What dressings are recommended and contraindicated for wound care?

Wound Dressing Selection and Contraindications

Use basic dressings that absorb exudate and maintain a moist wound environment as your standard approach—hydrocolloid or foam dressings are recommended for most wounds, while antimicrobial, antiseptic, honey, collagen, and alginate dressings should be avoided as they do not improve healing outcomes. 1, 2

Recommended Dressings by Wound Type

For Pressure Ulcers

• Hydrocolloid dressings are superior to gauze dressings for reducing wound size and are equivalent to foam dressings for complete healing 1
• Foam dressings (hydrocellular or polyurethane) perform similarly to hydrocolloids and are effective for moderate to heavy exudate 1, 2
• Both options maintain the moist environment necessary for optimal healing 1

For Diabetic Foot Ulcers

• Basic moisture-retentive dressings that absorb exudate are the standard of care 1, 2
• Sucrose-octasulfate impregnated dressings may be considered only for non-infected, neuro-ischemic ulcers that have failed to improve after at least 2 weeks of standard care including appropriate off-loading 1, 2
• This is a conditional recommendation and should be reserved for specific refractory cases 1

For Superficial Wounds and Abrasions

• Occlusive dressings (films, petrolatum, hydrogel, cellulose/collagen) promote better wound healing than dry dressings 1
• Simple coverage with occlusive materials is reasonable for clean superficial wounds 1

Based on Exudate Level

• Dry or necrotic wounds: Use hydrogels to facilitate autolysis, or continuously moistened saline gauze 2, 3
• Moderate to heavy exudate: Use foams or alginates for absorption 2, 3
• Light exudate: Hydrocolloids absorb exudate while maintaining moisture 2, 3

Strongly Contraindicated Dressings

For Diabetic Foot Ulcers (Strong Recommendations)

• Do NOT use topical antiseptic or antimicrobial dressings—they do not improve wound healing outcomes 1, 2
• Do NOT use honey or bee-related products—no evidence of benefit 1, 2
• Do NOT use collagen or alginate dressings—specifically contraindicated for diabetic foot ulcers 1, 2
• Do NOT use topical phenytoin 1
• Do NOT use herbal remedy-impregnated dressings 1, 2

General Contraindications

• Avoid occlusive dressings if infection is present—they may promote bacterial growth 2
• Do NOT use antibiotic or antibacterial dressings for clean wounds—no evidence they improve healing or decrease infection rates 1

Critical Wound Care Principles

Wound Preparation

• Clean with running tap water or sterile saline before dressing application—both are equally effective and superior to antiseptic agents like povidone-iodine 1, 2
• Sharp debridement is the standard for diabetic foot ulcers, not autolytic, biosurgical, hydrosurgical, chemical, or laser debridement 1, 2
• Frequency of debridement should be determined by clinical need 1

Dressing Change Frequency

• Change dressings at least daily for infected wounds to allow careful examination 1
• For stable wounds, change once or twice weekly based on exudate levels 2
• More frequent changes may be needed for heavily exudating wounds 2

Special Considerations for Vaginal/Vulvar Surgery

• Vaginal packing does NOT decrease postoperative bleeding or hematoma formation and may increase infection rates when left longer than 24 hours 1
• Occlusive dressings may be used after laser treatment to promote healing 1

Common Pitfalls to Avoid

The antimicrobial trap: Despite intuitive appeal, antimicrobial and antiseptic dressings have consistently failed to demonstrate benefit in multiple high-quality studies and should not be used routinely 1, 2. This represents a strong recommendation with moderate-quality evidence.

The specialty dressing misconception: Collagen and alginate dressings, while effective for some wound types, are specifically contraindicated for diabetic foot ulcers despite being marketed for wound care 1, 2. The evidence shows no benefit and represents wasted resources.

Wound irrigation confusion: Tap water performs as well as sterile saline for irrigation—there is no need for expensive sterile solutions or antiseptics for routine wound cleansing 1, 2.

Over-reliance on packing: Vaginal packing after surgery does not prevent complications and prolongs catheterization, increasing UTI risk 1. This practice should be abandoned or limited to very short durations.

Monitoring for Complications

Watch for signs requiring dressing removal and medical evaluation 1:

• Redness or swelling around the wound
• Foul-smelling drainage
• Increased pain
• Fever
• These signs indicate possible infection requiring antibiotic therapy 1