Introduction to ulcer and wound dressings

A wound dressing is a product intended for application to a wound. This is not limited to dressing pads, and can include tulle, films, gels, bandages and pumps.

Wound dressings are used to:

  • optimise the wound environment
  • cover and protect the area
  • minimise contamination and infection
  • provide comfort
  • facilitate the patient’s needs (eg allow showering).
Note: Dressings do not heal wounds.

Dressings do not heal wounds. The aetiology of the wound must be accurately diagnosed, and the patient must have the physiologic capacity for tissue repair (eg adequate blood supply); see Fundamentals of ulcer and wound management. Additionally, factors impairing wound healing (eg venous hypertension, smoking, oedema, pressure) must be addressed; see Factors affecting ulcer and wound healing and Venous leg ulcers.

Before choosing a dressing, assess the wound characteristics using the TIME acronym (see Wound characteristics summarised using the TIME acronym). Wounds should be cleansed at each dressing change, and if nonviable tissue is present, consider debridement (see Cleansing and debridement). For clinically infected wounds, see Ulcer and wound infection.

The primary consideration when selecting a dressing is exudate management because maintaining an appropriate moisture balance optimises healing. Within each class of dressing, there is little evidence to recommend one dressing over another.

Secondary considerations when selecting a dressing include:

  • the aetiology and pathophysiology of the wound
  • the prognosis
  • patient preference
  • the wound tissue (eg need for autolytic debridement of nonviable tissue)
  • presence or risk of infection
  • wound depth
  • skin condition (both prior to wounding, and the skin surrounding the wound)
  • wound-related pain (including pain when applying and removing dressings).

Occasionally, multiple layers of dressings are required. The dressing in contact with the wound is the primary dressing. If a dressing is placed over this, it is called the secondary dressing. More than two layers of dressings are generally not necessary. The choice of dressing and the frequency of dressing changes is known as the dressing regimen. Patients may request dressing change at the first sign of strikethrough, but this is often not necessary.

Healthcare professionals must understand how to use the dressings they recommend. This includes the following: functionality; clinical indications; technique for application and removal; when the dressing should be changed; the expected behaviour of the dressing when in use; and any precautions and contraindications. If there is uncertainty about the dressing or how it is used, seek specialist advice or contact the manufacturer.

Educate patients and carers about how to manage the dressing. Inform patients and carers about:

  • the expected wear time (ie duration between dressing changes)
  • what to do if the dressing becomes dislodged, contaminated or leaks
  • the expected dressing appearance during the wear time
  • managing the dressing while showering or bathing
  • what to report to a healthcare professional (eg increased pain, exudate volume, odour)
  • who will change dressings and when
  • if the patient or carer is to change dressings, how to change the dressing and where to purchase dressings.