GB2439525A

GB2439525A - Dressing for treating burns

Info

Publication number: GB2439525A
Application number: GB0612787A
Authority: GB
Inventors: Maggie Galvin; Celia Cross
Original assignee: MID ESSEX HOSPITAL SERVICES NH
Current assignee: MID ESSEX HOSPITAL SERVICES NH
Priority date: 2006-06-28
Filing date: 2006-06-28
Publication date: 2008-01-02
Also published as: WO2008001100A2; GB0612787D0; WO2008001100A3

Abstract

A dressing for treating a burn wound or the like, the dressing comprising a first layer and 10 a second layer 20; wherein: the first layer 10 is shaped to correspond with a wounded body part and is configured to be positioned on the wound in use, the first layer 10 being made of a material adapted to allow passage of exudate from the wound whilst maintaining a moist interface between the wound and the first layer; the second layer 20 is shaped to cover and correspond with the first layer, the second layer 20 being made of an absorbent material to absorb and retain exudate from the wound in use; and the second layer 20 is removable from the first layer 10 and replaceable in use. The dressing may be shaped as a glove, a mitten, a boot or sock, a sleeve for an arm or leg, or a facemask. Also provided is a dressing comprising a tacky or adhesive layer and a water-soluble nonstick coating, the non-stick coating being dissolvable in exudate from a wound in use.

Description

DRESSINGS FOR TREATING BURNS

This invention relates to dressings for treating burns, burn wounds and the like on patients.

The invention is particularly applicable, but by no means limited, for treating burns on a patient's hands, feet, arms, legs or face.

BACKGROUND TO THE INVENTION

Burn wounds, and other such injuries and ailments in which exudate is released, require specialist treatment in order to effectively manage the exudate and to assist the healing process.

Particular difficulties are encountered by healthcare professionals when dressing hand wounds, especially burns. Traditionally, dressing a hand has been a time consuming procedure, requiring application of cream and then one or more layers of dressing material.

The resulting dressing can be bulky and can envelop the whole hand, causing loss of function of the hand and the individual fingers. Such issues are considered in US 5,328,449 and US 5,437,621.

Currently, there are two established techniques that are often used for dressing burn wounds. The first technique comprises firstly applying an anti-infection or antibacterial cream over the wound, for example a silver sulphadiazine cream such as Flamazine (RTM) by Smith & Nephew. A sterile polythene glove (or a sterile latex-free surgical glove, or sometimes simply a polythene bag) is then fitted over the hand and then bandaged and taped. Such a glove does not enable the exudate to leave the wound site, and so the exudate collects in the glove, in contact with the wound site. This can lead to maceration of the wounded skin, which is undesirable and does not help the healing process. Further, the exudate collected within the glove can combine with the Flamazine (RTM), which reduces the efficacy of the cream and also becomes aesthetically unattractive. Because of these problems, the glove and the Flamazine (RTM) generally need to be replaced daily, and it will be appreciated that this is labour-and resource-intensive for healthcare professionals.

The second established technique comprises firstly applying a cream such as Flamazine (RTM) over the wound. A porous wound contact layer is then applied, such as Mepitel (RTM), which is made of silicone and produced by MOlnlycke Health Care AB of Sweden.

Then, padding and gauze bandaging are applied around the hand, over the contact layer.

Typically, each finger is wrapped and bandaged individually. This results in a bulky dressing, which may prevent movement of the fingers and hand, and may cause the joints to become stiff and require physiotherapy in order to regain flexibility after the dressing is finally removed. The wrapping and bandaging of the hand is often painful and traumatic for the patient, and time consuming (and sometimes traumatic too) for the healthcare professional.

The wrapping and bandaging of the hand is particularly time consuming if each finger needs to be dressed separately, and if the dressing needs to be replaced daily.

The second technique provides an advantage over the first technique in that, in use, the porous silicone contact layer keeps some exudate in contact with the wound site, thereby maintaining a moist environment to assist the healing process and to speed up epithelialization, but allows excess exudate to pass through the contact layer, away from the wound, to prevent maceration of the wounded skin. The exudate which passes through the contact layer is absorbed by the outer padding and gauze bandaging. However, the outer padding and bandaging typically need to be replaced daily, which is labour-and resource-intensive for healthcare professionals. Furthermore, as with the first technique described above, the exudate can mix with the Flamazine (RTM), which reduces the efficacy of the cream and also becomes aesthetically unattractive.

SUMMARY OF THE INVENTION

According to a first aspect of the present invention there is provided a dressing for treating a burn wound or the like, the dressing comprising a first layer and a second layer; wherein: the first layer is shaped to correspond with a wounded body part and is configured to be positioned on the wound in use, the first layer being made of a material adapted to allow passage of exudate from the wound through the first layer in use whilst maintaining a moist interface between the wound and the first layer; the second layer is shaped to cover and correspond with the first layer, outward from the wound in use, the second layer being made of an absorbent material to absorb and retain exudate from the wound in use; and the second layer is removable from the first layer and replaceable in use.

This provides the advantage that the wound is kept in a moist environment to aid epithelialization, but excess exudate is removed from the wound site to prevent or mitigate against maceration. Moreover, the second layer, in which the excess exudate is absorbed, may be replaced as and when required, independently of the first layer, thus improving patient comfort. Furthermore, due to the first and second layers both being shaped to correspond with the wounded body part (e.g. glove-shaped to fit a hand), both layers may be quickly and easily fitted, thereby saving time and reducing discomfort and trauma for the patient, and also enabling the interchangeable second layer to be quickly and easily removed and replaced. Being shaped to correspond with the wounded body part may also enable the patient to retain flexibility of that body part -for example in the case of wounded hands.

The expression burn wound or the like" as used herein should be interpreted broadly, to encompass any wound, lesion, inflammation or ailment from which exudate is produced.

Preferably the first layer is impregnated or treated with an anti-infection or antibacterial agent, to reduce the likelihood of infection to the patient. The anti-infection or antibacterial agent may be a silver-based agent such as silver sulphadiazine, although other suitable silver-based agents, and indeed non-silver-based agents, will be familiar to those skilled in the art.

Preferably the first layer is made of a polymer and/or lipido-colloid material. Particularly preferably the first layer is made of Urgotul (RTM) S.S.D (as manufactured by Laboratoires URGO, Chenôve, France).

Preferably the first layer is made of a non-adherent material. This advantageously facilitates removal of the first layer from the wound at the appropriate time, without the first layer sticking to the wound and tearing or pulling at the wound area during removal.

Particularly preferably the non-adherent material is tacky. That is to say, preferably the material does not stick to the patient, but nevertheless provides a tacky contact to facilitate positioning the first layer on the wound and to retain it in place.

Preferably the second layer is formed from an absorbent paper or fabric material.

Advantageously, such materials, for example as used in disposable nappies or diapers, are very effective at absorbing and retaining liquids.

Particularly preferably the second layer incorporates a hydrogel. Such materials are particularly effective at absorbing and retaining liquids.

The dressing may be shaped as a glove, a mitten, a boot or sock, a sleeve for an arm or leg, or a facemask. Other shapes, to correspond with other anatomical parts, are possible and will be apparent to those skilled in the art of burns treatment.

The outside of the second layer may further comprise means for enhancing grip between the dressing and an external object or surface.

The dressing may further comprise separating means for preventing the first layer from sticking to itself prior to use. For example, the separating means may comprise a removable divider member, or a water-soluble non-stick inner coating.

According to a second aspect of the invention there is provided a method of treating a burn wound, the method comprising the steps of: (a) applying a first dressing layer onto the burnt body part, the dressing being shaped to correspond with the burnt body part, and made of a material adapted to allow passage of exudate from the wound through the first layer whilst maintaining a moist interface between the wound and the first layer; (b) applying a second dressing layer over the first dressing layer, the second dressing layer being shaped to cover and correspond with the first layer, and made of absorbent material to absorb and retain exudate; (c) allowing exudate to pass from the wound through the first dressing layer and to be absorbed in the second dressing layer; and (d) removing and replacing the second dressing layer without replacing the first dressing layer.

In some cases, the step of removing and replacing the second dressing layer may be performed by a patient without the assistance of a healthcare professional. This advantageously reduces the amount of professional time spent by healthcare professionals on treating patients.

According to a third aspect of the invention there is provided a dressing comprising a tacky or adhesive layer, and a water-soluble non-stick coating on the tacky or adhesive layer, wherein the non-stick coating is for initially contacting a wound in use and is dissolvable in exudate from the wound such as to cause the tacky or adhesive layer to come into contact with the wound. The presence of the water-soluble non-stick coating advantageously facilitates application of the dressing to the wound, preventing the tacky or adhesive layer from sticking to itself during fitting, but enabling the tacky or adhesive layer to come into contact with the wound once fitted and subjected to exudate.

According to a fourth aspect of the invention there is provided a method of attaching a dressing to a wound, the dressing comprising a tacky or adhesive layer and a water-soluble non-stick coating on the tacky or adhesive layer, the method comprising the steps of: (a) attaching the dressing to the wound such that the water-soluble non-stick coating contacts the wound; and (b) allowing exudate from the wound to dissolve the water-soluble non-stick coating, thereby causing the tacky or adhesive layer to come into contact with the wound.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the invention will now be described, by way of example only, and with reference to the drawings in which: Figure 1 illustrates a glove-shaped inner dressing, as initially supplied, for use on a burnt hand; Figure 2 illustrates a glove-shaped interchangeable outer dressing, as initially supplied, for application over the inner dressing of Figure 1; Figure 3 illustrates the inner dressing of Figure 1 having been applied to a burnt hand; and Figure 4 illustrates the outer dressing of Figure 2 applied over the dressing of Figure 1.

In the figures, like elements are indicated by like reference numerals throughout.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The present embodiments represent the best ways known to the applicant of putting the invention into practice. However they are not the only ways in which this can be achieved.

Although the embodiments described herein will be described primarily in relation to burn wounds, it should be emphasised that they are also applicable to other types of wounds, lesions, inflammation or ailments from which exudate is produced.

Further although the embodiments described herein will be described primarily in relation to treating hands, it should be emphasised that the embodiments may be readily adapted to treat other regions of the human body -for example, the feet, arms, legs and face.

By way of an initial overview, the present embodiments provide a porous or mesh-like inner dressing (Figure 1) which allows passage of exudate away from the wound in use whilst maintaining a moist interface between the wound and the first dressing, and an interchangeable/replaceable absorbent outer dressing (Figure 2) for absorbing and retaining the exudate that passes through the inner dressing. Both the inner dressing and the outer dressing are shaped to correspond with the wounded body part (in this case, a hand). The inner dressing may be impregnated with an anti-infection or antibacterial agent, and may be allowed to remain in place for several days in use. The outer dressing may be replaced more frequently, independently of the inner dressing -for example every few days, or as often as necessary.

The inner dressing Figure 1 illustrates an inner dressing 10 which is shaped to correspond with the wounded body part from which exudate is produced -in this case, a burnt hand. By being shaped to correspond with the wounded body part, fitting of the dressing may be performed more quickly than with conventional dressings.

The inner dressing 10 is made of a porous polymer material that is essentially net or mesh-like, incorporating an array of small holes or pores between the material of the mesh. The shape, size and configuration of the holes or pores is such as to allow some exudate to remain in contact with the wound during use, thereby providing a moist environment to assist the healing process, whilst allowing excess exudate to pass through the holes, away from the wound, to prevent or mitigate against maceration of the wounded skin.

The inner dressing 10 is preferably impregnated or treated with an anti-infection or antibacterial agent to reduce the likelihood of infection to the patient, and to help the healing process. The anti-infection or antibacterial agent may be a silver-based agent such as silver sulphadiazine, although other suitable silver-based agents, and indeed non-silver-based agents, will be familiar to those skilled in the art.

The inner dressing 10 is preferably made of a non-adherent yet tacky material. This helps to prevent the inner dressing 10 from sticking to the wound during removal, but nevertheless provides a tacky contact to facilitate positioning the inner dressing 10 on the wound and to retain it in place.

Preferably the inner dressing 10 is made of Urgotul (RTM) S.S.D, which is supplied pre-impregnated with silver sulphadiazine. The physical characteristics and properties of Urgotul (RTM) S.S.D are outlined in the Appendix. Pre-impregnation of silver suiphadiazine or another anti-infection or antibacterial agent in the inner dressing is highly advantageous, since the agent does not then become dissolved or washed away by exudate.

An inner dressing 10 made of Urgotul (RTM) S.S.D or similar material may be left in place on the wounded skin for about seven days, depending on the condition of the wound. The inner dressing 10 may then be replaced, or removed altogether if the wound has healed sufficiently.

The inner dressing 10 is preferably configured not to stick to itself prior to, or during, fitting.

To further reduce the likelihood of the inner dressing 10 sticking to itself, it may be applied to the patient's hand underwater. This also helps to cool the patient's hand. Alternatively, or in addition, the inner dressing 10 may be supplied with internal separating means (such as a plastic non-stick divider) inside the inner dressing 10, to keep the opposing inner surfaces of the dressing apart. The internal separating means may be removed underwater, immediately prior to fitting to the patient's hand underwater, and the presence of the water reduces the likelihood of the inner dressing 10 sticking to itself.

As a further alternative, the inner dressing 10 may be provided with a water-soluble non-stick internal coating, thus preventing the opposing inner surfaces of the dressing 10 from sticking to themselves prior to, or during, fitting to the patient. The water-soluble non-stick coating is dissolvable in exudate from the wound. This advantageously means that, once the dressing has been fitted in place and is subsequently subjected to exudate from the wound, the water-soluble non-stick coating dissolves in the exudate and the tacky surface of the inner dressing 10 then comes into contact with the wound, thereby attaching the dressing 10 to the patient. It will be appreciated that such a technique, whereby a water-soluble non-stick coating is provided for dissolving in wound exudate, may be employed with dressings other than the two-layer dressing described herein.

The outer dressing Figure 2 illustrates a replaceable/interchangeable outer dressing 20 which is shaped to correspond with the inner dressing 10 and with the wounded body part from which the exudate is produced.

The outer dressing 20 is made of absorbent padding material. In use, the outer dressing 20 is fitted over the inner dressing 10, and serves to absorb any exudate which passes through the inner dressing 10, whilst allowing some exudate to remain between the wound and the inner dressing 10. This provides a moist (but not excessively damp) environment at the wound site, thereby assisting healing, and also preventing or mitigating against maceration.

During the treatment of a wound, the outer dressing 20 absorbs exudate from the wound.

The outer dressing 20 may be removed and replaced with a fresh outer dressing 20 at intervals or as required, independent of the inner dressing 10.

The outer dressing 20 preferably incorporates "nappy technology', to wick excess exudate away from the wound and to retain the exudate inside the absorbent material, thus preventing maceration. This should be contrasted with conventional gauze dressings, which allow exudate to pass back onto the wound, which can lead to maceration.

The outer dressing 20 may comprise a number of sub-layers. For example, the outer dressing may have a paper or fabric outer layer, a moisture-wicking inside layer and an absorbent inner core. The inner core may advantageously incorporate a dried hydrogel, as used in modern disposable nappies or diapers. As those skilled in the art will appreciate, hydrogels can be "superabsorbent" -i.e. able to contain over 99% water -thus making them particularly suitable for absorbing and retaining exudate produced from a wound. Other hydrophilic crystals or other hydrophilic substances may alternatively be used within the core of the outer dressing 20.

The outer dressing 20 may incorporate a greater amount or a greater concentration of hydrogel around the lower wrist or cuff area, to prevent exudate from escaping down the patient's arms during use.

Further, the outer dressing 20 may be provided with an elasticated cuff and/or a fastening strap 22 around the cuff area, to enable the dressing 20 to be secured to the hand and to prevent any leakage of exudate. The fastening strap may be provided with hook-and- loop fastening material 24 (e.g. Velcro (RTM)), to facilitate fastening and to enable single-handed fitting and removal, thereby enabling a patient to remove and replace the outer dressing 20 himself in some cases.

The outer dressing 20 may also incorporate a slit 26 to enable the dressing 20 to be opened up in order to facilitate fitting.

The outside of the outer dressing 20 may incorporate rubberised pads or other means for enhancing grip between the dressing and an external object or surface. In the case of a glove-shaped dressing, this provides the patient with a basic ability to grip and manipulate objects whilst wearing the dressing (depending on the severity of the wound and the amount of pain felt by the patient). In cases in which the dressings are sock-or boot-shaped, rubberised pads may be provided on the underside of the outer dressing, to provide grip between the dressing and the floor, to prevent the patient from slipping over on smooth floors. Rubberised grips may also be provided inside a sock-or boot-shaped dressing, to prevent the dressing from slipping off the patient's foot.

Method of use In practice, the wound may first be cleaned, and could then be treated with an anti-infection or antibacterial cream, for example a silver sulphadiazine cream such as Flamazine (RTM).

As illustrated in Figure 3, the inner dressing 10 is then applied to the patient 30. Then, the outer dressing 20 is applied over the inner dressing 10, as illustrated in Figure 4.

The inner dressing 10 may be left in place on the wound for about seven days, depending on the condition of the wound. The inner dressing 10 may then be replaced, or removed altogether if the wound has healed sufficiently.

The outer dressing 20 may be replaced as often as necessary, for example every other day, or once every three to four days, independently of the inner dressing 10. Thus, it will be appreciated that the outer dressing 20 may be replaced two or three times during the period in which the inner dressing 10 remains in place prior to replacement or disposal. In some cases, replacement of the outer dressing 20 may be performed by the patient himself, at home, thereby reducing the amount of work required from healthcare professionals during the treatment of the wound.

An inner dressing 10 may be supplied in a kit with a corresponding outer dressing 20.

Further replacement outer dressings 20 may be supplied individually or in batches. The dressings may be manufactured in a range of different sizes, to suit different patients. With glove-shaped dressings for hands, it is envisaged that the inner and outer dressings would be made larger than the glove size the patient would normally wear, to allow for swelling of the wounded hand. Likewise, for sock-shaped dressings for feet, the inner and outer dressings would be made larger than the sock size the patient would normally wear, again to allow for swelling.

Although in some cases the inner and outer dressings may be more expensive to manufacture than the prior art dressings described previously (i.e. sterile polythene gloves; or Mepitel (RTM) in combination with padding and gauze), the wear time of such prior art dressings is typically only one day, and they need to be replaced by a skilled healthcare professional. Use of the prior art dressings is therefore resource-intensive, due to the amount of time that has to be spent by the healthcare professional. However, with the present embodiments, any additional manufacturing cost is at least partly offset by a quicker fitting time, thus reducing the resource demands made on healthcare professionals.

Moreover, if the patient is able to replace the outer dressing himself at home, then effectively no professional time needs to be used for this task, thus significantly reducing nursing costs and/or enabling healthcare professionals to attend to other matters (such as emergencies) instead.

Dressings for other body parts In addition to inner and outer glove-shaped dressings (10, 20) for treating hands, other complementary pairs of inner and outer dressings may be provided for treating other body parts. In such cases, the inner and outer dressings are shaped and configured to correspond with the body part to be treated. For example, sock-or boot-shaped dressings may be provided for treating burns or other exuding wounds or ailments on the feet or the legs (e.g. leg ulcers or diabetic foot ulcers, as well as burn wounds etc.). Facemask-shaped dressings may be provided for head or face wounds or ailments, Open-ended sleeves may be provided for treating wounds or ailments on arms or legs. In all such cases, the dressings may be provided in a range of predetermined sizes, to suit different shapes and sizes of patients. The principle of operation of such dressings is as described above in relation to the glove-shaped dressings for hands.

APPENDIX

Composition and physical characteristics of the URGOTUL (RTM) S.S.D dressing material (taken from the manufacturer's data sheet) Manufacturer Laboratoires URGO, 42 Rue de Longvic, B.P. 157, 21300 Chenôve, France (www.urgo.com).

Definition URGOTUL (RIM) S.S.D is a non-occlusive antibacterial lipido-colloid interface containing a mixture of CMC-Na dispersed in a lipophilic network of petroleum jelly combined with an anti-bacterial agent. It is intended for topical treatment of superficial, intermediate or deep second-degree burns at risk of secondary infection.

On contact with the exudate from the wound, URGOTUL (RTM) S.S.D forms a lipido-colloid gel which: * prevents adherence of the dressing to the wound * makes changing the dressing painless * creates conditions favourable to the healing process.

URGOTUL (RIM) S.S.D contains an antibacterial agent active against the microorganisms involved in the secondary infection of burns: this agent is called silver sulphadiazine.

Presentation URGOTUL (RTM) S.S.D may be packaged in an individual sterile pouch, and sterilized by ionizing radiation.

Composition Textile net, 100% polyester, with continuous and non-deformable yarns, coated with a hydrocolloid, antibacterial agent, petroleum jelly, and cohesion polymer.

Silver sulphadiazine: 3.75% Physical characteristics URGOTUL (RTM) S.S.D is a hpido-colloid interface for topical treatment of second-degree burns at risk of secondary infection; URGOTUL (RTM) S.S.D protects the wound and drains the exudate towards the secondary dressing thanks to its open-mesh structure.

URGOTUL (RTM) S.S.D is non-occlusive and does not adhere to the wound, which means that the dressings can be changed less frequently, depending on how the treated wound develops.

On contact with the wound, URGOTUL (RTM) S.S.D forms a moist lipido-colloid gel which favours the wound-healing mechanism. The addition of silver suiphadiazine does not delay healing.

* Formation of the lipido-colloid gel on contact with the exudates Non-adherence to the wound, and totally painless removal of the dressing.

Moist environment which favours wound-healing.

Cohesion of the colloid gel >90%, guaranteeing the non-occlusive character of the dressing.

* Structure of the net of the dressing Continous yarns: no release of microfibres into the wound, ruling out any foreign-body reaction.

Non-deformable meshes which ensure that the mesh remains open in all situations and avoid any maceration and any risk of granulation tissue catching in the dressing.

Flexible yarns which allow the dressing to be perfectly shaped to fit all types of wounds and in all difficult locations; fingers, commissures, etc. * pHofthedressing Biological processes tolerate only minimal deviations of the pH from neutral.

The pH of the wound is the combined result of the pH of the exudates, the pH associated with the bacterial metabolism and, finally, the pH of the dressing used.

The acidity of URGOTUL (RTM) S.S.D is a reflection of the acidity of the environment in which the wound-healing process takes place.

The pH of URGOTUL (RTM) S.S.D is between 6 and 7.

* Mechanical strength Because URGOTUL (RTM) S.S.D may be left on the wound for several days, the dressing may be subject to repetitive mechanical stresses. It is important to avoid any tearing of the dressing so as to ensure that microfibres from the textile web are not released into the wound which would risk causing an inflammatory reaction. This is the reason why URGOTUL (RTM) S.S.D has been given such a high degree of mechanical strength.

These mechanical properties give URGOTUL (RIM) S.S.D the mechanical strength needed to permit its adaptation to different anatomical contours and to ensure that it remains in place during treatment.

Claims

CLAIMS

1. A dressing for treating a burn wound or the like, the dressing comprising a first layer and a second layer; wherein: the first layer is shaped to correspond with a wounded body part and is configured to be positioned on the wound in use, the first layer being made of a material adapted to allow passage of exudate from the wound through the first layer in use whilst maintaining a moist interface between the wound and the first layer; the second layer is shaped to cover and correspond with the first layer, outward from the wound in use, the second layer being made of an absorbent material to absorb and retain exudate from the wound in use; and the second layer is removable from the first layer and replaceable in use.

2 A dressing as claimed in Claim 1, wherein the first layer is impregnated or treated with an anti-infection or antibacterial agent.

3. A dressing as claimed in Claim 1 or Claim 2, wherein the first layer is made of a polymer and/or lipido-colloid material.

4. A dressing as claimed in Claim 1, Claim 2 or Claim 3, wherein the first layer is made of a non-adherent material.

5. A dressing as claimed in Claim 4, wherein the non-adherent material is tacky.

6. A dressing as claimed in any preceding claim, wherein the second layer is formed from an absorbent paper or fabric material.

7. A dressing as claimed in any preceding claim, wherein the second layer incorporates a hydrogel.

8. A dressing as claimed in any preceding claim, shaped as a glove.

9. A dressing as claimed in any of Claims I to 7, shaped as a mitten.

10. A dressing as claimed in any of Claims Ito 7, shaped as a boot or sock.

11. A dressing as claimed in any of Claims I to 7, shaped as a sleeve for an arm or leg.

12. A dressing as claimed in any of Claims I to 7, shaped as a facemask.

13. A dressing as claimed in any of Claims I to 10, wherein the outside of the second layer further comprises means for enhancing grip between the dressing and an external object or surface.

14 A dressing as claimed in any preceding claim, further comprising separating means for preventing the first layer from sticking to itself prior to use.

15. A dressing as claimed in Claim 14, wherein the separating means comprise a removable divider member.

16. A dressing as claimed in Claim 14, wherein the separating means comprise a water-soluble non-stick inner coating.

17. A method of treating a burn wound or the like, the method comprising the steps of: (a) applying a first dressing layer onto the wounded body part, the dressing being shaped to correspond with the wounded body part, and made of a material adapted to allow passage of exudate from the wound through the first layer whilst maintaining a moist interface between the wound and the first layer; (b) applying a second dressing layer over the first dressing layer, the second dressing layer being shaped to cover and correspond with the first layer, and made of absorbent material to absorb and retain exudate; (c) allowing exudate to pass from the wound through the first dressing layer and to be absorbed in the second dressing layer; and (d) removing and replacing the second dressing layer without replacing the first dressing layer.

18. A method as claimed in Claim 17, wherein the step of removing and replacing the second dressing layer is performed by a patient without the assistance of a healthcare professional.

19. A dressing comprising a tacky or adhesive layer, and a water-soluble non-stick coating on the tacky or adhesive layer, wherein the non-stick coating is for initially contacting a wound in use and is dissolvable in exudate from the wound such as to cause the tacky or adhesive layer to come into contact with the wound.

20. A method of attaching a dressing to a wound, the dressing comprising a tacky or adhesive layer and a water-soluble non-stick coating on the tacky or adhesive layer, the method comprising the steps of: (a) attaching the dressing to the wound such that the water-soluble non-stick coating contacts the wound; and (b) allowing exudate from the wound to dissolve the water-soluble non-stick coating, thereby causing the tacky or adhesive layer to come into contact with the wound.

21. A dressing substantially as herein described with reference to and as illustrated in any combination of the accompanying drawings.

22. A method of treating a burn wound or the like substantially as herein described with reference to and as illustrated in any combination of the accompanying drawings.