Know your options for secondary dressings

By Liza G. Ovington, PhD 

Program Director 

Wounds and Continence Management 

Columbia Healthcare Corporation 

Southeast Florida 

Ft. Lauderdale, FL

Wound care providers obviously are concerned about the types of primary dressings they use that come into direct contact with the skin, but attention also must be paid to secondary dressings, or those that are not in direct contact with the wound but are used to hold the primary dressing in place. 

The adjectives "primary" and "secondary" refer only to the placement of the dressing with respect to the wound, so many dressings could serve as primary in one instance and as secondary in another. An example would be as follows: a 4-inch by 4-inch transparent film dressing placed directly over a mild abrasion is a primary dressing. A 6-inch by 8-inch transparent dressing placed over a 4-inch by 4-inch foam being used to cover a Stage II decubitus is a secondary dressing. While the category of secondary dressing products may encompass many of the aforementioned primary dressings, there are also specific products designed only for retention and not for direct wound contact. 

If the primary dressing contains its own adhesive components, such as an adhesive border or coating, a secondary dressing may not be required for attachment. However, there are some instances when a secondary dressing may be applied as a precautionary measure, such as when the outer edges of hydrocolloid dressing are taped to prevent edge roll-up. 

Products designed as primary wound contact materials that also are useful as secondary dressings include transparent films and the extra-thin hydrocolloids. Some of the products specifically designed as secondary dressings include various types of elastic wraps, tubular nettings and bandages, self-adherent wraps, and different types of tapes. 

If the patient’s skin can withstand adhesive, possible secondary dressings could include transparent films, thin hydrocolloids, or tapes. The transparent films are especially useful because they allow observation of the primary dressing and make it easy to monitor dressing saturation by wound exudate. It is important to select a size of film dressing that extends at least an inch or an inch and a half beyond the margins of the primary dressing for adequate anchoring to the periwound skin. One particular brand of transparent film dressing is available in a roll format especially designed for use as a secondary dressing. (For details, see box, below right.) 

The thin hydrocolloids are useful due to their ability to adhere to either dry or damp skin. The extra thin versions of the hydrocolloids are more appropriate than the regular thickness versions due to their lower profile and their greater ability to conform to anatomical contours. In some cases, thin hydrocolloid can be used to border the wound and remain in place as a protective barrier. Then tapes or other adhesive products can be anchored to the hydrocolloid surface and even subsequently removed without disturbing the periwound skin. 

If the patient’s skin cannot withstand adhesive or if the anatomical location of the wound makes adhesive products impractical, there are numerous non-adherent products that can be used for dressing retention. These include: 

Gauze and elastic bandages. In some cases, simply wrapping the primary dressing with multiple turns of a gauze or elasticized gauze can be adequate to keep it in place. 

Tubular nettings and elastic bandages. These are useful for primary dressing retention on fingers, arms, legs, the truck, or the head. (At right are examples and their manufacturers.) 

Self-adherent wraps. These are elasticized wraps that adhere to themselves but not to skin. (At right are examples.) 

Tapes and apertured tapes. Tapes are available in a wide variety of materials, including paper, silk, cloth, and foam, which come coated with a variety of adhesives. Of great importance in selecting a tape for dressing retention is its width. The tape should be wide enough to allow secure anchorage both to the dressing and to the skin. A one-inch tape is usually not wide enough. Rather than list all of the tapes here, a good reference listing is the yearly buyer’s guide issue of the Ostomy/Wound Management journal. 

What is of particular interest as a secondary dressing retention product are the subset of tapes that are non-woven and apertured, usually coated with a skin-friendly acrylic adhesive and available on a roll in several widths, from one to four inches. The apertures give these tapes a superb flexibility on skin. The greater widths are especially useful for dressing retention. (Examples are listed below.) 

Which type of secondary dressing product you select will depend on several factors: 

1. What is the condition of the patient’s skin? If it is thin, fragile, and dry, you may want to select a non-adherent product such as tubular bandage or self-adherent wrap as opposed to a tape or adhesive product. 

2. How often will the dressing be changed? Repeated application and removal of an adhesive product may result in tape stripping the skin. 

3. Where is the wound located? Is the wound on an extremity, the trunk, a bony prominence, or an angular anatomical site? The sacral area is a particularly challenging location to secure a dressing. Location may dictate the choice of secondary dressing. 

4. How active is the patient? An ambulatory patient may require a different level of attachment than a bed-bound patient.