Composite dressings have multiple layers and can be used as primary or secondary dressings. They are appropriate for wounds with minimal to heavy exudate, healthy granulation tissue, necrotic tissue (dough or moist eschar), or a mixture of granulation and necrotic tissue (Figure 1).

Because some composite dressings cannot be used on infected wounds, it is important to check the manufacturer's instructions. Composite dressings with an adhesive border require intact skin around the wound to anchor the dressing.

Use composite dressings cautiously if the patient is dehydrated or has fragile skin. Keep in mind that some insurers will not reimburse a facility or provider if a composite dressing is used as a secondary dressing with a hydrogel or impregnated gauze.

Looking at the Layers

Most composite dressings have 3 layers:

a semiadherent or nonadherent Layer that touches the wound and protects the wound from adhering to other material. This layer allows the dressing to be removed without disturbing new tissue growth. Exudate passes through it into the next layer, which is absorptive. If a topical agent is applied to the wound, such as an antibiotic ointment, the dressing's inner layer will not stick to the topical product.

an absorptive layer that wicks drainage and debris away from the wound's surface, which helps prevent skin maceration and bacteria growth and maintains a moist healing environment. This absorptive layer is made of material other than an alginate, foam, hydrocolloid, or hydrogel. Besides protecting the intact skin from excessive moisture, the absorptive layer helps liquefy eschar and necrotic debris, facilitating autolytic debridement.

a bacterial barrier layer that may have an adhesive border. This outer layer allows moisture vapor to pass from the wound to the air and keeps bacteria and particles out of the wound. It also helps maintain the moist healing environment. Unlike gauze, the bacterial barrier layer prevents moisture leakage to the outside of the dressing (strike-through), meaning that the dressing can be changed less frequently.

Examples of composite dressings include Alldress (Molnlycke Health Care); Covaderm Plus (DeRoyal); Telfa, Ventex, and Viasorb dressings (all by Kendall); and Tegaderm dressing with absorbent pad (3M Health Care)

Using a Composite

Before applying a composite dressing, gently cleanse the wound with normal saline solution and blot the wound dry with gauze. Apply the dressing following the manufacturer's instructions. Change the dressing when it is nearly saturated, or according to the manufacturer's instructions. At each dressing change, document the wound measurement, color, odor, condition, and amount of drainage.  Medical Supply.