Can I use Mesalt (sodium chloride‑impregnated gauze) together with a topical collagen dressing?

Can You Use Mesalt with Topical Collagen Dressing?

No, you should not use Mesalt (sodium chloride-impregnated gauze) with topical collagen dressings for diabetic foot ulcers or most chronic wounds, as both products lack evidence for improving wound healing outcomes and collagen dressings are specifically not recommended for diabetic foot ulcers. 1

Evidence Against Both Products

Collagen Dressings Are Not Recommended

• The International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines provide a strong recommendation against using collagen dressings for wound healing in diabetes-related foot ulcers (Strong recommendation; Low certainty of evidence). 1
• Of 12 RCTs examining collagen or alginate dressings, nine showed no difference in wound healing or ulcer area reduction at study completion. 1
• The evidence base is compromised by moderate to high risk of bias across studies, with most being non-blinded. 1

Mesalt (Antimicrobial/Salt Dressings) Are Not Recommended

• The IWGDF 2024 guidelines strongly recommend against using topical antiseptic or antimicrobial dressings for wound healing of diabetes-related foot ulcers (Strong recommendation; Moderate certainty of evidence). 1
• Dressings should be selected based on exudate control, comfort, and cost—not antimicrobial properties or healing enhancement claims. 2, 3

What You Should Use Instead

Standard of Care Approach

• Use basic wound contact dressings (simple gauze or non-adherent dressings) that absorb exudate and maintain a moist wound environment. 1, 3
• These perform equally well as expensive specialized dressings and are more cost-effective. 3
• For high-exudate wounds, foam or alginate dressings are appropriate solely for their absorption properties—not for healing enhancement. 2, 3

Critical Components That Actually Matter

• Sharp debridement is the cornerstone of management and should be performed regularly based on clinical need. 1, 3
• Proper off-loading is essential and more critical than dressing choice. 3
• Address vascular insufficiency, infection control, and glycemic management. 1

Common Pitfalls to Avoid

• Do not select dressings based on marketing claims about antimicrobial properties or accelerated healing—these have not been shown to improve outcomes in diabetic foot ulcers. 2, 3
• Do not combine multiple specialized dressings without evidence—there is no data supporting synergistic effects of Mesalt plus collagen. 2
• Do not use expensive specialized dressings routinely when basic dressings are equally effective. 3

When Standard Care Fails

If a non-infected, neuro-ischemic diabetic foot ulcer shows insufficient improvement after at least 2 weeks of best standard care (including appropriate off-loading):

• Consider sucrose-octasulfate impregnated dressing (Conditional recommendation; Moderate certainty). 1, 3
• Consider autologous leucocyte, platelet, and fibrin patch where resources and expertise exist. 1, 3