A review of blisters caused by wound dressing components: Can they impede post-operative rehabilitation and discharge?

Abstract

This review highlights that some wound dressings can be the cause of blistering. It also presents the mechanisms by which blisters may be caused by poor choice of dressings. The subsequent impact of the blisters on preventing patient mobility -and hence rehabilitation in terms of physiotherapy -are also identified. The possibility that the clinical sequelae (e.g. delayed wound healing, restricted joint range of motion (ROM), muscle atrophy and increased risk of deep vein thrombosis (DVT)) resulting from this might have a significant and deleterious impact upon patient-related outcomes is discussed. Strategies for the treatment and prevention of blisters are proposed, based upon current knowledge and expertise. The criticality of the wound care specialist and the physiotherapist working together to overcome these challenges and enhance patient care, are underlined. This article is a review of the relevant literature combined with opinions based upon experience and knowledge of the authors.

The Effect of a Skin Barrier Film on the Incidence of Dressing‐Related Skin Blisters After Spine Surgery

“…Surgical patients who develop postoperative wound complications are at risk for a prolonged hospital stay, which can be an increased burden on both the patients and the health care practitioners who care for them. 3,14 A question that continues to perplex clinicians is why certain patients develop skin problems after surgery. Length of surgery, type of dressing, patient sex and comorbidities, positioning, and other extrinsic and intrinsic factors all may lead to an increased risk for blistering.…”

“…A review of the literature on skin blisters specifically related to postoperative dressings found that the occurrence of dressing-related skin injuries varies according to multiple factors, including surgical specialty and type of dressing. 3 A quasi-experimental study of 169 total hip and knee arthroplasty patients found that 22 (13%) developed blistering around the surgical site. 2 In a different study of orthopedic surgery patients, the postoperative blister rate ranged from 6% to 24% depending on the type of dressing.…”

“…1 The development of postoperative dressing-related skin blisters can lead to increased pain, risk for infection, and delayed rehabilitation for surgical patients and an increased associated burden for the hospital. 2,3 Skin blisters or tears increase costs because of increased nursing care for the wound and use of wound dressing supplies and medications. 4,5 Previous research generally supports using a silicone or liquid skin barrier film as a protective interface between the skin and an adhesive dressing to reduce the risk of skin blistering.…”

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

“…Postoperative compression might be clearly beneficial for hemostasis to reduce hematoma formation and blood loss and to reduce edema to control pain and wound healing (365,(371)(372)(373)(374)(375). However, excessive compression can result in nerve palsy, blistering, pressure sore development, and even necrosis (366,376,377). Because the compression force is not easily measureable and the ideal force varies among individuals, a patient's feedback is important to avoid these complications.…”

Evaluation of Absorbent Versus Conventional Wound Dressing

“…This wet environment favors moisture-associated skin damage (maceration) and bacterial contaminations of the wound, especially if the dressing has a mechanical leak (26). Postoperative wound complications or infections may result in increased rehabilitation time (27,28), hospital length of stay as well as morbidity and mortality rates (18,29).…”