Can Xeroform gauze be used as a primary dressing for a venous leg ulcer?

Xeroform Gauze for Venous Leg Ulcers

Xeroform gauze is not recommended as a primary dressing for venous leg ulcers, as there is no evidence supporting its use for this indication, and moisture-retentive dressings are preferred for managing venous ulcers beneath compression therapy.

Why Xeroform Is Not Appropriate for Venous Ulcers

Lack of Antimicrobial Activity

• Xeroform (petrolatum gauze impregnated with 3% bismuth tribromophenate) demonstrates no measurable antimicrobial activity against common wound pathogens in laboratory testing, including MRSA, Pseudomonas aeruginosa, and other bacteria commonly found in chronic wounds 1
• While bismuth tribromophenate shows antimicrobial properties when tested independently, once bound to the Xeroform dressing material, this activity is completely lost 1
• The utility of Xeroform appears limited to serving as an impervious barrier dressing rather than providing any therapeutic antimicrobial benefit 1

Wrong Wound Type

• Xeroform has been studied primarily for clean surgical wounds such as skin graft donor sites and clean partial-thickness burns, not chronic wounds like venous ulcers 2, 3
• Venous leg ulcers are chronic wounds with a cyclical pattern of healing and recurrence that require moisture management and exudate control, which Xeroform does not adequately provide 4

What Should Be Used Instead

Evidence-Based Dressing Selection for Venous Ulcers

• Moisture-retentive dressings (hydrocolloids, foams, alginates, or hydrogels) should be selected based on exudate level and applied beneath compression therapy 4
• For moderate exudate in venous ulcers, hydrocolloid dressings are appropriate as they absorb exudate while maintaining a moist wound environment 5
• For heavy exudate, foam dressings with superior absorption capacity are preferred 5

The Evidence on Dressing Types

• A Cochrane systematic review of 42 randomized controlled trials found no evidence that any one dressing type was superior to others for venous ulcer healing when used beneath compression 4
• Importantly, hydrocolloid dressings showed no significant difference in healing rates compared to simple low-adherent dressings (RR 1.09,95% CI 0.89-1.34) 4
• The type of dressing does not affect ulcer healing as long as it maintains a moist wound environment and is used beneath appropriate compression therapy 4

Critical Clinical Considerations

Compression Is the Primary Treatment

• The main treatment for venous leg ulcers is compression therapy (compression bandages or hosiery), not the dressing itself 4
• Dressings are applied beneath compression primarily to aid comfort and control exudate, not as the primary healing modality 4

Practical Dressing Selection

• Choose dressings based on local costs, exudate management needs, and patient/practitioner preferences rather than expecting superior healing outcomes from expensive advanced products 4
• Avoid antimicrobial dressings solely to accelerate healing, as evidence does not support their use for wound healing enhancement in venous ulcers 6

Common Pitfalls to Avoid

• Do not use Xeroform for venous ulcers—it lacks evidence for this indication and does not provide the moisture management needed for chronic wound healing 1, 4
• Do not select dressings based on marketing claims when basic moisture-retentive dressings perform equally well 4
• Do not forget that compression is essential—even the best dressing will fail without adequate compression therapy for venous ulcers 4