Best Dressing for Bedsores (Pressure Ulcers)
Select dressings primarily based on exudate control, comfort, and cost—not on antimicrobial properties or advanced wound healing claims. 1
Initial Wound Preparation
Before selecting any dressing, perform sharp debridement to remove necrotic tissue, slough, and any surrounding callus from the pressure ulcer. 1, 2, 3 This is the single most important intervention for promoting healing and should be done unless contraindications exist such as severe pain or ischemia. 1, 2
Dressing Selection Algorithm Based on Exudate Level
For Minimal to Moderate Exudate:
- Foam dressings are the optimal first choice, providing superior absorption while maintaining a moist wound environment. 3, 4
- Hydrocolloid dressings are an acceptable alternative, with evidence showing good performance in Stage II and shallow Stage III pressure ulcers. 5
- Transparent absorbent acrylic dressings may offer advantages in patient comfort, conformability, and longer wear time (5.7 vs 4.7 days) compared to hydrocolloids. 5
For Heavy Exudate:
- Alginate dressings are indicated due to their superior absorption capacity for moderate to high exudate levels. 6, 4
For Minimal Exudate or Dry Wounds:
- Hydrogel dressings can provide moisture to facilitate autolytic debridement. 4
What NOT to Use
Do not use dressings containing antimicrobial agents (silver, iodine, honey, polyhexamethylene) with the sole aim of accelerating healing. 1, 2, 3 The evidence does not support their use for wound healing enhancement. 1
Do not use collagen or alginate dressings specifically for the purpose of wound healing enhancement. 1 Nine of 12 studies showed no difference in healing outcomes. 1
Avoid occlusive dressings if infection is present, as they may promote bacterial growth. 2
Special Consideration for Hard-to-Heal Ulcers
If the pressure ulcer shows insufficient improvement after 2 weeks of optimal standard care (including proper offloading and debridement), consider sucrose-octasulfate impregnated dressing as an adjunctive treatment. 1, 6 This is supported by one large, high-quality randomized controlled trial showing significant improvement in complete wound healing at 20 weeks. 1
Essential Concurrent Interventions
Pressure relief is mandatory and equally important as dressing selection. 7 The ulcer will not heal without eliminating pressure from the affected area. 7
Maintain a moist wound environment, which facilitates autolytic debridement, reduces pain and scarring, and supports keratinocyte migration. 4, 7
Clean the wound regularly with clean water or saline to remove debris. 6
Common Pitfalls to Avoid
Do not select expensive advanced dressings based on marketing claims when basic dressings selected for exudate control perform equally well. 1
Do not use topical phenytoin or herbal preparations—the evidence is of low certainty despite multiple studies. 1
Do not neglect underlying conditions such as diabetes or vascular disease, which require concurrent management for optimal healing. 7
Reassess the wound weekly and adjust treatment if no improvement is seen after 2-4 weeks. 3, 6