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WOUND DRESSING CATEGORIES

Information in green denotes Medicare B and insurance requirements
for the use of each product.

Please click on underlined words to see a definition.

ANTIMICROBIAL GAUZE WRAP – ANTIMICROBIAL GAUZE SPONGE

Amount allowable:  30 per month

Drainage requirements:  Can be used on any wound with any type of drainage

Roll gauze impregnated with an antimicrobial substance to prevent contamination of a wound site.

Indicated for

Use on any wound site to prevent infection from entering the wound site from the outside

Action

Prevents infection by eliminating bacteria

Contraindications

None known

Example

Biogard roll gauze

Biogard gauze sponge

Kerlix AMD

CALCIUM ALGINATE DRESSINGS

Amount allowable: 30 pc./month

Drainage requirement: moderate to heavy

Secondary dressing should be used to cover

Hydrophilic, non-woven fiber dressings that are derived from seaweed and when contacted by wound exudate form a gel mass in the wound.  These come in a sheet or rope form and are absorbent.

Indicated for

Partial thickness and full thickness wounds having moderate to heavy exudate.

Infected wounds

Filling cavities, tracts and undermining

Partial thickness and full thickness wounds

Action

Absorbs excess exudate while maintaining a moist wound environment

Facilitates autolytic debridement of loose, necrotic tissue

Contraindications

Dry wounds

• Examples

Algicel

Melgisorb

Reliamed

Sorbion Sachet S

CALCIUM ALGINATE WITH SILVER

Amount allowable: 30 pc./month

Drainage requirement: moderate to heavy

Secondary dressing should be used to cover

Same composition and indications as calcium alginate with silver added for antimicrobial benefits.

Indicated for

Draining wounds with signs of infection

Filling cavities, tracts and undermining

Action

Absorbs excess exudate while maintaining a moist wound environment

Facilitates autolytic debridement of loose, necrotic tissue

Decreases or eliminates bacterial load in an infected wound

Contraindications:

Do not use with hydrogels

Should not be used with products that create an ionic exchange in the wound site

Cannot be used with enzymes (ie Santyl Collagenase)

• Examples

Silverlon CA

Algicel AG

Reliamed AG-CMC (hydrofiber)

CALCIUM ALGINATE WITH HONEY

Amount allowable:  30 pc./month

Drainage requirement:  moderate to heavy

Secondary dressing should be used to cover

Active Leptospermum Honey impregnated into a calcium alginate pad.  As wound exudate is absorbed, the alginate forms a gel to assist in maintaining a moist wound environment for optimal wound healing.  Alginate is removable in one piece.

Indicated for

diabetic foot ulcers, leg ulcers, pressure ulcers

1st and 2nd degree partial thickness burns

donor sites

traumatic and surgical wounds

• Action

Cleanses and debrides

lowers overall wound pH

promotes a moisture-balanced environment

eliminates bacteria and multi-resistant bacteria with natural honey

Example    

Medihoney

COLLAGEN DRESSINGS

Amount allowable:  12-30 pc./month depending on the Medicare region, 5 grams of the powdered form, 3 oz. for gel

Drainage requirements: may be supplied with any kind of drainage

These dressings come in pads, gels or particles and promote the deposit of newly formed collagen in the wound bed. They can be used on any type of wound with any type of drainage. Some specific brands require the wound to be free of necrotic tissue.

Indicated for

Any type of wound with minimal, moderate or heavy drainage

Some specific brands require the wound to be free of necrotic tissue

Action

Provides a moist healing environment

Some brands reduce destructive elements in wound fluid to “kick-start” healing while allowing the patient’s growth factors to effectively heal the wound

Promotes tissue granulation and epithelialization

Burns

Grafts

Contraindications

none known

Examples

pads – Prisma, Promogran (collagen with silver), BioPad, Fibracol Plus (alginate/collagen combination)

gel – Stimulen Gel

powder – Stimulen

HYDROCOLLOID DRESSINGS

Amount allowable: 12 pc./month  or 3 oz tube

Drainage requirement: minimal to moderate

Can be either a primary or a secondary dressing

Wafer-type dressings that contain hydroactive particles which, when in contact with wound exudate, form a fluid/gel environment over the wound bed.  They can be self-adhering  with a surface that repells water, bacteria and other outside contaminants.  They are considered occlusive or semi-occlusive

• Indicated for

partial thickness to shallow full thickness wounds

• Action

maintains a moist wound environment

provides protection and insulation to a healing wound

facilitates autolytic debridement

Contraindications for use

infected wounds

wounds with heavy exudate, deep cavities, sinus tracts (unless used as a secondary dressing over packing)

Burns

Grafts

• Examples

Tegaderm Thin

Reliamed border sacral

Reliamed beveled

Flexicol bordered

Medihoney sheet (hydrocolloid with honey)

Medihoney tube

HYDROFERA BLUE

Foam impregnated with Methylene Blue and Crystal Violet

Indicated for

Wounds containing bacteria, yeast and fungus

Action

Provides a protective, bacteriostatic cover which may help prevent infection

When used under an occlusive dressing, product will create a mild negative pressure that will reduce an epiboly (rolled edge).

Contraindications

None known

HYDROGEL DRESSINGS

Amount allowable: 30 pc./month or 3 oz. of gel/month or

Drainage requirement: no to minimal

(A non-adherent dressing may be placed over it to prevent absorption into the cover dressing)

Must be covered with a secondary cover dressing

Vary in composition but most are non-occlusive and water or glycerin based, depending on manufacturer.  This product comes in sheets, impregnated in gauze and in gel form.

Indicated for

Any type of wound needing additional moisture

Burns

Grafts

Sheet form can be used for quicker healing of cosmetic procedures and/or scar reduction

Action

Adds moisture to dry wounds

Maintains a moist wound environment

Facilitates autolytic debridement.

Contraindications

Because of the moist nature of these dressings, care must be taken to observe the wound edges and protect from maceration

Examples

hydrogel sheets– SpanGel

amorphous hydrogel –Normlgel

HYDROGEL - ANTIMICROBIAL

Amount allowable: 3 oz./month

Drainage requirement:  no to minimal

Amorphous hydrogel combined with sodium hypochlorite for elimination of bacteria, multi-resistant bacteria, viruses and fungi.

Indicated for

Any wound needing additional moisture and infection protection

Dry wounds with signs of infection

Burns

Grafts

Action

Provides moisture to a wound site while eliminating or preventing infection

Biocompatible with other dressings

Contraindications

None known

• Example

Anasept

HYDROGEL WITH SILVER

Amount allowable:  3 oz./month

Drainage requirement:  no to minimal drainage

Hydrogel with silver added for antimicrobial benefits

Indicated for

Wounds needing additional moisture and infection protection

Dry wounds with evidence of infection

Action

Provides moisture in a wound site while eliminating or preventing infection

Absorbs a small amount of wound exudate

Contraindications:

Should not be utilized in conjuction with Tegaderm Matrix as deactivation of both dressings will result

Examples

SilverSept

Elta silver hydrogel

HYPERTONIC DRESSINGS

Amount allowable: 30/month or 3 oz. gel

Drainage requirements – may be used with any type of

Available in impregnated gauze and gel form, these dressings provide a high sodium chloride level to eliminate necrotic tissue.

Indicated for

autolytic debridement of necrotic tissue

fills wound space to wick drainage out of a tunnel or undermining

provides or encourages a moist environment

Action

creates osmotic changes in the wound environment to encourage debridement

Contraindications:

cannot apply to granulation tissue as it can cause a burning sensation

Examples:

Hypergel – gel used to break down eschar of necrotic tissue

Mesalt – dry sheet or strip (used to wick infection out of tunneling areas)

Curasalt moist hypertonic tape

FOAM DRESSINGS

Amount allowable: 12 pcs. per month

Drainage requirements:  moderate to heavy

May be used as a primary or secondary dressing

Available as self-adhering or non-adherent (though some may have adhesive border). Polyurethane foam dressings which have an absorbent wound contact surface and most have a moisture-repellant outer surface which is non-occlusive.  Ability to absorb exudate is dependant upon thickness and density of the dressing.

Indicated for

Partial and full thickness wounds

To cover wounds containing packing material

Action

Absorbs excess exudate to prevent maceration

Provides a moist wound environment

Insulation and protection

Contraindications

Wounds with dry eschar

No or minimal exudate

Examples:

Mepilex (with Safetac technology)

Mepilex Border (water resistant with Safetac technology)

Polymem

Polymem Dot (with silver)

Reliamed

MOISTURE REGULATION

Amount allowable:  30 pcs. per month

Drainage requirements: no to minimal

Requires a secondary dressing to cover it

An inert breathable polymer combined with a nonwoven medium which provides fluid balance at the wound surface instead of within the dressing.

• Indicated for:

partial and full thickness wounds of any type

grafts

burns

• Action:

Controls moisture and facilitates healing by releasing or absorbing moisture based on wound conditions

Prevents maceration

High oxygen permeability

Compatible with most other medications

One-piece removal

• Contraindications:

Wet wounds unless fenestrated

Example:

TheraGauze

MMP REDUCTION

Amount allowable:  30 pcs. per month

Drainage requirements:  no to minimal

Requires a secondary dressing to cover it

Cellulose impregnated with potassium, zinc, calcium and rubidium. 

Indicated for

All types of wounds including burns, grafts and incisions

“Kick-starting” stalled wounds

Action

Corrects the MMP balance in the wound site enabling the patient’s growth factors to heal the wound

Creates a moist wound environment while preventing maceration

Contraindications

Use with silver products will cause deactivation of both products.

Examples

Tegaderm Matrix

TRANSPARENT FILM DRESSINGS

Amount allowable: 12 pc./month

Drainage requirements:  Can be used on any wound with any type of drainage

Semipermeable membranes which are self-adhering, thin and waterproof. They allow gaseous exchange between the wound bed and the environment, but water, bacteria or other contaminants cannot penetrate the dressing

Indicated for:

partial thickness wounds

stage II ulcers

dry, necrotic wounds requiring debridement

Action

helps to maintain a moist wound surface

facilitates autolytic debridement. 

Contraindications for use:

heavy exudatingwounds

deep cavities, sinus tracts or undermining (unless used as a secondary dressing) or wounds with friable skin in the periwound area.

• Examples:

3M Tegaderm

Mefilm

ReliaMed Transparent Thin film dressings

Common Wound Care Terminology

Amorphous – Without a clear shape as in a wound dressing in gel form
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Antimicrobial – An agent that inhibits the growth of bacteria
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Arterial Ulcer – Related to the presence of arterial occlusive disease.  Presenting symptoms mainly involve pain and tissue loss.
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Autolytic Debridement - Removal of devitalized tissue through normal wound exudate or through the use of any topical dressing or preparation that encourages moisture retention or by the body’s own mechanisms
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Bedsore – The traditional name for a pressure ulcer. Also called a decubitus ulcer.
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Beefy Red – A term used to describe a healthy looking wound with good blood supply
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Blanching – To become white with pressure
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Biocompatible – refers to the ability of a product to perform its desired function without eliciting any undesirable effects
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Cellulitis – Inflammation of tissue characterized by redness.  Signifies a spreading infection.
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Chemical Debridement – The removal of dead or devitalized tissue by using enzymatic debriding agents.
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Chronic Wound – A wound that takes longer than normal to heal due to underlying conditions such as pressure, diabetes, poor circulation, immune deficiencies or infection.
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Contraction – The pulling together of wound edges/margins in the healing process.
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CWOCN – Same as “ET Nurse” (Certified wound, ostomy, continence nurse).
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CWS – Certified Wound Specialist
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Debride – to remove dead or devitalized tissue
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Debridement – Removal of dead or devitalized tissue.
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Decubitus Ulcer – The Latin term for a pressure ulcer. (Sometimes referred to as a “decub.”)
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Dehisced – Describes a surgical wound which has broken open or is not healing properly
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Denuded – Loss of epidermis.
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Depth – Distance from the wound’s surface downward. The last measurement in wound description in centimeters.
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Dermis – The second layer of skin that contains hair follicles, sweat glands, sebaceous glands, blood vessels and lymph vessels: involved in stage 2, 3, and 4 pressure ulcers as well as partial and full thickness wounds.
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Edema – Observable swelling from fluid accumulation in body tissues
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Enterostomal Therapy Nurse or Certified Wound, Ostomy, Continence Nurse
Often referred to as “ET nurse.”  Nurse who provides Care expertise to patients with abdominal stomas, draining  wounds and fistulas, incontinence and general wound care.
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Epidermis – The outer cellular layer of the skin
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Epiboly – edges of the top layer of the epidermis roll down to cover lower edge of epidermis, causing the inability of epithelial cells to migrate from wound edges. Wound healing cannot take place in this circumstance.
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Epithelialization – Regeneration of the epidermis across a wound surface
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Erythema – Redness of the skin surface produced by widening of the blood vessels.
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Eschar – Thick, leathery dead or devitalized tissue.
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Etiology – The science and study of the causes of diseases and their mode of operation.
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ET nurse – Commonly used term for an Enterostomal Therapy Nurse.
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Excoriation – Linear scratches on the skin.
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Exudate – Accumulation of fluids in a wound.
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Fenestrated – sliced or cut open
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Fibrous Tissue – Tightly bound yellow film found on the granulation tissue surface composed of or containing fibroblasts
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Friable – refers to a delicate wound that may bleed easily
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Friction – Surface damage caused by skin rubbing against another surface.
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Full Thickness Wound – Tissue destruction extending through the dermis to involve subcutaneous tissue and possibly muscle/bone.
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Granulation Tissue – The formation or growth of small blood vessels and connective tissue in a full thickness wound and a stage 3 and 4 pressure ulcer: beefy red, shiny, granular tissue which generally indicates healing.
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Growth Factors - refers to naturally occurring substances capable of stimulating cellular growth and proliferation
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Hydrophilic – Attracting moisture
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Hydroactive – Activated by moisture
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Hypertonic – movement of water from a high H2O concentration inside the cell, to a low H2O concentration outside the cell. Hypertonic wound dressings pull water or exudate out of an area and create a moist environment that is more conducive to wound healing.
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Hypergranulation – Increased thickness in the granular layer of the epidermis.
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Ionic exchangeDenotes the processes of purification, separation, and decontamination.
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Infection – Overgrowth of microorganisms capable of tissue destruction and invasion, accompanied by local or systemic symptoms
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Inflammation – Defensive reaction to tissue injury: involves increased blood flow and capillary permeability Signs and symptoms include heat, redness, swelling and pain of the affected area.
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Inflammatory Phase – The first phase in the normal wound healing process that lasts approximately from time of the initial injury to four days post injury.
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Ischemia – A deficiency of blood supply due to functional constriction or obstruction of a blood vessel.
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Maceration – A “waterlogged” appearance of the area surrounding a wound which is an indication of excessive moisture or an inappropriate dressing or dressing application.  
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Macrophage – “Giant Eater:” eats up unwanted dead tissue, cleans the wound and releases chemicals.
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Mechanical Debridement – The removal of dead or devitalized tissue, for example by the use of wet-to-dry dressings, whirlpool or surgical debridement.
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Moisture Retentive Dressings – Dressings that allow wounds to remain moist.
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MMP’s – Enzymes in chronic wounds which when imbalanced with their natural inhibitors can become destructive and delay the healing process.
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Necrotic – Dead
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Negative pressure – a vacuum-action that is used to reduce pressure around a wound, drawing out excess fluids and cellular wastes.
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Non-occlusive – Allowing the passage of moisture and air
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Occlusive - A dressing that prevent the passage of air that can dry out a wound bed or to prevent unwanted or unneeded moisture from going into or out of an area.
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Osmotic – relating to osmosis: a physical process in which a solvent moves, without input of energy, across a semi-permeable membrane. This term relates to movement of wound fluid from one place to another.
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Osteomyelitis – Inflammation of the bone marrow and adjacent bone.
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Partial Thickness Wound – Tissue destruction through the epidermis extending into but not through the dermis.
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Periwound – Around the wound
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Permeability -  Ability to pass through
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Pressure Ulcer – An area of localized damage caused by ischemia due to pressure.
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Serous – Producting a serous secretion or containing serum
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Sinus tract – A pathway which can extend in any direction from the wound surface resulting in dead space
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Sodium Hypochlorite – a chemical compound frequently used as a disinfecting agent
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Slough – Necrotic tissue that is usually loose, stringy, yellow, tan, white or gray in color.
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Shear – Trauma caused by tissue layers sliding against each other.
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Stasis – Stagnation of blood caused by venous congestion.
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Staging – An anatomical description of depth used to describe pressure ulcers.
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Surgical Debridement – The removal of dead or devitalized tissue by a physician or trained healthcare professional at the bedside or in the operating room.
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Tunneling – Tissue destruction underlying intact skin along wound margins.
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Ulcer – An open lesion or sore
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Undermining – Another term used to describe tunneling: tissue destruction underlying intact skin along wound margins
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Vasoconstriction- Dilation of blood vessels
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Vasodilation – Dilation of blood vessels
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Venous – pertaining to the veins.
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Venous Ulcer – Local losses of epidermis and variable levels of dermis and subcutaneous tissue occuring over or near the ankle and/or lateral lower leg.
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WOCN – An acronym for Wound, Ostomy, Continence Nurse
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