17.7 Guide to primary dressing selection

Basic principle of moist wound healing: if it is dry wet it, if it is wet dry it and if it is moist maintain it. Dressings do not heal wounds, what they do is provide the correct environment for healing to occur.

Use a barrier to surrounding skin when using wet dressings, when the wound is highly exuding or the skin is fragile. For wet wounds use extra absorbent secondary dressing.

Refer to relevant specialist if wound is not responding or deteriorating with standard treatment choices or if you require support to make choices in complex situations.

When treating infected wounds use topical antimicrobials in combination with antibiotics – see Chapter 5, Skin infections and infected wounds for more information

Dry - low exudate

Necrotic heel

Consider vascular supply prior to debridement. If patient is diabetic ensure appropriate podiatry input is accessed in line with the Community Diabetic foot pathway or Acute Diabetes Foot pathway.

  • Hydrogel (except for diabetic foot)
  • Hydrocolloid (except for diabetic foot)
  • Honey
  • Sharp/surgical

Necrotic other

  • Hydrogel
  • Hydrocolloid
  • Honey
  • Sharp/surgical

Sloughy

  • Hydrogel
  • Hydrocolloid
  • Honey
  • Larvae

Granulating

  • Hydrogel
  • Hydrocolloid

Epithelialising

Wound contact low adherent layer

  • Layer
  • Film
  • Fabric + pad
  • Film + pad

Infected

Consider need for antiseptic irrigation/soak product

  • Povidone iodine
  • Honey
  • PHMB
  • Silver sulphadiazine cream

Moist - medium exudate

Necrotic heel

  • Alginate
  • Hydrofibre
  • Honey
  • Larvae
  • Sharp/surgical

Necrotic other

  • Alginate
  • Hydrofibre
  • Larvae
  • Sharp/surgical

Sloughy

  • Alginate
  • Hydrofibre
  • Honey
  • Larvae

Granulating

Wound contact low adherent layer

  • Foam
  • Alginate
  • Hydrofibre

Epithelialising

Wound contact low adherent layer

  • Layer
  • Foam

Infected

  • Cadexomer iodine
  • DACC low adherent layer
  • Honey
  • PHMB
  • Silver

Wet - high exudate

Use barrier to surrounding skin

Necrotic heel

  • Hydrofibre
  • Alginate
  • Cadexomer iodine
  • Sharp/surgical

Necrotic other

  • Hydrofibre
  • Alginate

Sloughy

  • Hydrofibre
  • Alginate
  • NPWT

Granulating

  • Hydrofibre
  • Alginate
  • Foam
  • NPWT

Epithelialising

Unusual presentation – consider referral to Tissue Viability

  • Hydrofibre
  • Alginate
  • Foam

Infected

  • Cadexomer iodine
  • DACC low adherent layer
  • Honey
  • PHMB
  • Silver
  • NPWT

 

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