Introduction

The use of wet-to-dry dressings has been the standard treatment for many wounds for decades. However, this technique is frowned on because it has various disadvantages. In this process, a saline-moistened dressing is applied to the wound bed, left to dry, and removed, generally within four to six hours.¹

Outcomes With Wet-to-Dry Dressings

This form of mechanical debridement of the wound results in several outcomes²:

• It increases pain and suffering in the patient. As the gauze is pulled from the wound bed, it pulls away any tissue that has adhered during the drying process. Sometimes, this includes newly formed healthy tissue, and that causes trauma to and additional bleeding in the wound bed, as well as and increased pain.¹
• Changing the dressings disturbs the wound bed and causes hypoxia, vasoconstriction, cooling, and re-injury to tissues.
• It may leave strands of gauze in the wound bed.
• Removal of dried dressings exposes the wound to significant bacteria in the air.
• Tissue cooling during the evaporation period can impair leukocyte and phagocyte activity and increase the affinity of hemoglobin for oxygen, all of which impair healing.³

Despite the drawbacks of using wet-to-dry dressing therapy and mounting evidence that it is a substandard treatment modality, it is still widely used.² As early as 1985, optimal wound dressing performance parameters were identified to recreate the wound microenvironment necessary for healing. These requirements included that dressings should remove excess exudate, maintain moist conditions at the wound dressing interface, provide thermal insulation, protect against secondary infection, and not cause trauma during removal.⁴

Wound Care Best Practices and the Evolving Role of Gauze Dressings

Modern dressings are generally non-adherent and ensure appropriate healing through maintaining a moist wound healing environment and maximizing patient comfort.⁵ Implementing advanced dressings and alternative debridement methods (aside from mechanical debridement provided by wet-to-dry dressings) as best practices for wound care will help clinicians maintain a moist healing environment.

Impregnated gauze, such as gauze containing substances such as petroleum, honey, hydrogel, iodine, bismuth, and zinc, can decrease trauma and prevent desiccation during dressing changes. It can also decrease moisture loss from the wound, thereby preventing local cooling and its adverse effects.³ It has also been demonstrated that the use of advanced dressings can be more cost-effective than the use of gauze because of the massive decrease in clinician time required for the application of the dressings, even though gauze is generally a far less expensive material.² When selecting the optimal wound dressing, it should⁶:

• Maintain a moist wound healing environment.
• Facilitate gas exchange.
• Manage bacteria balance.
• Decrease the surface necrosis of the wound.
• Protect the wound from further trauma.
• Enable easy removal and dressing change frequency.
• Be biocompatible, biodegradable, elastic, and nontoxic.
• Decrease wound pain by preventing exposure of the wound to air.
• Be cost-acceptable.

Despite the advances in modern dressings, there is still a role for gauze in advanced wound care. With superficial wounds, low-adherence dressings can be used in conjunction with gauze to make dressing changes more comfortable.⁷ The use of impregnated gauze with secondary dry gauze dressings is also common for chronic wounds.³ The idea of scrubbing a wound with gauze has been in practice since the 2000s and was inspired by the effectiveness of brush scrubbing for contaminated injuries. When subcutaneous scrubbing occurs in conjunction with high-pressure washing following surgery, it can be effective at lowering the risk of infection.⁸

Conclusion

Although wet-to-dry dressings using gauze have been the standard treatment for many wounds for decades, this treatment method is outdated. It has many negative impacts on the healing environment and leads to increased pain and suffering for the patient. Maintaining a moist healing environment with modern dressings is far better at promoting an optimal healing environment and can be combined with alternative debridement methods when necessary. Despite the preference for using alternative dressings and debridement methods, gauze still plays a role in advanced wound care. Rather than having direct contact with the wound, gauze is preferred as a secondary dressing. It is also very effective at lowering the risk of infection when it is used to scrub wounds.

References

1. Rodriguez N. Clinical blog: Say goodbye to wet to dry. Association for the Advancement of Wound Care. https://aawconline.memberclicks.net/index.php?option=com_dailyplanetblo…. Accessed December 19, 2020.
2. Fleck C. Why “wet to dry”? J Am Col Certif Wound Spec. 2009;1(4):109-113.
3. Sood A, Granick MS, Tomaselli NL. Wound dressings and comparative effectiveness data. Adv Wound Care (New Rochelle). 2014;3(8):511-529.
4. Rippon M, Davies P, White R. Taking the trauma out of wound care: The importance of undisturbed healing. J Wound Care. 2012;21(8):359-368.
5. Kothari DC, Smith L, Steele D. A history of materials and practices for wound management. Wound Pract Res. 2012;20(4):174-186.
6. Ghomi ER, Khalili S, Khorasani SN, Neisiany RE, Ramakrishna S. Wound dressings: current advances and future directions. J Appl Polym Sci. 2019;136(27). doi: https://doi.org/10.1002/app.47738.
7. Dinah F, Adhikari A. (2006). Gauze packing of open surgical wounds: empirical or evidence-based practice? Ann R Coll Surg Engl. 2006;88(1):33-36.
8. Goi T, Ueda Y, Nakazawa T, et Al. Measures for preventing wound infections during elective open surgery for colorectal cancer: scrubbing with gauze. Int Surg. 2014;99:35-39.