What is the recommended dressing and management for a wound?

Recommended Wound Dressing and Management

The optimal wound dressing should be selected based on wound characteristics, with regular cleansing using sterile saline or clean water, debridement of necrotic tissue when possible, and application of a sterile dressing that maintains a moist wound environment while controlling exudate. 1, 2

Initial Wound Assessment and Cleansing

• Clean the wound thoroughly with sterile saline or clean potable tap water until all visible debris is removed 2
• Use warm water for irrigation as it is more comfortable while being equally effective 2
• Avoid additives such as soap or antiseptics in irrigation solutions as they provide no additional benefit and may impair healing 2
• Debride the wound when possible to remove slough, necrotic tissue, and surrounding callus, preferably using sharp debridement techniques 1
• For diabetic foot ulcers, regular debridement is associated with higher healing rates 1

Dressing Selection Based on Wound Characteristics

For dry or necrotic wounds:

• Use continuously moistened saline gauze 1
• Consider hydrogels to facilitate autolysis 1, 2
• Films (occlusive or semi-occlusive) can help moisturize dry wounds 1, 2

For exudative wounds:

• Use alginates to dry exudative wounds 1, 2
• Foam dressings are appropriate for absorbing exudate 1, 2
• Hydrocolloids can absorb exudate and facilitate autolysis 1, 2

For stoma sites (specific guidance):

• A glycerin hydrogel or glycogel dressing should be used as an alternative to classical aseptic wound care during the first week(s) 1
• After stoma healing (approximately one week), dressings can be reduced to once or twice weekly 1
• The site can be cleansed using soap and water of drinking quality 1

Important Considerations

• Do not use antimicrobial dressings with the goal of improving wound healing or preventing secondary infection 1
• There is no evidence that any specific type of dressing is superior to others for preventing infection or improving outcomes 1
• Simple gauze dressings have performed as well for healing diabetic foot ulcers as silver dressings, hydrogels, alginates, and foam dressings 1
• Apply a thin non-adherent contact layer directly to the wound surface to prevent adhesion to the wound bed 2
• Secure dressings with tubular bandage rather than adhesive tape to prevent further skin damage 2

Dressing Change Frequency

• Change dressings at least daily for infected wounds to allow careful examination of the wound 1
• For stoma sites, after healing, dressings can be reduced to once or twice weekly 1
• For adults and children over 2 years of age, apply dressing 1-3 times daily as needed 3

Special Considerations

• For negative pressure wound therapy (NPWT), use continuous settings of up to 80 mmHg 1
• When using NPWT for open abdomen wounds, an interface layer must be used to protect exposed organs and avoid adhesions 1
• For diabetic foot infections, total contact casts are generally not appropriate as they make it difficult to visualize and evaluate the wound 1

Monitoring and Follow-up

• Regular follow-up is necessary to assess healing progress and monitor for complications 2
• Arrange for wound check within 24-48 hours to ensure proper healing 2
• Monitor for signs of infection: redness, swelling, warmth, increasing pain, purulent drainage, or fever 2
• As wounds heal, the ideal dressing type may change depending on exudate amount and wound depth 4

The evidence consistently shows that no single dressing type is superior for all wounds, and selection should be guided primarily by wound characteristics, particularly moisture level and exudate control, rather than by claims of advanced healing properties 1.