Dressing a Venous Stasis Ulcer with Only Gauze
Use sterile gauze moistened with normal saline or clean water as the primary dressing, changed every 2 days, to maintain a moist wound environment and control exudate while preventing adherence to the wound bed. 1
Wound Preparation
Before applying any dressing, clean the ulcer with clean water or normal saline to remove debris from the wound surface. 1 If possible, debride necrotic tissue and surrounding callus with sharp debridement to promote healing, though this should be done by trained personnel and avoided in severe ischemia. 1
Primary Dressing Application
Moisten sterile gauze with normal saline or clean water before applying directly to the wound bed—this prevents the gauze from adhering to the ulcer and causing trauma during removal while maintaining the moist environment essential for healing. 1, 2
Apply the moistened gauze gently over the entire wound surface, ensuring complete coverage without excessive pressure. 1
The gauze serves as a sterile, inert dressing that controls exudate and maintains warmth and moisture—both critical factors for promoting venous ulcer healing. 1
Secondary Dressing Layer
Cover the primary moistened gauze with additional dry sterile gauze layers to absorb excess exudate and provide cushioning. 1
Secure the dressing with tape or a bandage roll, ensuring it remains occlusive but not constrictive. 1, 2
If the wound is bleeding or oozing significantly, sterile gauze is actually preferable to other dressing types as it provides better absorption for these situations. 1
Dressing Change Frequency
Change gauze dressings every 2 days as standard practice. 1
Change the dressing sooner if it becomes damp, loosened, or soiled—moisture breakthrough compromises the sterile barrier and can lead to infection. 1
At each dressing change, inspect the wound for signs of infection including increased exudate, odor, pain, or surrounding erythema. 3
Critical Technique Points
Use no-touch or aseptic technique when applying dressings—avoid touching the wound or the inner surface of the gauze with hands or gloves. 1
Perform hand hygiene before and after dressing changes, and use clean or sterile gloves throughout the procedure. 1
After removing the old dressing, clean the wound area, allow it to dry completely, then apply fresh moistened gauze. 1
Common Pitfalls to Avoid
Never apply dry gauze directly to the wound bed—this will adhere to granulation tissue and cause painful trauma and bleeding during removal, disrupting the healing process. 1, 2
Do not use topical antimicrobial ointments routinely at the wound site, as these may promote fungal infection and antimicrobial resistance without improving healing outcomes. 1
Avoid excessive tension or compression from the external dressing that could compromise local blood flow—venous ulcers require adequate perfusion for healing. 1
Do not rely solely on dressings to heal venous ulcers; compression therapy and addressing underlying venous hypertension are essential components that gauze dressings alone cannot provide. 4, 5
Limitations of Gauze-Only Approach
While gauze dressings are acceptable for basic wound care, they have significant limitations compared to modern dressings. Gauze requires more frequent changes (every 2 days versus 7 days for transparent dressings), provides less effective exudate management than foam dressings, and offers no compression to address the underlying venous hypertension. 1, 3 The recurrence rate for venous ulcers approaches 70%, largely because dressings alone do not address the pathophysiology—compression therapy and lifestyle modifications are critical for long-term success. 4