Dressing Selection for Low Exudate Leg Wounds with Active Cellulitis
For low exudate leg wounds with active cellulitis, use a simple, cost-effective non-adherent or basic foam dressing that maintains moist wound healing—avoid antimicrobial dressings as they provide no benefit for healing or infection control when systemic antibiotics are appropriately treating the cellulitis. 1
Primary Dressing Approach
Select dressings based on exudate control, comfort, and cost rather than antimicrobial properties, as guideline evidence demonstrates no benefit from antimicrobial dressings for wound healing or prevention of secondary infection. 1, 2
For low exudate wounds specifically, avoid highly absorbent dressings like alginates or thick foams designed for moderate-to-high exudate, as these will remove necessary moisture from an already minimally draining wound. 3
Simple non-adherent dressings or thin foam dressings are appropriate as they maintain the moist wound environment necessary for healing without over-absorbing from low exudate wounds. 1
Why Antimicrobial Dressings Should Be Avoided
Strong guideline evidence explicitly recommends against using antimicrobial dressings (silver, iodine, or honey-based) with the goal of improving wound healing, as large multicenter RCTs showed no difference between non-adherent dressings, iodine-impregnated dressings, and carboxymethylcellulose dressings in terms of healing or infection incidence. 1
The cellulitis requires systemic antibiotic therapy—topical antimicrobials in dressings do not contribute to infection control and add unnecessary cost without improving outcomes. 1, 3
A Cochrane review found no evidence of benefit from antiseptic preparations for either healing or secondary infection in infected or contaminated wounds. 1
Practical Algorithm for Dressing Selection
Assess exudate level at each dressing change: For low exudate, use thin foam or non-adherent dressing; if exudate increases, switch to more absorbent options. 4
Monitor for signs of worsening infection (increased exudate, odor, pain, surrounding erythema) that would indicate need for antibiotic adjustment rather than dressing change. 4
Change dressing frequency based on saturation and comfort, typically every 2-3 days for low exudate wounds, but this can be extended if the dressing remains intact and the wound shows no concerning changes. 5
Critical Pitfalls to Avoid
Do not use occlusive dressings if infection is present, as they may promote bacterial growth—however, with active cellulitis being treated systemically, a semi-occlusive thin foam is acceptable. 2
Avoid the misconception that antimicrobial dressings will "help" the infection—they waste resources and provide no clinical benefit when systemic antibiotics are appropriately managing the cellulitis. 1, 3
Do not select highly absorbent gelling-fiber or hydrofiber dressings designed for moderate-to-high exudate wounds, as these are inappropriate for low exudate and will dry out the wound bed. 6, 7, 8