The role of antimicrobials in wound dressings

Dressings have a major part to play in the modern management of wounds, whether they are closed, sutured wounds of surgical origin, or open wounds of various aetiologies, healing by secondary intention. Since George Winter described the value of the prevention of scab formation to promote the epithelialisation of experimental superficial wounds by using a moist wound environment (Winter, 1962), there has been a progressive exponential increase in the numbers and types of dressings available in clinical practice.

Progress and development has been considerable during the subsequent 40 years from the introduction of passive through to active dressings with sophisticated additional therapies (Leaper et al. 2002). Hydrocolloids, polyurethane films and foams and hydrogels were introduced for their exudate handling and ability to promote auto-debridement, and alginates and collagen-based dressings for an alleged promotion of granulation tissue (Cullen et al. 2002). Active dressings are now also available which allow the removal of cytokines and proteases, and this is most effectively achieved by topical negative-pressure (vacuum assisted closure) therapy (Thomas and Banwell, 2004), which is beginning to find a niche in wound management.