicrobial dressings are recommended for the following types of burns:
• Contaminated burns
• Clinically infected burns
• Deep or full thickness burns
• Burns of mixed or unknown depth
• Minor burns with larger surface areas
Consideration should be given to the size of the burn. The risk of infection increases as the burn size increases. Therefore silver dressings should be considered for minor superficial burns with greater surface size.