Clinical Update TEN TOP TIPS Preventing orthopaedic surgery-related wound blisters


“Formulation of a patient care plan – based on the patients’ history


and the condition of the perioperative wound area – is paramount in preventing would


blisters, particularly if the assessment


reveals the patient is at increased risk.“


the skin remains intact. Presurgical procedures should be followed for the sterilisation of the skin surface, and sterilising agents used should be compatible with the intended postoperative dressing to be applied. Current guidelines indicate that the most appropriate skin preparation agents should be aqueous or alcohol based antiseptic preparations (e.g. povidone iodine or chlorhexidine) and ideally the postoperative dressing should have any compatibility issues identifiable in product information.[11] In order to minimise risk to skin integrity, policies for pressure relief and redistribution should be observed, particularly in older people who often have fragile, dry skin. These strategies should minimise friction and shear forces exerted on the skin.[12] Formulation of a patient care plan – based on the patients’ history and the condition of the perioperative wound area – is paramount in preventing would blisters, particularly if the assessment reveals the patient is at increased risk.


3


WOUND DRESSING CHOICE SHOULD BE MADE AHEAD OF


SURGERY AND IMPLEMENTED IMMEDIATELY AND CONSISTENTLY IN


THE POSTOPERATIVE PERIOD Some local practice guidelines may suggest that theatre and ward nursing staff should know – prior to surgery – which postoperative dressing has been selected for each patient (as per their care plan), so that the agreed, ideal dressing to prevent blistering is applied as the first dressing.[1] The surgical team and ward staff need to


have up-to-date knowledge of wound dressing product types that have been proven to be effective in the prevention of blisters. Aide memoire’s to the most clinically appropriate choice of postoperative wound dressings should be available and visible in theatre and ward areas. Staff should be familiar with the wound care formulary.


4 18


THE DRESSINGS USED SHOULD BE FLEXIBLE


The wound dressing chosen should have optimum flexibility, however should be able to remain in situ for the optimum length of time. Flexibility can be enhanced by using a


dressing that has maximum conformity to the wound, therefore clear and accurate


assessment and documentation of the wound size, position and closure technique is important. Having components within the dressing, which are layered enables flexibility, for example, a soft-silicone dressing will enhance the dressings’ ability to conform to the wound shape and skin contours. A wound dressing that incorporates layers , however remains thin, will enhance conformity and flexibility. Other wound dressing types which are layered and have been shown to reduce blister formation include having a highly absorbent hydrofiber outer layer.[5]


5


MAKE SURE THE DRESSING SELECTED IS THE MOST


APPROPRIATE FOR THE WOUND TYPE AND SIZE


An easy-to-apply dressing that is self-adhesive and does not require the use of additional medical tape to secure it will aid in the prevention of wound blisters. On removal, the dressing should come away easily, without causing trauma or pain. Mepilex® Border (Mölnlycke Health Care), for example, incorporates a Safetac® wound contact layer, allows non-traumatic removal by preventing the dressing from sticking to the wound and therefore reduces the risk of blister formation.[6]


6


LOW-FRICTION DRESSINGS SHOULD BE USED TO ALLOW


PATIENTS TO MOBILISE EARLY WITHOUT RISKING BLISTERING


It is important that patients are mobilised early following orthopaedic surgery, to reduce risk of adverse postsurgical events (e.g. venous thromboembolism[13]


) and promote healing,


however adverse frictional forces at the wound site should be avoided. Although there is limited randomised controlled trial research in wound dressings, friction-lessening choices should be made where possible, whereby the dressing has been designed to reduce the effect of friction and shear forces on the wound.[14]


7


BALANCING PERMEABILITY AND ABSORBENCY OF THE


SELECTED DRESSING


Considerable attention has been given to absorbent wound dressing research and development. To prevent blistering, a moist, foam-filled, absorbent dressing should be


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


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