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Making Sense of Film Dressings

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Introduction

Film dressings were first used on a large scale in the 1970s; since then, the choice of dressings has increased, their cost has reduced hugely, and they probably actually do what they claim to do. And yet there is still confusion and ignorance concersing their use and possible disadvantages. This article aims to make sense of a very useful dressing, which is probably severely underused in this age of resistent bacterial strains.

What are film dressings?

Film dressings are flexible, transparent and adhesive; while they have no capacity to absorb fluid, they are able to exude small amounts of fluid by a process known as moisture vapour transpiration (MVT). The rate of MVT varies between brands but is, at best, minimal. Therefore film dressings are not suitable for wounds where exudate is an issue. Film wound dressings are not interchange with cannula retention film products dressings, which are designed to keep the site dry higher MVT rate. Film wound dressings are designed to keep the wound moist, to assist healing. [1]

Film dressings offer a highly effective barrier to infection; as well as potential protection of the wound, such dressings can also contain infection, and thus potentially protect other patients and the wider environment.

Post-operative wounds healing by primary intention are not often seen as a problem; a recent article challenged this assumption, and asks "are we looking at postoperative dressing selection with the same vigour we attach to other areas of wound care" - and if postoperative wound infection is a problem, should we consider more effective barrier dressings? [2]

1. Fletcher J. Using film dressings. Nurs Times. 2003 Jun 24-30;99(25):57. PMID: 12861644

2. Aindow D, Butcher M. Films or fabrics: is it time to re-appraise postoperative dressings?
Br J Nurs. 2005 Oct 27-Nov 9;14(19):S15-6, S18, S20. PMID: 16301916

What is the role of films in burns management?

Films have been used extensively for minor burns, with or without other measures. In general, their use has been associated with pain reduction, better fluid management, and containing - or preventing - infection.

One study compared a vapour permeable film with silver sulphadiazine in a randomized prospective manner for burns in an outpatient setting. The film group demonstrated a 39 per cent greater reduction in pain after application of the dressing over the silver sulphadiazine group; these patients also reported significantly less difficulty with their wound care and less interference with their daily activity. The infection rate and time to healing were similar in both groups. Sadly, this study did not have a third group using both silver sulphadiazine and a film dressing.

Waffle C, Simon RR, Joslin C. Moisture-vapour-permeable film as an outpatient burn dressing. Burns Incl Therm Inj. 1988 Feb;14(1):66-70. PMID: 3370523

What is the role of film dressings in donor sites?

A study compared paraffin gauze, alginate alone, alginate with film cover or film alone in forty patients. The dressing that caused patients most discomfort and trauma on removal was paraffin gauze. Alginate with film dressing was found to be most successful in treating these patients. [1]

It may be purely the occlusion that gives the benefit, however, as another study made a comparison between film dressings, paraffin gauze, and PVC film, looking at healing time and patients' perceptions of pain. Each wound was followed until it was completely healed; donor sites dressed with PVC film had a healing time of 10.44 days, film took 10.54 days; both were significantly faster than paraffin gauze, at 17.84 days. Pain, measured with a visual analogue scale, was 1.48 in the PVC film group and 1.34 in the film dressing group. Again, not significantly different - but significantly better than the paraffin gauze group, at 5.45. There was no difference in the rate of infection between each group. The research highlights the potential of PVC film as a donor site dressing, as it pperforms well and is inexpensive. [2]

1. Beldon P. Abstract Comparison of four different dressings on donor site wounds.
Br J Nurs. 2004 Mar;13(6 Suppl):S38-45. PMID: 15126974

2. Poonyakariyagorn T, Sirimaharaj W, Pinchai O, Angspatt A. Comparison among Op-site, polyvinyl chloride film and tulle gauze in the treatment of skin graft donor sites. J Med Assoc Thai. 2002 Apr;85(4):455-61. PMID: 12118492

Can film dressings reduce post-operative wound pain?

A trial compared a group treated with a film dressing left intact until suture removal, with l group treated with a dry dressing removed after 48 hours. Patient-controlled analgesia use and infection rates were also compared.

The pain scores were not significantly different between the groups on Days 1 or 2 postoperatively. However, on Day 3, when the wounds in the dry dressing group were exposed, there was a significant difference in 24-hour mean pain scores. Those whose wounds were covered with the film dressing experienced less pain and requested fewer non-steroidal anti-inflammatory drugs on Day 3. A film dressing was useful in this respect as it allowed inspection of the wound without removing the dressing.

Briggs M. Surgical wound pain: a trial of two treatments. J Wound Care. 1996 Nov;5(10):456-60. PMID: 9117817

What is the role of films in peritoneal dialysis exit sites?

In patients on continuous ambulatory peritoneal dialysis (CAPD), exit site care is a constant concern. One study investigated avoiding dressing changes for up to six weeks. The exit site was cleaned with a povidone iodine solution, covered with a small piece of gauze, and sealed with dressing film. dressing changes ranged from daily (control - no film) to once in six weeks. In the control group, bacterial culture were positive in 87.5% of sawabs. In the 'film' groups, the rates were 15% (weekly dressing change); 6.6% (two weeks); 6.3% (three weeks); 2.2% (four); and 0% (five or six weeks). In the film-method groups, the rates of positive bacterial culture were significantly low.

Tanaka S, Yosizawa K, Sakuma M. Keeping the catheter exit site clean by sealing with a dressing film in patients under continuous ambulatory peritoneal dialysis. Adv Perit Dial. 2002;18:158-60. PMID: 12402610

What is the role of films in abrasions?

A small study in an athletic training setting set out to find out which film, hydrocolloid, "conventional method", or no dressing allowed abrasions to heal in the least amount of time, with the greatest decrease in wound area. Fourteen subjects participated in this study, which used daily photographs to confirm progress and final healing date. Subjects received four treatments, placement determined by random assignment. Healing time was found to be affected by covering the wound, and area was decreased by using a hydrocolloid or a film. The study recommended using a film; with the hydrocolloid equally effective, the decision reflected the cost savings with a film dressing.

Claus EE, Fusco CF, Ingram T, Ingersoll CD, Edwards JE, Melham TJ. Comparison of the Effects of Selected Dressings on the Healing of Standardized Abrasions. J Athl Train. 1998 Apr;33(2):145-149. PMID: 16558502

Useful Resources

Film dressings On The Drug Tariff


Written in April 2006© Andrew Heenan

 

Andrew Heenan is a Nurse, Journalist and Web Editor. Enquiries via the email address at the foot of the page.

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