Elizabeth

The application of a wet-to-dry dressing entails using a single layer large weave gauze moistened with saline placed directly in contact with the wound bed then allowed to dry out over the next 4-6 hours. The gauze is then forcibly removed in hopes that it will remove necrotic tissue with it. Repeat this process 4-6 times per day. In adhering to current standards of care and principles of wound healing, a wet-to-dry dressing is never appropriate because it allows the wound bed to dry out, causes repetitive trauma and potential bleeding of the wound and provides no protection from external bacteria contaminating the wound. That applies to the use of wet-to-wet dressings using only gauze. Gauze can be appropriately used and placed directly into the wound as long as an occlusive or semi-occlusive dressing is used as a secondary dressing to prevent moisture loss and bacteria contamination.

Bill Richlen PT, WCC, CWS

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A true wet to dry dressing is ONLY appropriate when there is heavy necrotic tissue that needs to be pulled from the wound and the wound is insensate (as this is a painful technique). Gauze should be used and DAMPENED with saline.This is packed directly into the wound.It can be covered with a thin dry gauze dressing. When the gauze is dry it is pulled from the wound pulling with it the tissue that has become stuck to the dried gauze. A large loose weave is used to pull large amounts of tissue. A fine, smaller wave is used to pull smaller amounts. This is usually done once a day.

Some of the doctors I work with have defined wet to dry quite differently (I encourage you to investigate what your referring physician means when they order this dressing). They use this to mean a wet dressing applied to the wound bed covered by a dry dressing (not specifically gauze, could be tegaderm to retain the moisture).

Either way, I highly encourage you to read a great article called "Hanging wet to dry out to dry."

Michelle, PT, CWS

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I work in a Wound Management Clinic. We have not used wet to dry dressings in years. The appropriateness must be well thought out as there are many other, more sophisticated options available to you.



However, to use a wet to dry, you would moisten a gauze pad with NS, squeeze it out and apply it to the wound. If you apply a barrier first, you’ve got basic moist wound healing and you might as well use hydrogel with a moisture retaining dressing (Adaptic, Mepitel, Mepiform, etc) to cover. Today, our wound care options have far exceeded what a wet to dry can do. If you want a hyper to hypotonic setting, Mesalt is NaCl impregnated guaze which actually is more of a dry to wet. If you want to debride, chose enzymatic (Panafil, Accuzyme) or surgical if the wound is vascularized enough – not a wet to dry.. Relying on the debriding effect of a wet to dry or the healing potential of this dressing is just not in our parameters of advanced wound healing and will lend you feeling very frustrated as you just won’t get the results you had hoped for.
Serrina DPM

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Elizabeth, in reply to your question about saline wet to dry dressings. Wet to dry dressings are only used for mechanical debridement of eshcar/slough. The saline gauze is squeezed out prior to applying to the wound bed. Do not cover good tissue with the wet dressing as you will cause maceration. I usually recommend the dressing to be changed at least every eight hours. The moistened gauze can be covered with an Abdominal pad or further dry gauze. This is a very painful procedure and to be kinder to the patient I would prefer sharp debridment or Aquzyme ointment. Hope this helps with your question.

Julie Palmer RN WCC