What creams are recommended for wound healing?

Wound Healing Creams and Topical Applications

For most wounds, basic dressings that maintain a moist environment and control exudate are recommended over specialized creams or antimicrobial products, as evidence does not support superior healing with expensive topical agents. 1

Standard Approach to Wound Care

Primary Wound Management

• Select dressings based on exudate control, comfort, and cost—not on antimicrobial properties or healing enhancement claims. 1, 2
• Basic wound contact dressings (simple gauze, non-adherent dressings) perform equally well as expensive specialized products for most wounds. 2
• The goal is to maintain a moist wound environment while controlling drainage and avoiding tissue maceration. 1, 3

What NOT to Use

Strongly avoid these topical agents for wound healing purposes:

• Do not use antimicrobial creams or dressings (silver, iodine, povidone-iodine) with the goal of accelerating healing—these show no benefit over standard care. 1 (Strong recommendation; Moderate certainty)
• Do not use honey or bee-related products for wound healing. 1 (Strong recommendation; Low certainty)
• Do not use collagen creams or alginate dressings for the purpose of wound healing. 1 (Strong recommendation; Low certainty)
• Do not use topical phenytoin for wound healing. 1
• Do not use herbal remedy-impregnated creams or applications. 1, 2

Specific Clinical Scenarios

For Diabetic Foot Ulcers

• Sharp debridement is the cornerstone of management—more critical than any topical agent. 1, 2
• Proper off-loading is essential and takes priority over dressing selection. 2
• Consider sucrose-octasulfate impregnated dressing only for non-infected, neuro-ischemic diabetic foot ulcers that have failed standard care (including appropriate off-loading) for at least 2 weeks. 1, 2 (Conditional recommendation; Moderate certainty)

For High-Exudate Wounds

• Use foam or alginate dressings for their superior absorption properties—not for healing enhancement. 4, 5
• The primary purpose is exudate management, not antimicrobial activity. 4, 5

For Critical Limb-Threatening Ischemia (CLTI)

• Wound care must be implemented concurrently with revascularization. 1
• After revascularization, optimize the wound-healing environment with basic wound care principles. 1
• Consider hyperbaric oxygen therapy for nonhealing diabetic foot ulcers after revascularization where resources exist. 1 (May be considered; Moderate certainty)

Advanced Therapies (Second-Line Only)

Consider these only when standard care has failed:

• Autologous leucocyte, platelet, and fibrin patch for diabetic foot ulcers where resources and expertise exist for regular venepuncture. 1, 2 (Conditional recommendation; Moderate certainty)
• Placental-derived products as adjunct therapy where standard care has failed. 1 (Conditional recommendation; Low certainty)
• Negative pressure wound therapy (NPWT) after revascularization and minor amputation when primary closure is not feasible. 1

Common Pitfalls to Avoid

• Do not select dressings based on marketing claims about antimicrobial properties—these have not been shown to improve outcomes. 2
• Do not use expensive specialized creams routinely—basic wound contact dressings are equally effective and more cost-effective. 2
• Do not use multiple antimicrobial agents simultaneously without evidence for improved outcomes. 4
• Do not neglect debridement and off-loading in favor of topical agents—these mechanical interventions are more important than any cream. 1, 2

Essential Components Beyond Topical Agents

These interventions are more critical than any cream or topical application:

• Sharp debridement based on clinical need 1, 2
• Pressure off-loading when appropriate 1, 2
• Revascularization for adequate perfusion in ischemic wounds 1
• Management of infection with antibiotics and surgical debridement 1
• Medical optimization: smoking cessation, glycemic control, cardiovascular risk modification, nutrition 1