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Wound contact layers

VIEW PRODUCTS: Wound contact layers

Wound contact layers comprise a single layer of non-adherent mesh-like material designed as protection for fragile tissue on the wound bed. They are usually used in the early, proliferative stages of healing to promote granulation and epithelialisation (Benbow, 2002).

They can be applied directly to granulating wound beds to protect against trauma, for example during dressing change, and covered with a secondary dressing to ensure a moist wound-healing environment. They are usually perforated or permeable, allowing moderate-to-heavy exudate to pass through to a secondary dressing.

These dressings can be manufactured from simple traditional materials such as gauze or polyester (Barrett, 2012), or from more advanced materials, including:

  • Soft silicone
  • High density polyethylene
  • Fine polyester mesh.

Wound contact layers are thin and non-adherent, meaning they can be used on wounds that have fragile periwound skin. They should be used on clean wounds that are free of necrotic tissue and can be applied in conjunction with topical medication.

A particular benefit of contact layers is that they are specifically designed to stay on the wound bed for several days without disrupting the growth of new tissue. Depending on the condition of the wound and the periwound skin, they can usually be left in place for up to 14 days in some cases. 

Wound contact layers are designed for use on the following wound types:

  • Skin tears
  • Traumatic wounds
  • Graft fixation
  • Partial-thickness burns (NOT third-degree burns)
  • Skin conditions, particularly those with blisters
  • Granulating wounds
  • Primary dressing in pressure ulcers and negative pressure wound therapy (NPWT). 

There are a number of wound contact products available — how can I choose the correct one?

Each patient will have different wound care needs that need to be considered when choosing the right product. The following questions will help with dressing selection.

Do you need the dressing to absorb exudate?

Normally, the amount of exudate produced by a wound will reduce over time as the wound heals. A certain amount of exudate is healthy as it aids moist wound healing by promoting growth factor as well as proteins (metalloproteinases) and cells (macrophages), which help toward healing (Cutting, 2003).

A 'healthy' amount of exudate also prevents a wound from drying out (World Union of Wound Healing Societies [WUWHS], 2007). However, if a wound becomes chronic (where healing is delayed) the amount of exudate can increase, which should alert the practitioner to problems such as infection or inflammation (Ratliff, 2009).

Wound contact layers are designed to absorb light exudate (WUWHS, 2007) and to allow heavier exudate to pass through their porous structure, where it can be taken up by a more absorbent secondary dressing. They offer protection to the healing wound bed and a barrier between the wound and the absorbent dressing.

Providing a moist wound environment

Maintaining a moist rather than a dry environment in the wound bed helps to promote wound healing, as it prevents dehydration of tissue and subsequent cell death, promotes angiogenesis (the growth of new blood vessels), and helps to erode dead tissue (Field and Kerstein, 1994).

Wound contact layers can be applied directly to granulating wound beds and covered with a secondary dressing to ensure a moist wound-healing environment. They can also help to transfer excess moisture away from the wound bed and into a secondary dressing.

Is the patient undergoing NPWT?

Wound contact layers can be used in conjunction with NPWT (Barrett, 2012). They are placed between the wound bed and the NPWT dressing, helping to reduce pain and trauma when the NPWT dressing is changed. They can also help prevent new tissue from growing into the NPWT dressing as well as protecting new tissue structures (Chadwick et al, 2010). 

Are you concerned about infection?

Some wound contact layers have an antimicrobial action, for instance through the addition of silver.

Is pain an issue at dressing change?

Wound contact layers help to form a layer between the secondary dressing and the wound surface, meaning that the secondary dressing does not adhere to the wound bed. This helps to minimise trauma and pain at dressing change (Thomas, 2003).

These dressings are designed to be non-adherent themselves. For example, some products contain an adhesive technology incorporating ‘soft’ silicone, a material that adheres to intact dry skin but does not stick to the surface of a moist wound, thus reducing the chance of wound bed damage and ‘skin-stripping’ on removal (White, 2005). 

Is the patient’s periwound skin at risk?

Maceration can be a significant problem, especially in the case of heavily exuding wounds where exudate leaks onto the surrounding skin. Wound contact layers can protect the periwound skin in two ways. Firstly, their porous nature is designed to let excess exudate pass through into the secondary dressing, where it can be absorbed. Secondly, the soft silicone technology mentioned above seals the edges of the wound contact layer, preventing wound fluid from leaking onto the periwound skin.

If the wound is in an awkward position, wound contact layers can be cut to fit different shapes, particularly important in difficult-to-dress areas such the feet and hands, where it can be hard to form an adequate seal around the wound (Barrett, 2012). 

When should a wound contact layer not be used?

These dressings should not be used in third-degree burns or in patients with sensitivity to any of the components (i.e. some dressings contain silicone). Also, use should be avoided on ulcers resulting from infection (e.g. tuberculosis or deep fungal infections), or if signs of infection (temperature, oedema, redness) appear and the wound deteriorates unexpectedly. Wound contact layers should also not be used with skin sealants/barriers.

Always check the manufacturer’s recommendations before the application of any wound care product.

Cost-effectiveness

Wound contact layers have been shown to be cost-effective as they allow for periods of uninterrupted healing (for up to 14 days in some cases), reducing the need for frequent dressing changes and saving clinicians’ time (Barrett, 2012).

Patient choice

Patient choice and preference should always be considered. This helps to build up a good nursing-patient relationship and is in line with national policy.

Cost-effectiveness

Wound contact layers have been shown to be cost-effective as they allow for periods of uninterrupted healing (for up to 14 days in some cases), reducing the need for frequent dressing changes and saving clinicians’ time (Barrett, 2012).

Patient choice

Patient choice and preference should always be considered. This helps to build up a good nursing-patient relationship and is in line with national policy.

Performance indicators

  • Avoiding pain and trauma at dressing change
  • Uninterrupted healing
  • Reducing maceration of periwound skin
  • Promote growth of new tissue in the wound bed.

References

Barrett S (2012) Mepitel® One: a wound contact layer with Safetac® technology. Br J Nurs 21(21): 1271–77

Benbow, M (2002) Urgotul: alternative to conventional non-adherence dressings. Br J Nur 11(2): 135–38

Chadwick P, Harrison M, Morris C, Bamford A, Stansby G (2010). Avance® negative pressure wound therapy system: a clinical focus. Wounds UK 6(4): 114-22

Cutting K (2003) Wound exudate: composition and functions. Br J Comm Nurs 8(9): 4–9

Field FK, Kerstein MD (1994) Overview of wound healing in a moist environment. Am J Surg 167(1A): 2S–6S

Ratliff CR (2008) Wound exudate: an influential factor in healing. Adv Nurs Practice 16(7): 32–5

Thomas S (2003) Atraumatic dressings. World Wide Wounds. Available online (accessed 17/7/13)

World Union of Wound Healing Societies (2007) Wound Exudate and the Role of Dressings: a consensus document. Wounds International  Available online. (accessed 29/1/13)

White R (2005) Evidence for atraumatic soft silicone wound dressing use. Wounds UK Available online (accessed 17/7/13)