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Types of Wound
Dressings:
FEATURES, INDICATIONS AND CONTRAINDICATIONS

JUNE 2018
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Types of Wound
Dressings:
FEATURES, INDICATIONS AND CONTRAINDICATIONS

Wound Dressings 101

Considerations in Dressing Selection
When treating a wound—whether chronic or acute—health care professionals have many
choices for dressings; but which dressing will best help to facilitate rapid healing in the patient?
Different dressings are meant for different types of wounds, and it is not always easy to select
the correct dressing.
When choosing a dressing, health care professionals should always keep in mind their individual
patient’s needs, history, and environment. What worked for one patient may not work for another;
perhaps a collagen dressing worked well for a younger patient with a full-thickness wound, but
the same dressing could cause damage to the more fragile skin of an older adult patient with a
similar wound. It is important to consider all aspects of a dressing before selecting it.

Note: always refer to manufacturer information for Warnings and Precautions for a specific
product. The information provided herein is intended to provide an overview of
the various dressings categories; specific products may have different indications,
contraindications, or warnings.

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Alginate Dressings Antimicrobial Dressings
Alginate dressings are highly absorptive, non-occlusive Antimicrobial dressings deliver sustained release of
dressings made of soft, non-woven calcium alginate antimicrobial agents to the wound bed that allow for
fibers derived from brown seaweed or kelp. Alginate a lower concentration of the agent and reduce the
dressings are available as a primary dressing in pad or potential toxicity to host cells. These dressings typically
rope form. These dressings gel on contact with wound obtain their antimicrobial activity from silver, iodine,
exudate, thus allowing for a moist wound environment polyhexamethylene biguanide (PHMB), chlorhexidine
and promoting autolytic debridement. gluconate (CHG), dialkylcarbomoyl chloride (DACC), or
other antimicrobial agents. They come in a variety of
Features delivery systems, shapes, and sizes.
Alginate dressings feature the following general Silver dressings specifically are available in foams,
performance properties and attributes: hydrocolloids, alginates, gelling fiber, contact layers,
and activated charcoal cloth dressings.
• Atraumatic removal
• Non-occlusive
Features
• Can be cut to fit
Antimicrobial dressings feature the following
• Can be layered for more absorption
general performance properties and attributes:
• Can absorb up to 20 times their weight in exudate
• Provide a broad range of antimicrobial or
antibacterial activity
Indications
• Reduce or prevent infection
Alginate dressings are indicated for use as a primary
dressing in the treatment of moderately to heavily • Control bacteria bioburden
exuding partial-thickness draining wounds such as stage
2 pressure ulcers, full-thickness draining wounds such
as stage 3-4 pressure ulcers, dermal wounds, surgical Indications
incisions, dehisced wounds, tunneling wounds, sinus Antimicrobial dressings are indicated for use as either
tracts, and donor sites. Alginates that contain silver can a primary or secondary dressing in the treatment of
be used to manage infected wounds. Alginates can draining, exuding, infected, and non-healing wounds
also provide hemostasis for postoperative wounds with where protection from bacterial contamination is de-
minimal bleeding. sired. This can include both acute and chronic wounds,
including burns, surgical wounds, diabetic foot ulcers,
Contraindications pressure ulcers, and vascular ulcers. The amount of ex-
udate that can be properly managed depends on the
Alginate dressings are contraindicated for use on dry specific properties of the dressing. Certain dressings
eschar, for third-degree burns, for surgical implantation, can be used under compression.
or for wounds with heavy bleeding.

Contraindications
Antimicrobial dressings are contraindicated for use on
Warnings patients with known sensitivities to any of the product
• May dehydrate wound bed components. Silver dressings cannot be worn during
magnetic resonance imaging (MRI) procedures.
• Not appropriate for dry wounds
• Because of low tensile strength, avoid packing in
narrow, deep sinuses
• May require secondary dressing to secure Warnings
• May be malodorous during dressing change • Dressings containing metallic silver may cause
• May leave fibers in wound bed if drainage is staining on wound and intact skin
insufficient to gel the product fully • May cause stinging or sensitization

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Collagen Dressings Composite Dressings
Collagen dressings are sheets, pads, particles, Composite dressings are wound covers that combine
powders, and gels derived from bovine, equine, physically distinct components into a single product
porcine, or avian sources. These dressings to provide multiple functions, such as a bacterial
encourage the deposition and organization of barrier, absorption, and adhesion. Usually, they are
newly formed collagen fibers and granulation comprised of multiple layers and incorporate a semi-
tissue in the wound bed. or non-adherent pad that covers the wound. These
dressings may also include an adhesive border of
Features non-woven fabric tape or transparent film.
Collagen dressings feature the following general
performance properties and attributes: Features
Composite dressings feature the following gener-
• Absorbent al performance properties and attributes:
• Maintain moist wound healing environment • Provide multiple functions in one dressing
• May be used with topical agents • Moldable
• Conformable • Can be used on infected wounds
• Non-adherent • Easy to apply and remove
• Easy to apply and remove • Moisture vapor permeable
• Promote autolytic debridement
Indications
• Available in a variety of shapes and sizes
Collagen dressings are indicated for use as a primary
dressing in the treatment of partial- and full-thick- • May be used with topical medications
ness wounds such as skin grafts, donor sites, surgical
wounds, tunneling wounds, infected and non-in-
fected wounds, and wounds with minimal to heavy Indications
exudate (depending on the form of the dressing). Composite dressings are indicated for use as either
a primary or secondary dressing in the treatment of
Contraindications minimally to heavily draining partial- and full-thick-
ness wounds such as stage 2-4 pressure ulcers, dermal
Collagen dressings are generally contraindicated ulcers, and surgical incisions.
for dry wounds and third-degree (full-thickness)
burns and in patients with sensitivities to collagen
or bovine products. Contraindications
Some composite dressings are contraindicated for use
on stage 4 pressure ulcers.
Warnings Not all composites promote a moist wound environ-
ment, and some may dry out the wound bed. Always
• Require a secondary dressing refer to manufacturer information for Warnings and
Precautions for a specific product.
• Not recommended for necrotic wounds
• May require rehydration on removal

Warnings
• Adhesives may limit the use of these dressings
on fragile skin

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Contact Layer Dressings Foam Dressings
Contact layer dressings are thin, non-adherent Foam dressings are sheets and other shapes of
sheets made of woven or perforated material that foamed polymer solutions (most commonly polyure-
can be placed on an open wound bed to protect thane) with small, open cells capable of holding fluids.
tissue from direct contact with other agents or They may be impregnated or layered in combina-
dressings applied to the wound. These dressings tion with other materials. The absorption capability
provide interface between the wound and the depends on the thickness and composition of the
dressing, thus protecting fragile healing tissue specific dressing. The area in contact with the wound
and preventing new epithelium from sticking to surface is non-adherent for easy, atraumatic removal.
the dressing. Foam dressings are available in pad, sheet, strip, and cavity
Contact layer dressings can also be used as a liner dressing form, as well as with an adhesive border and/or
a transparent film coating that acts as a bacterial barrier.
for deep wounds that need packing to ensure
removal of all packing material. Contact layers con-
form to the shape of the wound and are porous to
Features
allow exudate to pass through for absorption by Foam dressings feature the following general
an overlying, secondary dressing. performance properties and attributes:
• Help maintain moist wound environment
Features • Protect wound and periwound area against trauma
Contact layer dressings feature the following • Easy to apply and remove
general performance properties and attributes: • May be used under compression
• Conformable
• Wick exudate away from the wound • Can be used with topical agents or enzymatic
debridement methods
• May be used with topical medications • Non-linting
• Non-adherent
• Protect wound base from trauma during • Allow for atraumatic removal
dressing change • Semi-permeable
• Provide thermal insulation for the wound
• Available in pads, sheets and rolls
• Wear time of one to seven days depending on
amount of exudate
Indications
Contact layer dressings are indicated for use as Indications
primary dressings on partial- and full-thickness Foam dressings are indicated for use as primary or
wounds with minimal to heavy exudate, donor secondary dressings for minimally to heavily exudating
sites, and split-thickness skin grafts. partial- and full-thickness wounds such as stage 2-4
pressure ulcers, surgical wounds, and dermal ulcers.
Depending on the product, foam dressings may be
Contraindications used on infected wounds, tunneling wounds, or cavity
wounds. Foam dressings can also be used to protect
Contact layer dressings are not recommended intact skin over bony prominences or friction areas.
for stage 1 pressure injuries, third-degree burns,
tunneling wounds, clean or debriding wounds,
shallow wounds, dry wounds, wounds covered Contraindications
with eschar, or wounds with viscous exudate. Contraindications vary by product. Foam dressings
• Require a secondary dressing are generally contraindicated for use on third-degree
burns and dry or non-draining wounds unless used
• Not intended to be changed with every for prevention or protection.
dressing change
Warnings
• May macerate periwound skin if saturated
• Not effective on wounds with dry eschar
• May require secondary dressing

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Gauze and Non-Woven Dressings Gelling Fiber Dressings
Gauze and non-woven wound dressings are dry Gelling fiber dressings are absorbent wound covers that
woven or non-woven sponges and wraps with help manage drainage and removal of dead, damaged,
varying degrees of absorbency, based on design. and infected tissue from the wound. Gelling fibers are
Fabric composition may include cotton, polyester, typically composed of sodium carboxymethylcellulose
or rayon. They are available sterile or non-sterile in (CMC), strengthening cellulose fibers, and other blended
bulk and with or without an adhesive border. They superabsorbent materials. As wound fluid is absorbed
are used for cleansing, packing, and covering a into the dressing, a gel forms, and this assists in maintain-
variety of wounds. ing a moist environment for optimal wound healing and
the formation of granulation tissue. Gelling fiber dress-
ings can retain and control exudate levels to reduce the
Features risk of periwound maceration and can also conform to
Gauze and non-woven dressings feature the various wound shapes and be removed in one piece.
following general performance properties and
attributes: Features
• Absorbent Gelling fiber dressings feature the following
general performance properties and attributes:
• Available in a variety of shapes, sizes and formats
• Flexible • Flexible
• Moisture vapor permeable • Remove harmful bacteria from wound
• Can be cut to fit • Respond to wound fluid levels by forming cohesive gel
• Compatible with topical agents • Available in various sizes
• Retain and control exudate levels
Indications
Gauze and non-woven dressings are indicated for Indications
use as a primary or secondary dressing over light to
Gelling fiber dressings are indicated for chronic, acute,
moderately draining wounds.
and partial- or full-thickness wounds, as well as various
ulcers, pressure injuries, and burns.
Contraindications
Gauze or non-woven dressings may cause trauma to Contraindications
wound tissue upon removal. Moistening adherent
dressings during removal will help prevent damage Do not use gelling fiber dressings if you are sensitive to
to fragile tissue. the dressing or its components or have had an allergic
reaction to the dressing.

Warnings Warnings
If the wound continues to grow larger after the
• May leave residue in the wound bed first few dressing changes, consult a health care
professional. The wound should be inspected
• Non-occlusive
during dressing changes. Consult a health care
• May injure fragile skin or granulating tissue professional if you see:
on removal • Signs of infection (increased pain, increased
redness, wound drainage)
• Bleeding
• A change in wound color and/or odor
• Irritation (increased redness and/or inflammation)
• Maceration (skin whitening)
• Hypergranulation (excessive tissue formation)
• Sensitivity (allergic reaction)
• No signs of healing

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Hydrocolloid Dressings Hydrogel Dressings:
Hydrocolloid wound dressings are occlusive or Amorphous, Impregnated, Sheets
semi-occlusive dressings made of gelatin, pectin, Amorphous hydrogels are glycerin- and water-based
polysaccharides, or sodium carboxymethylcellulose products primarily manufactured for the purpose
(CMC). Hydrocolloid dressings are available in paste, of wound hydration. Impregnated hydrogel wound
powder, gel, or sheet/wafer forms with a polyurethane dressings are gauzes and non-woven sponges, ropes,
or film outer layer (pastes and gels require secondary and strips saturated with an amorphous hydrogel. Hy-
dressing). These dressings gel on contact with wound drogel wound dressing sheets are three-dimensional
exudate, thus providing a moist wound healing networks of cross-linked hydrophilic polymers that are
environment and promoting autolytic debridement. insoluble in water and interact with aqueous solutions
by swelling. These dressings help maintain a moist
Features wound healing environment, promote granulation and
Hydrocolloid dressings feature the following epithelialization, and facilitate autolytic debridement.
general performance properties and attributes: Because of the high water content of hydrogels, they
typically cannot absorb large amounts of exudate.
• Non-adherent to moist wound base
• Water-resistant Features
• Impermeable to bacteria, gases, water, water Hydrogel dressings feature the following general
vapor, and other external contaminants performance properties and attributes:
• Self-adherent
• Cooling action soothes and reduces pain
• Moldable
• Non-adherent
• Can be used under compression products • Rehydrate the wound bed
• Maintain moisture by gelling on contact with exudate • Fill in dead space
• Designed to be worn for one to seven days • Easy application and removal
• Can be cut to fit • Can be used on infected wounds
• Facilitate autolytic debridement
• Atraumatic removal
Indications • Can be used with topical medications
Hydrocolloids are indicated for use as either a primary
or secondary dressing in the treatment of lightly to
moderately exuding partial- and full-thickness wounds Indications
such as dermal ulcers, skin tears, lacerations, pressure Hydrogels are indicated for use as a primary dressing
injuries, or wounds with necrotic tissue or slough. in the treatment of minimally draining partial- and
full-thickness wounds such as stage 2-4 pressure
ulcers, deep wounds, minor burns, infected wounds,
Contraindications dermal ulcers, skin tears, donor sites, radiation derma-
Hydrocolloid dressings are generally contraindicated titis, and wounds with necrosis or slough.
for burns or dry wounds, wounds with heavy exudate,
tunneling wounds or sinus tracts, infected wounds,
wounds with exposed tendon or bone, or wounds with Contraindications
fragile periwound skin. Some hydrocolloid dressings are Hydrogel dressings are contraindicated for use on
contraindicated for use on full-thickness wounds. wounds with heavy exudate.

Warnings Warnings
• May leave residue in wound bed • May leave residue in wound bed
• May encourage hypertrophic granulation •M ay encourage hypertrophic granulation
• May cause maceration of periwound skin •M ay cause maceration of periwound skin
• May increase the risk for anaerobic infection •M ay increase the risk for anaerobic infection
• Limit gas exchange between wound bed and • L imit gas exchange between wound bed and
environment environment
• May injure fragile skin on removal •M ay cause odor on dressing change, which
• May cause odor on dressing change, which should not be confused with a sign of infection
should not be confused with a sign of infection

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Impregnated Dressings Medical Grade Honey Dressings
Impregnated wound dressings are gauzes and Medical grade honey dressings contain active
non-woven sponges, ropes, and strips saturated Leptospermum honey, or Manuka honey, as a main
with a solution, an emulsion, oil, or some other component. These dressings help to prepare the wound
agent or compound. The most commonly used bed and promote an optimal healing environment by
agents include saline, oil, zinc salts, petrolatum, reducing edema, lowering wound pH, and promoting
xeroform, and scarlet red. autolytic debridement of slough and eschar.

Features Features
Impregnated dressings feature the following Medical grade honey dressing products feature
general performance properties and attributes: the following general performances properties
and attributes:
• Minimally adherent to wound bed
• Promote moist wound healing environment • High sugar levels in the honey result in osmotic
pressure, promoting autolytic debridement
Indications • Maintain a moist wound environment
Indications vary based on the composition of the
impregnated dressing. • Help reduce wound odor

• Multiple formulations available to handle differing

Contraindications levels of exudate
Contraindications vary based on the composition of
the impregnated dressing.
Indications
Medical grade honey dressings are indicated for
Warnings use on partial- and full-thickness wounds, acute or
chronic wounds such as venous insufficiency ulcers,
• May adhere to wound bed or shed fibers pressure ulcers (stages 2-4), diabetic foot ulcers,
first- and second-degree burns (superficial and
• Usually require a secondary dressing partial-thickness), donor sites, traumatic wounds,
• May cause periwound maceration surgical wounds, fungating wounds, superficial
wounds, and malodorous wounds.

Warnings
• May cause a slight stinging sensation
• Always refer to manufacturer’s Instructions
for Use

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Silicone Gel Sheets Specialty Absorptive and
Silicone gel sheets are soft wound covers composed Super Absorbent Dressings
of cross-linked polymers reinforced with or bonded Specialty absorptive and super absorbent dressings
to mesh or fabric. These dressings can be used in the are multilayered wound covers that provide either
treatment of hypertrophic and keloid scars to improve a semi-adherent quality or a non-adherent layer,
appearance, as well as to help prevent the formation combined with highly absorptive layers of fibers, such
of these kinds of scars. as cellulose, cotton, or rayon. These dressings are
Hypertrophic scars can be caused by poorly designed designed to minimize adherence to the wound and
surgical wound closure, too much tension applied to manage exudate.
a surgical wound closure, wound infection, or partial-
and full-thickness burns. Hypertrophic scars tend to Features
be limited to the original margins of the wound. Ke- Specialty absorptive dressings feature the
loid scars result from an inherited metabolic alteration following general performance properties
in collagen and often extend beyond the original and attributes:
margins of the wound.
• Easy to remove
Features
Silicone gel sheets feature the following general • Highly absorptive (moderate to heavy drainage)
performance properties and attributes:

• Conformable Indications
• Some silicone gel sheets may be cut to size Specialty absorptive dressings are indicated for
use as a primary or secondary dressing to manage
partial- and full-thickness wounds such as surgical
incisions, lacerations, abrasions, burns, donor or skin
Indications graft sites, or any exudating wound.
Silicone gel sheets are indicated to prevent or im-
prove the appearance of old and new hypertrophic
and keloid scars. Contraindications
No known contraindications exist.
Contraindications
Silicone gel sheets are contraindicated for use on
patients with a silicone allergy or sensitivity.
Warnings
• Specialty absorptive dressings may not be
appropriate for use over an undermined wound
Warnings
• May require a secondary dressing
• Not for use on unhealed, open wounds
• May cause maceration or a rash

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Transparent Film Dressings Wound Fillers
Transparent film dressings are polymer membranes Wound fillers are beads, creams, foams, gels, oint-
of varying thickness coated on one side with an ments, pads, pastes, pillows, powders, strands, or
adhesive. They are impermeable to liquid, water, and other formulations that are non-adherent. Wound
bacteria but permeable to moisture vapor and atmo- fillers function to maintain a moist environment and
spheric gases. The transparency of the dressing allows manage exudate. They may include a time-released
visualization of the wound. Available in a wide variety antimicrobial, and their absorption capability depends
of sizes, both sterile and in bulk. on the composition of the specific product.

Features Features
Transparent film dressings feature the following Wound filler dressings feature the following gen-
general performance properties and attributes: eral performance properties and attributes:
• Conformable • Fill in dead space
• Waterproof • Easy application and removal
• Impermeable to bacteria and contaminants • Facilitate autolytic debridement
• Allow for moisture vapor and oxygen transmission • May be absorptive
• Maintain moist wound environment
• Promote autolytic debridement Indications
• Allow for wound inspection Wound fillers are indicated for use as a primary
• Prevent or reduce friction dressing in the treatment of minimally to moderately
exuding partial- and full-thickness wounds, infected
• Variety of thicknesses and sizes wounds, and deep wounds that require packing to fill
dead space.
Indications
Transparent films are indicated for use as primary Contraindications
or secondary dressings for wounds with little to no Wound fillers are typically contraindicated for use on
exudate such as stage 1 pressure injuries and stage wounds with little to no exudate. They are contrain-
2 pressure ulcers, partial-thickness wounds, donor dicated for use on third-degree (full-thickness) burns
sites, and full-thickness wounds with necrotic tissue or and dry wounds.
slough.

Contraindications Warnings
Transparent film dressings are not recommended for
use on wounds with moderate to heavy exudate. • Require a secondary dressing

Warnings
• Not recommended for use on fragile or friable skin
• May become dislodged in high-friction areas
• Require intact periwound skin for adhesion
• Not for use on infected wounds
• May cause maceration

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