Primary
Hydrogels
Comes in ...
gel form, amorphous or in sheets
Works by...
- lubricating, softening tissue
- promoting autolytic debridement
Best for...
- Shallow wounds (depth less than 1 cm) with minimal exudate
- Deeper wounds (depth greater than 1cm) with significant granulation tissue and without dense necrotic tissue or slough
- Wounds with thin layers of necrosis or slough in preparation for sharp debridement
- Painful wounds in which a cooling effect is desired
Other indications/contraindications
- Can be mixed with 2% lidocaine gel or morphine liquid for additional analgesia.
- Ideal for palliative care settings as frequency of dressing changes can be up to one week; users are advised to refer to manufacturers insert of each product for details.
- Not recommended for moderately to heavily exudative wounds or venous stasis ulcers.
Hydrocolloids
Comes in...
sheets, powders, pastes
Works by...
- binding water in the colloid matrix to create a gel covering that promotes a moist wound environment
- for dry wounds, it is impermeable to moisture and acts as a cushion against friction
Best for...
- Well granulating wounds with mild exudate
- Shallow wounds with thin necrosis or slough in preparation for sharp debridement
- Over bony prominences subject to repeated trauma from friction or shear stress such as the sacrum
Other indications/contraindications
- Often used as secondary dressing for Stage II or shallow Stage III ulcers
- Advised in palliative care settings as frequency of dressing changes can be up to a week
- Not recommended for use in deep wounds, infected wounds or venous stasis ulcers
Alginates
Comes in...
ribbons and pads
Works by...
binding of water in the seaweed-derived fiber matrix to form a gel that promotes a moist wound environment
Best for...
- Heavily exuding wounds
- Ideal for filling large craters, tunnels and undermining
- Excellent primary dressing for venous stasis ulcers
- Can be used with antimicrobial gels in infected wound beds
- When impregnated with silver, offers additional barrier to bacterial growth
Other indications/contraindications
- Not recommended for use in wounds with low drainage as the dressing can dry out the wound or impregnate into the wound causing difficulty in removing residual fibers.
- Dressing frequency can be every other day.
- For wounds with minor bleeding, alginates can induce hemostasis
Hydrofibers
Comes in...
pads and ropes, sometimes impregnated with silver
Works by...
similar principle as alginates, but matrix is made of carboxymethylcellulose (CMC) with enhanced absorptive properties over alginates
Best for...
Same as alginates
Other indications/contraindications
- Non-recommended uses are the same as alginates.
- Benefit over alginates is that the frequency of wound care dressings can be several days longer ( )
Foams and Hydropolymer Derivatives
Comes in...
sheets with adhesive or ropes +/- antimicrobial
Works by...
foam
- trapping exudate and creating moist wound environment, polyurethane foam does this
hydropolymers
- promoting evaporation of exudate
Best for...
- A primary dressing for any sized cavity with moderate to heavy exudate
- A secondary dressing for heavily exudative wounds; may be placed on top of the primary dressing; the latter can include alginates or hydrofibers
- A secondary dressing for non-exudative wounds to limit shear force during the healing process
- Primary or secondary dressing for venous stasis ulcers
- Primary or secondary dressing for friable or painful neuropathic foot wounds
Other indications/contraindications
- Polyurethane foam dressings with high moisture-vapor transmission rates (MVTR) may allow for more days between dressing changes for highly exudative wounds.
- Foams are not indicated as primary dressings for dry wounds or wounds with minimal exudate as they may stick to the wound bed and removal may cause trauma or pain.
Gauze
Comes in...
sheets or bandages, dry or impregnated with iodine/petroleum
Works by...
trapping moisture in lattice
Best for...
- Petroleum-impregnation offers a non-stick and less painful variation that can promote a moist wound bed with varying occlusive properties
- Iodine-impregnated gauze strips offer wicking properties for small infected or moderately exudative wound spaces
- Elastic gauze bandages, when wrapped with tension, can compress venous stasis or bleeding wounds
- As a secondary dressing, gauze can provide adequate off-loading of pressure
Other indications/contraindications
- Dry gauze is only used as a secondary dressing over dressings with more potential to keep wound beds moist.
- With rare exception, dry gauze should not be applied as a primary dressing to any wound.
- Moist gauze as a wet-to-wet dressing is effective as a primary dressing for diabetic foot wounds.
- Wet-to-dry gauze, in which moist gauze is allowed to dry before removal, is contraindicated in palliative care settings due to excess trauma and pain.
Secondary and Tertiary
Transparent Film
- Waterproof yet permeable to oxygen
- Used to anchor the primary dressing
- Provides occlusion so that moisture is trapped within the wound
- Minimizes maceration of the peri-wound
- Transparent dressings can also be used as a primary dressing for shallow wounds, first-degree and second-degree burns and blisters.
Gauze
- Inexpensive common secondary dressing for heavily exudative wounds +/- foam dressing
- Anchor primary and secondary dressings
- Offloading foot wounds
Foam
- For heavily exudative wounds (particularly sacral ulcers, venous stasis ulcers).
- We do not advise foam dressings with adhesive for venous stasis ulcers as the latter can denude the surrounding tissue during removal.
Woven Abdominal Pads
- Woven abdominal pads are cost-effective alternatives to foam with higher absorptive strength than gauze.
Paper Tape
- Limited role as secondary dressing.
- Can close wounds with already closely approximated edges and area is free of moisture.
- Paper tape offers the advantages of low cost and low allergenic potential.
- When placed exclusively over the dressing without contact with the skin, it can provide adequate adhesion.
Cloth Tape
- Stretchable perforated cloth tape is a mainstay of home-based wound care.
- Stretchable cloth tape offers breathability, high adhesion, and conformability.
- Reduces moisture of the periwound, high occlusion to sweat, urine and feces and reduced blister-rates over traditional cloth tapes.
- The cost of stretchable tape, however, is significantly greater than standard silk or rubber-based tape.