What are the recommended dressings for pressure ulcers (bedsores) on the buttocks?

Recommended Dressings for Buttocks Pressure Ulcers

Use hydrocolloid dressings or foam dressings as your primary dressing choice for pressure ulcers on the buttocks, as they are superior to gauze for reducing wound size and achieving complete healing. 1

Primary Dressing Selection

Hydrocolloid dressings are the evidence-based first-line choice for buttocks pressure ulcers based on American College of Physicians guidelines, which demonstrate superiority over gauze dressings for reducing wound size 1. These dressings create a moist wound environment that facilitates autolytic debridement, reduces pain and scarring, and supports keratinocyte migration 2.

Key advantages of hydrocolloid dressings for buttocks ulcers:

• Two-layer design: Inner hydrocolloid adhesive absorbs exudate to form a hydrated gel, while the outer layer seals against bacterial contamination, urine, and feces—critical for buttocks location 3
• Extended wear time: Can remain in place 3-7 days depending on exudate levels, reducing disruption to wound bed 4, 3
• Equivalent efficacy to foam: Hydrocolloid and foam dressings show no significant difference for complete wound healing 1

When to choose foam over hydrocolloid:

• Heavy exudate: Foam dressings have superior absorptive capacity for copiously draining wounds 3
• Minimal drainage: Hydrocolloids require some exudate to function optimally; consider alternatives for very dry wounds 3

Dressings to Avoid

Do not use gauze dressings as they are inferior to hydrocolloid for wound size reduction 1.

Do not use dextranomer paste as it is inferior to other dressings for reducing wound size 1.

Avoid routine povidone iodine as it may impair healing compared to non-antimicrobial dressings 4.

Adjunctive Dressing Considerations

For infected wounds:

• Apply topical antimicrobials including iodine preparations, medical-grade honey, or silver-containing dressings when infection is clinically present 4
• Perform sharp debridement first to remove biofilm and necrotic tissue 4

For wounds with excessive inflammation:

• Consider collagen matrix dressings to reduce protease activity while promoting fibroblast proliferation 4

Transparent absorbent acrylic dressings:

• May offer advantages over hydrocolloid including better ability to assess wound without removal, improved conformability, longer wear time (5.7 vs 4.7 days), and superior patient comfort 5
• Particularly valuable when frequent wound visualization is needed 5

Critical Implementation Points

Change dressings based on clinical need, not fixed schedules: Typically every 1.5-3 days for moderate-to-heavy exudate, extending to 3-7 days as drainage decreases 4.

Essential concurrent interventions (these are non-negotiable):

• Protein or amino acid supplementation to reduce wound size, particularly in nutritionally deficient patients 1, 4
• Pressure offloading with support surfaces in all settings (sleeping, seating, transportation) 4
• Consider electrical stimulation as adjunctive therapy to accelerate healing for Stage 2-4 ulcers 4

Common Pitfalls

• Do not culture wounds without clinical signs of infection (using NERDS/STONES criteria), as this leads to inappropriate antibiotic use 4
• Do not supplement with vitamin C as no benefit has been demonstrated 1, 4
• Avoid rigid dressing change schedules—base frequency on exudate levels and dressing integrity 4
• Remember location matters: Buttocks ulcers require dressings with excellent barrier properties against fecal contamination 3