Part 2: Picking the correct wound dressing

The responsibility of choosing the correct wound dressing for multiple types and aetiologies of wounds we come across, is a daunting task for clinicians who specialise in Tissue Viability, let alone for the non-specialist clinicians managing wounds on a day-to-day basis.

White et al, (2017) comments on how the development of specialist nurses, has resulted in frontline staff waiting for a TVN assessment (across all healthcare settings), rather than thinking for themselves. Often, due to a lack of accessible training either at university or through the workplace, inexperienced nurses, who lack the knowledge on how dressings interact with the wound bed to promote healing, are being asked to work with limited formularies which may not have the most appropriate dressings available.

Alongside this, there is a growing number of Healthcare Assistants (HCAs) being requested to do things outside of their competencies and skills, for which they have not received the training or additional knowledge because of time, cost, and staffing pressures.

Guest et al, (2020) estimated there were 3.8 million patients with wounds managed by the NHS in 2017/18. This figure resulted in 54.4 million Community Nurse visits, 53.6 million HCA visits, and 28.1 million Practice Nurse visits. Guest et al also estimated the annual cost to the NHS for managing healed wounds to be £2.7 billion, with unhealed wounds costing £5.6 billion which accounts for 81% of the total NHS cost incurred in the community.

What to consider when picking a wound dressing

Wound healing is a complex, overlapping process which needs to occur to achieve closure of a wound and restoration of the epithelial layer of the skin (Cullen and Gefen, 2022). Clinicians who are responsible for day-to-day wound management should have an in-depth understanding of this process so they can assess if the healing process is ‘stuck’ in any phase and needs additional intervention to move it forward to healing again. This process has four overlapping phases:

1. haemostasis (controlling the initial bleeding)
2. inflammatory phase (cleaning and debriding damaged tissue)
3. proliferative phase (new tissue growth, wound contraction, epithelialisation)
4. and maturation phase (when the scar tissue matures and realigns)

The main objective of a wound dressing is to mimic the skin and functions to a standard that promotes healing (Siavash, M. Noursina, A. 2023). They are technical products designed to create an ideal environment for wound healing while managing the symptoms of the wound’s biological activity. They must manage moisture/exudate levels by absorbing excessive exudate, reduce bacterial contamination, conform to the wound interface (sit flush to the wound bed), to help eliminate dead space, promote gaseous exchange, debride devitalised tissue to help restore/repair the wound to as normal an appearance, structure and function of that of the original tissue that was there (Deutsch et al, 2017. Ashenden et al, 2021).

Although dressings are a very important part of wound care, they alone do not lead to successful healing, and therefore it should never be just about the dressing selection. To be able to choose the most appropriate dressing, the wound needs to be assessed and the aetiology of the wound determined so the dressing, or combination of dressings selected, best suit the local wound environment, phase of wound healing, and the expected wound healing outcomes that can be achieved.

The assessment needs to take into consideration the following characteristics which is critical to wound dressing selection. This process should follow the wound assessment guidelines set out by the Trust, care home group or acute sector.

• Location
• Size – length (measured head to toe), width (measured side to side), and depth.
• Extent of tissue loss – superficial thickness (epidermis), partial thickness (epidermis and dermis), and full thickness (extending below dermis and including subcutaneous fat, muscle, tendon, ligament and/or bone).
• What type of tissue is in the wound bed?
  • Necrotic tissue – usually dry, hard and black
  • Sloughy tissue – usually wet, yellow, brown or grey and associated with high exudate and odour
  • Granulation tissue – moist, red, healthy and filling up the space
  • Epithelial tissue – pink or white tissue migrating from the wound edges across the surface of the filled wound (Ashenden et al, 2021)
  • Wound edges – assessed for dryness, callus build up, maceration (peri-wound dermatitis), inflammation, oedema
• Amount of wound exudate
• Presence of local wound infection
• Pain
• Patient comorbidities which may impact on their ability to heal effectively
• Any allergies (which may restrict some dressing usage)
• Patient compliance (which may restrict the use of more complex dressings such as Topical Negative Pressure, compression, Larvae, pressure ulcers)
• What wound dressings have been used previously?
• What is acceptable to the patient, their lifestyle, cultural or religious or personal preferences?

(Ashenden et al, 2021. Brown, 2015. Deutsch et al, 2017)

(Adapted from Annesley, 2019)

The most common wound dressing Types

Gauze – its use as a primary dressing, to promote healing, is outdated as it will adhere if it dries out and becomes painful to remove. Its use in wound care is as a medium for cleansing and as a temporary dressing to stop bleeding or covering a wound which requires a temporary dressing while awaiting assessment.

Non-adherent dressing – normally a mesh impregnated with paraffin, lipid-colloid, or made from silicone, which is used to cover a superficial open wound, laceration. They are designed not to stick to a drying wound and to prevent damage to fragile granulation or epithelialisation tissue.

Examples include Atraumen, Jelonet, Mepitel, Silflex, Melonin, NA + NA Ultra.

Self-adhesive absorbent dressings – simple sterile dressings with a central semi-permeable pad and an outer adhesive border. They are cost effective dressings normally used for post-operative wound dressings, minor surgery, and non-complex, simple wounds.

Examples include Mepore, Cosmopor, Advapore, Ultrapore.

Semi-permeable dressings – these are transparent film dressings which allow water vapour and carbon dioxide to escape, while maintaining a local moist wound environment. They do not have good absorbency properties so should not be used on moderate to high exudating wounds. Their transparency allows for monitoring of the wound, where appropriate (may be suitable for young children). They can also be used as an adhesive secondary wound dressing to hold non adhesive primary dressings in place.

Examples include C-View, Mepitel film, Opsite, Tegaderm.

Occlusive dressings/Hydrocolloid – these are made from highly absorbent polysaccharides which change into a gel-like substance when in contact with wound fluid. Recommended for light to moderate exudating wounds as they do not cope well with high exudate. They provide a moist wound environment which can help promote autolytic debridement, promote granulation and epithelialisation. They are occlusive so should not be used on infected or heavily colonised wounds, or patients who are high risk of infection (i.e diabetic feet, peripheral vascular disease, immunocompromised). They may need to be changed more regularly initially and may need an adhesive remover to help to break the high adhesive seal.

Examples include Comfeel Plus, Duoderm Extra Thin, Granuflex.

Hydrogels – these are made up of mainly water suspended in a gel base and are generally used for hydrating a dry wound or necrotic tissue. They are able to absorb high levels of exudate and maintain a moist wound environment, so their use can be extended across a range of wound types, including wounds that are painful. Their use should be monitored as their hydration properties can lead to maceration of the wound bed or edges if the wound gets too wet.

Examples include Actiform cool, Aquaform Hydrogel, Intrasite gel or conformable.

Alginates – these wound dressings are made up of calcium alginate derived from brown seaweed and is a biodegradable product. The alginate interacts with the wound fluid causing the fibres to gel, creating a hydrophilic (attracts water) surface in contact with the wound bed. They are used for moderate to heavily exudating wounds and can be used on infected, sloughy cavity, as well as granulating tissue. Should not be used on wounds with a low exudate as there is a risk to the fibres sticking to the wound bed and margins, which may cause trauma on removal. 

Examples include Kaltostat, Sorbsan, UrgoSorb, Algosteril, Biatain Alginate.

Hydrofiber – these are similar in action to Alginates but are not biodegradable. They are made from shredded hydrocolloid fibres and are designed for use on moderate to high exudating wounds (in conjunction with a superabsorbent secondary dressing).

When the dressing encounters the wound exudate, it changes from a dry fibre to a soft gel, which retains the wound exudate within the cells. The soft gel creates a moist wound healing environment at the wound interface (where the dressing meets the wound bed), and any excessive moisture is wicked away into a suitable secondary dressing. The soft gel aids autolytic debridement of sloughy tissue and can be used on the same wound types as Alginate. Again, they should not be moistened prior to application or used on dry wounds.

Examples include Aquacel Extra, KerraCel, Versiva XC.

Foam dressings – these are designed to absorb wound exudate into a central pad taking it away from sitting on the wound bed. They tend to be vapour (gas) permeable and can absorb moderate amounts of exudate, partially through the mechanism of wicking and evaporation from the surface of the dressing. The absorbency of the dressing can be affected if they are covered by an occlusive dressing such as a film. They can be a non-adhesive pad which will need a secondary contact layer to stick it to the skin or can be used under bandages or with adhesive borders.

Many have a silicone contact layer making them easy to remove from fragile or granulation tissue.  It is important to note that the effectiveness of retaining the exudate, within the pad, can be affected by pressure and can cause leakage; for example, when they are used on feet and walked on (Schultz et al, 2019). This can increase the risk of maceration to the wound margins and therefore it is recommended that foams are not used on vulnerable feet.

Examples of companies that manufacture foam dressings are Biatain, Mepitel, Convatec, Coloplast, Activheal, Urgo, Tegaderm.

Absorbent and Superabsorbent wound dressings – these are designed to absorb moderate to high levels of wound exudate while maintaining a moist, warm wound environment which supports healing. They mostly have granules in the core of the dressing, like nappies, which absorb and lock away large amounts of fluid. They can be used as primary dressings to absorb fluid from superficial wounds and are often wrapped around leaky lower legs associated with oedema or venous insufficiency. They can be used as secondary dressings over larger, deeper wounds which are initially packed with a hydrofiber or alginate.

This combination increases the fluid healing capacity for the overall dressings and can result in increased wear time, reduce peri-wound maceration and leakage. It is still very important that they are not allowed to become heavy and uncomfortable for the patients. They are now available in bordered and non-bordered versions.

Examples include Xupad, Kliniderm, Zetuvit E, Eclypse, Mesorb.

(Lagoa et al, 2024. Ashenden et al, 2021. Deutsch et al,2017, Brown, 2015. Jones, 2016, Jones, 2015)

Final Tips:

• Follow your local guidelines/ protocols and wound dressing formulary.
• Read the manufacturer’s instruction if you are unfamiliar with that particular wound dressing.
• If the dressing is not managing the symptoms of the wound and supporting healing, please contact your District Nurse / Tissue Viability Nurse for advice.
• Anytime you change the type of dressing used on a wound, you should complete a new wound assessment and document your rationale for the change, so the wound progress is easy to follow.

The next article in this series will look at antimicrobial wound dressings and how they should be used correctly.

Please cite as: OSKA Care Ltd. (March 2025). Wound Management Series: Picking the correct wound dressing. Havant, Portsmouth: OSKA Care Ltd.

References

Annesley, S.H. (2019). Current thinking on caring for patients with a wound: a practical approach. British Journal of Nursing. Vol 28(5). Available at https://doi-org.ezproxy.brighton.ac.uk/10.12968/bjon.2019.28.5.290 (accessed 21/01/25)

Ashenden, L. et al (2021). Undressing the choice of dressings. British Journal of Hospital Medicine. (available at https://doi.org/10.12968/hmed.2021.0226) (accessed 21/01/25).

Cullen, B. Gefen, A. (2022). The biological and physiological impact of the performance of wound dressings. International Wound Journal. 15;20(4):1292-1303. (Accessed 21/01/25)

Deutsch, C.J., Edwards, D.M., Myers, S. (2017) Wound dressings. British Journal of Hospital Medicine. Vol 78, (7). Pg C103-109. (Downloaded from magonlinelibrary.com by 086.021.025.106 on January 10, 2025)

Guest JF, Fuller GW, Vowden P. (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open.  22;10(12):e045253. doi: 10.1136/bmjopen-2020-045253. PMID: 33371051; PMCID: PMC7757484. (Accessed 21/01/25)

Lagoa, T. Queiroga, M.C., Martins, L. (2024). An overview of wound dressing materials. Pharmaceuticals, 17, 1110. https://doi.org/10.3390/ph17091110 (accessed 21/01/25).

Lloyd Jones, M. (2016). Wound dressings, Part 3: absorbent dressings. British Journal of Healthcare Assistants, Vol 10 (3). Pg 112 – 116.

Lloyd Jones, M. (2016). Wound dressings, Part 4: Antimicrobials. British Journal of Healthcare Assistants, Vol 10 (1). Pg 9 – 11.

Schultz, G et al (2019). WUWHS Consensus Document: Wound exudate, effective assessment and management. Available at WUWHS Consensus Document: Wound Exudate, effective assessment and management – Wounds International. Accessed 11/02/25

White, R. et al. (2017). Letters: Comment on Guest et al. ‘The health economic burden that acute and chronic wounds impose. Journal of wound care, Volume 26, Issue 6, pg. 353-355. (Accessed 21/01/25)