What are the best practices for wound dressing selection and application in acute wound management?

Best practices for selecting and applying wound dressings in the management of acute wounds focus on promoting a warm, moist healing environment while avoiding materials that may delay healing or increase infection risk. For surgical wounds healing by secondary intention, use an appropriate interactive dressing designed to maintain moisture and support tissue repair, avoiding gauze, Eusol, or mercuric antiseptic solutions which are contraindicated ¹. Employ an aseptic non-touch technique when changing or removing dressings to minimise infection risk ¹. For wound cleansing, sterile saline is recommended up to 48 hours post-surgery, after which tap water may be used if the wound is open or draining ¹.

Dressings should be selected based on wound characteristics such as exudate level, location, pain, and patient tolerance, aiming to maintain a moist environment that facilitates healing and reduces dressing change frequency ¹,². Topical antimicrobial dressings may be considered in cases with clinical infection signs, such as spreading cellulitis, but routine use of topical antimicrobials or antiseptics is not advised to prevent resistance and unnecessary exposure ¹,².

Recent literature supports the use of hydro-responsive and interactive dressings that align with the T.I.M.E. (Tissue, Infection/Inflammation, Moisture balance, Edge of wound) framework, simplifying wound management by adapting to wound exudate and promoting optimal healing conditions (Ousey et al., 2016). In paediatric acute wounds, tailored approaches that consider the child's size, mobility, and pain tolerance are essential, with novel delivery methods improving adherence and outcomes (Bernabe et al., 2014). For burns and traumatic wounds, guidelines recommend dressings that protect the wound, maintain moisture, and prevent infection, consistent with the principles outlined for surgical wounds (Yoshino et al., 2016).

In summary, the best practice is to use interactive, moisture-retentive dressings selected according to wound and patient factors, apply them using aseptic technique, avoid routine antiseptics or gauze, and seek specialist advice for complex wounds or those healing by secondary intention ¹. Emerging evidence supports hydro-responsive dressings and patient-centred approaches to improve healing outcomes (Ousey et al., 2016; Bernabe et al., 2014; Yoshino et al., 2016).