What is the recommended dressing for diabetic foot ulcers?

Recommended Dressing for Diabetic Foot Ulcers

Select dressings based primarily on exudate control, comfort, and cost—not on antimicrobial properties or claims of accelerated healing. 1

Standard Dressing Approach

The evidence strongly supports a simple, practical approach to dressing selection:

• Basic wound contact dressings (simple gauze or non-adherent dressings) are the standard of care and perform equally well as more expensive specialized dressings for diabetic foot ulcers. 1, 2

• For high-exudate wounds, foam or alginate dressings provide superior absorption and are appropriate choices based on their exudate management properties—not for healing enhancement. 2, 3

• The primary function of any dressing is to maintain a moist wound environment, control exudate, and provide comfort. 1, 2

What NOT to Use

The 2024 IWGDF guidelines provide strong recommendations against multiple dressing types:

• Do not use antimicrobial dressings (including silver or iodine-impregnated dressings) with the goal of accelerating wound healing. 1 (Strong recommendation; Moderate certainty)

• Do not use collagen or alginate dressings for the purpose of wound healing in diabetic foot ulcers. 1, 4 (Strong recommendation; Low certainty)

• Do not use honey or bee-related products for wound healing purposes. 1, 4 (Strong recommendation; Low certainty)

• Do not use herbal remedy-impregnated dressings or topical phenytoin. 1, 4 (Strong recommendation; Low certainty)

Important Context: Dressings Are Secondary to Debridement and Off-Loading

The evidence makes clear that dressing selection is far less important than other interventions:

• Sharp debridement is the cornerstone of diabetic foot ulcer management and should be performed regularly based on clinical need. 1, 2

• Proper off-loading of the ulcer is essential and more critical than dressing choice. 2, 4

• Research consistently shows no statistically significant differences in healing rates between different dressing types when standard care (debridement and off-loading) is provided. 5, 6

Second-Line Options for Non-Healing Ulcers

If standard care fails after at least 2 weeks:

• Consider sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic ulcers that have shown insufficient improvement with best standard care including appropriate off-loading. 1, 4 (Conditional recommendation; Moderate certainty)

• Consider autologous leucocyte, platelet, and fibrin patch where resources and expertise exist for regular venepuncture. 1, 4 (Conditional recommendation; Moderate certainty)

Common Pitfalls to Avoid

• Do not select dressings based on marketing claims about antimicrobial properties or accelerated healing—these have not been shown to improve outcomes. 1

• Do not use expensive specialized dressings routinely—basic wound contact dressings are equally effective and more cost-effective. 1, 6

• Do not neglect the fundamentals—even the best dressing will fail without adequate debridement, off-loading, and vascular assessment. 2, 7

Practical Algorithm for Dressing Selection

1. Perform sharp debridement first (unless contraindicated by severe ischemia). 1, 2

2. Assess exudate level:

   • Minimal exudate → Basic wound contact dressing (simple gauze or non-adherent) 1, 2
   • Moderate to heavy exudate → Foam or alginate dressing for absorption 2, 3

3. Ensure proper off-loading is in place. 2, 4

4. If no improvement after 2 weeks with standard care → Consider sucrose-octasulfate dressing for non-infected neuro-ischemic ulcers. 1, 4

5. Change dressings frequently to allow wound inspection and prevent maceration of surrounding skin. 3