Walk into any dressing cupboard and you’ll find dozens of products. Choosing the right one can feel confusing, but the principle is simple: match the dressing to the wound, especially the amount of fluid (exudate) and the type of tissue in the wound bed. The goal for most wounds is a moist, clean, warm, protected environment that supports healing.
Assess first: the TIME framework
- T – Tissue: what’s in the wound bed? Red granulation (healthy), pink epithelium (healing), yellow slough, black necrotic tissue (eschar).
- I – Infection or inflammation: increasing pain, redness, heat, swelling, pus, odour, delayed healing.
- M – Moisture balance: is the wound dry, moist or very wet?
- E – Edge: are the edges advancing, rolled, undermined? Is the surrounding skin macerated or healthy?
Also measure and document size (length × width × depth), location, pain and any underlying cause (pressure, diabetes, poor circulation, venous disease). A dressing will not heal a wound if the cause isn’t addressed.
The main dressing types
| Dressing | Best for | Avoid / cautions |
|---|---|---|
| Low-adherent contact layers (e.g. silicone, paraffin gauze) | Superficial wounds, skin tears, protecting fragile tissue | Need a secondary dressing; paraffin gauze can stick if it dries |
| Transparent films | IV sites, superficial wounds, protecting at-risk skin, securing other dressings | Not for exuding or infected wounds |
| Hydrocolloids | Light to moderate exudate; Stage 2 pressure injuries; helps soften slough | Not for heavily exuding or infected wounds; can cause odour and macerate skin |
| Foams | Moderate to heavy exudate; cushion bony areas | Not for dry wounds |
| Alginates and gelling fibres | Heavy exudate, cavities, minor bleeding | Not for dry wounds; need a secondary dressing |
| Hydrogels | Dry wounds and dry slough or necrotic tissue (rehydrating to help autolytic debridement) | Not for heavy exudate; can macerate surrounding skin |
| Antimicrobial dressings (silver, iodine, honey, PHMB) | Wounds with local infection or high risk of infection | Short-term use (often a 2-week “challenge” then review); iodine cautions in thyroid disease, pregnancy and large wounds |
| Gauze | Packing (moistened), secondary dressing, where nothing else is available | Dries out and sticks; painful removal damages new tissue |
Matching dressing to wound: quick guide
- Dry, healthy granulating wound: keep moist and protected: hydrocolloid, film or hydrogel plus a cover.
- Sloughy wound with little exudate: hydrogel or hydrocolloid to soften slough.
- Wet wound: foam or alginate; change more often if exudate leaks.
- Cavity: loosely fill with alginate or gelling fibre ribbon; never pack tightly.
- Infected wound: antimicrobial dressing plus systemic antibiotics if prescribed, and medical review.
- Dry black eschar on heels in people with poor circulation: often kept dry and intact and not debrided. Seek specialist advice.
Doing the dressing
- Explain the procedure; offer pain relief beforehand if the dressing change is painful.
- Hand hygiene, then aseptic (or clean, according to policy) technique.
- Remove the old dressing gently; soak it if stuck.
- Assess and document, using photos if policy allows.
- Clean with warm saline or tap water of drinking quality, according to policy.
- Protect the surrounding skin with a barrier film if it’s at risk of maceration.
- Apply the dressing with a margin of 2–3 cm beyond the wound edge, and secure it.
- Record the dressing used and the date for the next change.
How often to change
Many modern dressings can stay on for several days. Unnecessary changes cool the wound, disturb healing tissue and waste money. Change when the dressing is saturated, leaking, lifting, soiled, or when the product guidance or a clinical concern says so.
When to refer
- Signs of spreading infection or sepsis.
- Exposed bone or tendon; deep cavities or sinuses.
- Diabetic foot ulcers: refer urgently to the diabetic foot team. These can lead to amputation.
- Leg ulcers: an ankle-brachial pressure index (ABPI) is needed before compression therapy.
- Wounds not improving after 2–4 weeks of appropriate care.
In low-resource settings
Advanced dressings are expensive and often unavailable. The principles still apply: clean the wound, manage moisture, protect the skin, treat infection, and address the cause (pressure, nutrition, glucose control). Medical-grade honey has evidence for some wounds and may be available. Moist saline gauze changed regularly is better than dry gauze left to stick. Teach patients and families to keep dressings clean and dry, and to return if the wound worsens.
Related: Pressure ulcers and the Braden Scale · Nursing documentation
Based on international wound care principles including the TIME framework, Wounds UK and World Union of Wound Healing Societies consensus documents. Educational content: follow your local wound care formulary.