Guide to choosing an ulcer or wound dressing

Dressings are classified according to functionality. Some dressings have multiple functions. Match the wound characteristics to the function of the wound dressing; see Overview of appropriate wound dressings based on wound characteristics. At a minimum, primary care providers should keep dressings that perform each of the functions listed in Overview of appropriate wound dressings based on wound characteristics. These can be used on the majority of wounds.

Some wounds require specialised dressings to be used for a defined period of time to manage a specific issue. Specialised dressings are listed in #lwg2-c17-s4__tlwg2-c17-tbl13 ¹. Primary care providers may need to also keep and be familiar with more specialised dressings based on common presentations in the local patient population. For example, cadexomer iodine (Iodosorb) dressings for wounds with nonviable tissue, or zinc paste dressings for venous dermatitis.

Advice about dressings is provided separately for specific ulcer or wound characteristics:

For advice on how to choose a new dressing after a dressing change, see #lwg2-c17-s4__tlwg2-c17-tbl15.

Table 1. Overview of appropriate wound dressings based on wound characteristics
Wound characteristic	Dressing function	Appropriate dressing type
Fragile skin or extensive wound	protection	wound contact layer or tulle low-adherent dressings thin foam dressings
Dry wound (no or minimal exudate)	hydration	hydrogel dressings
Moist wound (low exudate)	moisture retention	semipermeable film dressings hydrocolloid and other polymer dressings thin foam dressings
Wet wound (moderate exudate)	moderate absorption	foam dressings absorbent pad dressings
Wet wound (heavy exudate)	high absorption	super-absorbent pad dressings alginate fibre dressings gelling fibre dressings

Table 2. Wound contact layer or tulle
Function	Protection
Indication	Encourages epithelialisation and protects fragile tissue. Can be used for wounds unlikely to heal or extensive wounds. Silicone mesh generally recommended for skin tears.
Variants	Available as silicone mesh, hydrocolloid/petroleum mesh, triglyceride mesh, petrolatum, paraffin mesh. Available impregnated with an antimicrobial (including povidone-iodine, chlorhexidine, silver, honey)—antimicrobial dressings are not routinely required.
Precautions	Paraffin mesh is not routinely recommended as it can adhere to the wound bed and does not absorb exudate. Additionally, paraffin mesh is not permeable to water vapour or exudate, so can cause maceration.
Comments	Paraffin tulle is not recommended first line (can adhere to wound and cause maceration, as above); nonparaffin tulle is preferred. Wound contact layers are not absorptive, so the secondary dressing needs to be matched to the amount of wound exudate. Generally dressings require overlap onto the surrounding skin of at least 2 cm. A silicone mesh is usually left on for 7 to 14 days (check manufacturer’s recommendations for maximum wear time).
Examples	Silicone: Mepitel, Silflex Hydrocolloid/petroleum: UrgoTul Triglyceride: Atrauman Petrolatum: Adaptic, Cuticerin Paraffin: Jelonet Antimicrobial: Bactrigras (chlorhexidine), Inadine (povidone-iodine), UrgoTul Ag/Silver

Table 3. Low-adherent dressings
Function	Protection
Indications	Primary or secondary dressing on dry wounds or wounds with minimal exudate. Absorb minimal exudate; useful for surgical wounds.
Variants	Available as cotton acrylic fibres and knitted viscose, nonadhesive sheets or island dressings with a fabric or film adhesive border. Usually constructed with low-adherent perforated plastic film that allows passage of exudate from the wound bed into the fibre.
Precautions	If applied directly to an open wound they can adhere to the wound bed and cause trauma on removal. Not suitable for wounds with moderate to heavy exudate.
Comments	Nonadhesive variants need to be secured with tape or a bandage.
Examples	Melolin, Cutilin, Telfa, Primapore

Table 4. Semipermeable film dressings
Function	Moisture retention
Indications	Primary dressing over superficial, low exudate wounds. Fixation over nonadhesive dressings.
Variants	Available as a thin polyurethane membrane coated with a layer of acrylic adhesive. Available with a silicone adhesive for fragile skin. Can be used for fixation for a range of nonadhesive dressings including low-adherent dressings, foam dressings, absorbent pads or sheet hydrogels.
Precautions	Not suitable for infected wounds or wounds with moderate to heavy exudate. Variants with acrylic adhesive may cause trauma to fragile or compromised skin.
Comments	Permeable to gas and vapour, waterproof and impermeable to bacteria. Cannot absorb exudate if used alone. Overlap onto the surrounding skin by at least 2 cm. Change the dressing every 5 to 7 days, more often if exudate is pooling under dressing.
Examples	Acrylic adhesive: OpSite, Tegaderm, Mefilm Silicone adhesive: Mepitel Film, OpSite Flexifix Gentle

Table 5. Hydrogel dressings
Function	Hydration
Indications	Adds moisture to dry wounds and aids autolytic debridement. May be used for skin tears if there is a risk of the wound drying out. Can be used as first aid for minor burns for adults in specific circumstances only, or as a dressing for epidermal burns; see Semipermeable film dressings.
Variants	Available as amorphous (that have no shape) dressings, sheet dressings or impregnated dressings (eg gauze saturated with an amorphous hydrogel). Amorphous hydrogels vary in consistency and composition (eg some contain preservatives). Some are available with an antimicrobial (including polyhexamethylene biguanide [PHMB], hypochlorous acid with sodium hypochlorite or octenidine)—antimicrobial dressings are not routinely required. Sheet hydrogels can be adhesive or nonadhesive; nonadhesive variants can be combined with a secondary adhesive film dressing. Sheet hydrogel is preferred for use on flat or shallow wounds.
Precautions	Not for use if debridement is contraindicated (eg on stable dry eschar of the heel). Avoid on wounds with moderate to heavy exudate.
Comments	All are primary dressings. Amorphous and impregnated dressings require a secondary dressing that doesn’t absorb the gel or allow it to dry out (an occlusive dressing is recommended). Reduces risk of desiccation to structures (eg exposed bone or tendon). Amorphous and impregnated hydrogels are usually only applied to the wound. Sheet hydrogels require overlap onto the surrounding skin of at least 2 cm. Generally dressings should be changed every 3 to 7 days.
Examples	Amorphous hydrogel: SoloSite, DuoDERM Hydroactive Gel, Hydrosorb Gel, Normlgel Sheet hydrogel: Hydrosorb Impregnated hydrogel: Intrasite Conformable, Kendall Hydrogel Impregnated Gauze Antimicrobial amorphous hydrogel: Prontosan Wound Gel X, Octenilin Wound Gel, Microdacyn Hydrogel, Flaminal

Table 6. Hydrocolloid and other polymer dressings
Function	Moisture retention
Indication	Used as a primary dressing for moist wounds with low exudate. Maintains the moisture level of wounds and encourages epithelialisation. Used for flat or shallow wounds. Can assist with autolytic debridement. Thin hydrocolloid dressings can be used for skin protection around the wound for patients using topical negative pressure wound therapy.
Variants	Hydrocolloid dressings are available as sheet, paste and gel dressings; other polymer dressings include hydropolymers and acrylic dressings. Ability to retain moisture depends on the composition of the dressing and film backing.
Precautions	Hydrocolloid dressings should be avoided on wounds with infection, sinus tracts or heavy exudate. Do not use hydrocolloid dressings on the plantar surface of the foot.
Comments	Hydrocolloids form a gel in contact with exudate. Other polymer dressings absorb exudate into the matrix of the dressing. Generally a primary dressing. Can sometimes be used as a secondary dressing. Usually adhesive dressings. Overlap onto the surrounding skin by at least 2 cm. Change the dressing every 3 to 7 days. Applying warmth to the dressing before and after application can enhance dressing conformation and adhesion.
Examples	Hydrocolloid sheet: Comfeel Plus, DuoDERM, REPLICARE Hydrocolloid paste: DuoDERM Paste Hydrocolloid gel: DuoDERM Hydroactive Gel Hydropolymer: Leukomed Control, Tielle Acrylic: Tegaderm Absorbent

Table 7. Foam dressings
Function	Moderate absorption and protection
Indication	Foam dressings are widely used; they absorb excess exudate while maintaining a moist wound bed. Used as a primary or secondary dressing for wounds with low to moderate exudate, depending on foam thickness. They also provide thermal insulation, protection and cushioning.
Variants	Composition, construction and mode of action vary. Available with or without adhesive (composition of adhesives varies). Foam thickness usually reflects absorptive capacity. Available with various contact surfaces (including silicone or hydrogel) and shapes (for specific anatomical locations). Foams without a film backing are used for cavity wounds. Specific products available to manage thick or viscous exudate, or impregnated with an antimicrobial (including polyhexamethylene biguanide [PHMB], silver)—antimicrobial dressings are not routinely required.
Precautions	Usually avoid on very dry wounds. If used alone, foams do not facilitate autolytic debridement, but may provide skin protection. Provides protection but not offloading.
Comments	Primary or secondary dressing. A secondary dressing is not required for types with a film backing. Overlap onto the surrounding skin by at least 2 cm. Change the dressing every 2 to 7 days, when approximately 75% saturated. If using an adhesive variant, applying warmth to the dressing before and after application can enhance dressing conformation and adhesion. If used for skin graft management, adhesive must be beyond the margins of the wound.
Examples	Nonadhesive foam: Allevyn, Biatain Non-Adhesive, Lyofoam Max Adhesive foam: Tielle Plus, Allevyn Adhesive, Biatain Adhesive Silicone coated nonadhesive foam: Mepilex, Mepilex XT Silicone coated adhesive foam: Mepilex Border, Allevyn Gentle Border, Biatain Silicone Antimicrobial foam: Biatain Ag Non-Adhesive, Allevyn Ag, Mepilex Ag, AMD foam

Table 8. Absorbent pad dressings
Function	Moderate absorption
Indication	Absorbs excess exudate. Used for wounds unlikely to heal, extensive wounds, and surgical wounds if moderate amounts of exudate are likely.
Variants	Composition and construction vary; the absorbent layer is usually cellulose pulp. Usually nonadhesive.
Precautions	Can become adherent if applied directly to a wound. Some do not retain exudate well within the structure of the dressing, so can become soggy.
Comments	Generally used as a secondary dressing; often used over a wound contact layer or fibre dressing. Fixation is usually required. Change the dressing every 2 to 7 days when approximately 75% saturated. Overlap onto the surrounding skin by at least 2 cm.
Examples	Mesorb, Zetuvit, Exu-Dry

Table 9. Super-absorbent pad dressings
Function	High absorption
Indication	Absorb large amounts of exudate. Used for wet wounds with heavy exudate, extensive wounds, or those unlikely to heal.
Variants	Composition and construction vary. Some have water-repellent backings to reduce wetness from strikethrough. Specialised shapes are available. Usually nonadhesive.
Precautions	Avoid on dry wounds or wounds with minimal exudate. May adhere to wound if directly applied.
Comments	Generally used as a secondary dressing over a wound contact layer or fibre dressing. Overlap dressing onto the surrounding skin by at least 2 cm. Fixation is usually required. Change the dressing when approximately 75% saturated.
Examples	Mextra Superabsorbent, Zetuvit Plus, Cutimed Sorbion Sachet, Relevo

Table 10. Alginate fibre dressings
Function	High absorption
Indication	Absorbs excess exudate. Used for wet wounds with heavy exudate or cavity wounds. Can be useful for achieving haemostasis for bleeding wounds (see 'Precautions' below).
Variants	Composition varies. Some are soft-gelling and can break up when saturated, others are firm-gelling and maintain structure when saturated. Available as sheets, rope or ribbon. Some are impregnated with an antimicrobial (including silver)—antimicrobial dressings are not routinely required.
Precautions	Avoid on dry or low exudate wounds. Avoid in cavity wounds if the entire base is not visible. While alginate fibre dressings can help stop bleeding, if they dry out they can become adherent and cause trauma on removal. Not all alginates provide haemostasis, it depends on calcium concentration. Dressings must be removed from the wound; they are not biodegradable.
Comments	Used as a primary dressing; a secondary dressing is required. The entire dressing must be removed at each dressing change. Should be fitted to wound size. Change the dressing when saturated, usually every 1 to 3 days.
Examples	Nonantimicrobial alginate: Biatain Alginate, Algisite M, Sorbsan Antimicrobial alginate: Melgisorb Ag, Silvercel Non-Adherent

Table 11. Gelling fibre dressings
Function	High absorption
Indication	Absorbs excess exudate. Used for cavity wounds.
Variants	Available as sheets, rope or ribbon. Available impregnated with an antimicrobial (including silver)—antimicrobial dressings are not routinely required. Some have a ‘high wet strength’ so are suitable for cavity wounds even if the base of the wound is not visible.
Precautions	Avoid on dry or low exudate wounds. The entire dressing must be removed at each dressing change.
Comments	Used as a primary dressing; a secondary dressing is required. Overlap onto the surrounding skin by 1 cm because the dressing will shrink slightly as it absorbs exudate. Change the dressing when saturated, usually every 1 to 3 days.
Examples	AQUACEL Extra, DURAFIBER, Exufiber

¹ The Department of Veterans Affairs (DVA) website also provides a detailed guide to wound dressings.Return