Want moist wound healing? Look at composite dressings

First, understand what they are

By Liza G. Ovington, PhD, CWS

President

Ovington & Associates

Ft. Lauderdale, FL

Composite dressings constitute a very specific category of wound care products that can be a bit confusing to define. It is tempting to call any island dressing a composite dressing, but remember that the term "island dressing" refers to a particular construction of dressing components such that there is a central absorbent portion surrounded by an adhesive border. (See illustration, p. 7.) The "island dressing" designation refers to the dressing’s construction, but not to the materials involved. However, the term "composite dressing" refers both to a specific construction, as well as to specific materials — or actually, to an exclusion of specific materials. Confused yet?

Let’s examine and translate the definition of a composite dressing according to the Durable Medical Equipment Regional Carrier Medicare Part B reimbursement policy for surgical dressings:

A composite dressing is defined as any single dressing composed of more than one physically distinct material (e.g. heterogeneous), which also possesses the following features:

1. The dressing provides a bacterial barrier. To provide a bacterial barrier, the composite dressing will most likely have some sort of external waterproof coating, usually a semipermeable polymer film coated over a textile material or a polymer film alone.

2. The dressing has an absorbent layer or pad which is NOT an alginate, NOT a foam, NOT a hydrocolloid, and NOT a hydrogel. The absorbent layer will usually be a textile product such as cellulose, cotton, polyester, rayon, etc. There is also often a nonadherent layer to prevent the absorbent material from sticking to the wound.

3. The dressing is semi-adherent or nonadherent over the wound bed. There is not a uniform coating of adhesive on the wound contact side of the dressing; the absorbent area usually lacks adhesive entirely.

4. The dressing has an adhesive border. There is adhesive on the perimeter of the dressing only.

So, while most composite dressings are configured as island dressings, not every island dressing is a composite dressing. For example, Allevyn Adhesive consists of at least two distinct materials and has an island configuration, but it would not qualify as a composite dressing because it violates item No. 2 above: The absorbent portion is a foam.

Composite dressings can be useful tools in your wound care armamentarium. Because of their bacterial barrier/waterproof property, composite dressings can promote moist wound healing environments. They often look like traditional dressings in appearance, and may not be intimidating to clinicians unfamiliar or uncomfortable with advanced dressing materials such as hydrogels and hydrocolloids. Many composites are popular as post-surgical dressings.

Because they have an adhesive border, composite dressings are, in effect, a one-step dressing (as opposed to selecting a primary dressing and then a secondary dressing to secure it). Perhaps the only potential drawback of composite dressings is the fact that they come in specific sizes that cannot be adjusted to the size of the wound without destroying the dressing’s construction. For example, a 4-inch X 4-inch hydrocolloid can be cut down to fit a smaller wound, or cut into a shape to accommodate an irregular wound. But because of the adhesive border, a composite dressing (or any island configuration dressing, for that matter) cannot easily be shaped or downsized.

Listed on p. 6 are the currently available composite dressings, their manufacturers, and toll-free information lines for more details.