Wound Management: Dressing

1 May 2018

Author
Wound Healing and Management Node. Updated by: Dieu Huong Nguyen, MBBS, MHHSM

Question
What is the best available evidence regarding general principles for wound dressings?

Clinical Bottom Line

A wound requires different management and treatment at various stages of healing. Dressing is a key
component of wound management as it can facilitate debridement of the wound, control infection,
promote healing and provide protection from contamination and trauma. An ideal wound dressing is
capable of fulfilling the following functions: remove excess exudate and toxic components, maintain high
humidity at the wound-dressing interface, allow gaseous exchange, provide thermal insulation,
impermeable to bacteria, free from toxic components, allow change without trauma, acceptable to patient,
highly absorbent (particularly for highly exuding wounds), cost-effective, and provide mechanical
protection.1

• A clinical practice guideline for the prevention and management of venous leg ulcers found no evidence
to suggest a superior dressing for reducing healing time in venous leg ulcers. The choice of dressing
should be based on clinical assessment of the ulcer, cost, access and patient/health professional
preferences. (Level 1) Based on expert consensus, the guideline recommends the use of dressings or
bandages impregnated with zinc oxide to provide comfort and promote epithelialization of a healthy
granulated, superficial venous leg ulcer.2 (Level 5)
• A recent opinion –based guideline on venous leg ulcer management identified various types of dressings
along with their indications:3 (Level 5)

• Alginate is for wounds with heavy exudates

• Cadexomer iodine is for wound with malodorous exudate
• Foam is for wounds with mild to moderate exudates, wounds in granulation stage, surface epithelial
wounds in the setting of sensitive skin, ulcers in the terminal stage of clearing process and non-infective
wounds
• Hydrocolloid is for chronic wounds with mild to moderate exudates
• Hydrogel is for dry wound with covering fibrin and necrotic tissue

• A clinical practice guideline for the prevention and management of pressure injury identified the following

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recommendations:4

• ‘Consider using a hydrocolloid dressing to promote healing in non-infected stage II pressure injuries’
(Level 1)
• ‘Select wound dressings based on: comprehensive ongoing clinical assessment; management of pain,
malodour, exudate and infection; wound size and location; cost and availability; and patient preference.’
(Level 5)

• A clinical practice guideline for wound management of diabetic foot ulcers recommended the following:5
(Level 5)

• ‘Healthcare professionals should use wound dressings that match the clinical appearance and site of the
wound, as well as patient preferences. Dressing choice must begin with a thorough patient and wound
assessment.’
• ‘The status of the diabetic foot can change very quickly, especially if infection has not been appropriately
addressed. The need for regular inspection and assessment means that dressings designed to be left in
situ for more than five days are not appropriate for diabetic foot ulcer management.’
• ‘Wounds should be cleansed at each dressing change and after debridement with a wound cleansing
solution or saline. Cleansing can help remove devitalized tissue, re-balance the bioburden and reduce
exudate to help prepare the wound bed for healing. It may also help to remove biofilms.’

• A clinical practice guideline described various types of dressings suitable for managing wounds in
children:6 (Level 5)

• For dry necrotic wound: consider moisture retention dressings such as hydrocolloid and semi-permeable
dressing; review times should be 3-4 days.
• For slough-covered wounds: consider moisture retention and fluid absorption dressings such as
hydrocolloid and alginate; review times should be 3-4 days.
• For infected wound: avoidance of semi-occlusive dressings and consider alginate or hydrocolloid for
high exudate; review times should be 1-2 days.
• For clean graze, abrasions: dressing options are film, tulle, fixation sheet or dry; review times should be
2 days.
• For soiled graze, abrasions: dressing options are dry or tulle; review times should be 2 days.
• For puncture wounds or bites: dressings can be open or dry; review times should be 2 days.
• For laceration (sutured lacerations): dressings can be open or dry, also consider paper tape support
after suture removal; review times should be 3-7 days.
• For minor burns: dressing options are film, medicated tulle or fixation sheet; review times should be 4-5
days.
• For major burns: dressing can be plastic wrap prior to surgical review or medicated tulle; review times
dependent on inpatient review.
• For chronic wounds: dressing options are hydrocolloid, alginate or foam; review times should be 5 days.

• A clinical practice guideline described general principles for wound care, including considerations for the
choice of wound dressings. The guideline also identified dressing types for different characteristics of
wounds.7 (Level 5)

• General considerations for the choice of dressing: The dressing should maintain a moist environment at
the wound/dressing interface; be able to control excess exudate; not stick to the wound, shed fibers or
cause trauma to the wound or surrounding tissue; protect the wound from outside environment; good
adhesion to skin; sterile; aid in debridement; keep the wound close to normal body temperature; conform
to the body part; cost-effective; non-flammable and non-toxic; and for diabetic patients, should allow
frequent inspection.
• Guide for the choice of dressing for different types of wounds
• Dry wound: non-adherent island dressing, hydrocolloid, films (semi-permeable)
• Minimal exudate: hydrogel, hydrocolloid, silicone absorbent

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• Moderate exudate: calcium alginate, hydrofiber, foams, negative pressure, hydrocolloid (paste or
powder)
• Heavy exudate: hydrofiber, foam, absorbent dressing, negative pressure wound therapy, ostomy bags

• A systematic review investigated the effectiveness of wound dressings, and alternative wound dressings
in patients who had surgical intervention to prevent surgical site infections. The review reported as below:
8 (Level 1)

• There was inconclusive evidence to support the use of film dressing or hydrocolloid dressing or
silver-containing dressing in comparison to basic wound contact dressing following clean surgery (risk
ratio RR=1.34, 95%CI (0.70-2.55), and RR= 1.11, 95% CI (0.47-2.62) respectively).
• There was inconclusive evidence to support the use of hydrocolloid dressing or silver-containing
dressing in comparison to basic wound contact dressing following potentially contaminated surgery
(RR=0.57, 95%CI 0.22 to 1.51)

Characteristics of the Evidence

The evidence included in this summary is from a structured search of the literature and selected
evidence-based health care databases. Evidence in this summary is from:

• The findings and recommendations around wound dressing was underpinned by five systematic reviews
and over 40 moderate and low quality randomized controlled trials (RCTs), and consensus from experts.2

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• An article based on expert opinion.3
• The recommendations around wound dressing were informed by nine RCTs with moderate to high risk
of bias, and consensus from experts.4
• The recommendations are based on consensus from experts.5-7
• A systematic review of 29 trials that including 5,718 participants who had wounds as a result of surgical
procedures.8

Best Practice Recommendations

• No dressing is suitable for all wounds. The choice of wound dressing should be guided by a careful and
thorough assessment of the wound or ulcer (i.e. size, depth, exudate, color, and location), cost and
availability, and patient preference. (Grade A)

References
1. Nutrition, fluid balance and blood transfusion. In: Dougherty L and Lister S, editors. The Royal Marsden
Hospital Manual of Clinical Nursing Procedures. 8th edition. West Sussex: John Wiley & Sons; 2011. P.
371-460.
2. The Australian Wound Management Association Inc. and The New Zealand Wound Care Society Inc.
Australian and New Zealand clinical practice guideline for prevention and management of venous leg
ulcers. 2011; Available at:
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ext003_venous_leg_ulcers_aust_nz_0.p
df
3. Sinha S & Sreedharan S. Management of venous leg ulcers in general practice – a practical guideline.
Aust Fam Physician. 2014; 43(9):594-598. (Level 5)
4. The Australian Wound Management Association Inc. Pan Pacific clinical practice guideline for the
prevention and management of pressure injury. Cambridge Media Osborne Park, WA. 2012; Available at:
http://www.awma.com.au/publications/2012_AWMA_Pan_Pacific_Guidelines.pdf
5. Wounds International. International Best Practice Guidelines: Wound management in diabetic foot
ulcers. 2013; Available at: http://www.woundsinternational.com/media/issues/673/files/content_10803.pdf
6. The Royal Children’s Hospital Melbourne, Division of Medicine. Wound dressings – acute traumatic
wounds. 2013; Available at:
http://www.rch.org.au/clinicalguide/guideline_index/Wound_dressings_acute_traumatic_wounds/
7. The Royal Children’s Hospital Melbourne, Nursing Clinical Effectiveness Committee. Wound care.
2013; Available at: http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Wound_care/
8. Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. Dressings for the prevention of
surgical site infection. Cochrane Database Syst Rev. 2016; 12. (Level 1)

The author declares no conflicts of interest in accordance with International Committee of Medical Journal Editors (ICMJE) standards.
How to cite: Wound Healing and Management Node. Updated by: Dieu Huong Nguyen, MBBS, MHHSM. Evidence Summary. Wound Management:
Dressing. The Joanna Briggs Institute EBP Database, JBI@Ovid. 2018; JBI13924.
For details on the method for development see Munn Z, Lockwood C, Moola S. The development and use of evidence summaries for point of care
information systems: A streamlined rapid review approach. Worldviews Evid Based Nurs. 2015;12(3):131-8.
Note: The information contained in this Evidence Summary must only be used by people who have the appropriate expertise in the field to
which the information relates. The applicability of any information must be established before relying on it. While care has been taken to
ensure that this Evidence Summary summarizes available research and expert consensus, any loss, damage, cost or expense or liability
suffered or incurred as a result of reliance on this information (whether arising in contract, negligence, or otherwise) is, to the extent
permitted by law, excluded.
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