At WoundCon Spring, this Post-Acute Wound and Skin Integrity Council session with Mary Martin, BSN, RN, CWS, walked attendees through vital foundational concepts in selecting dressings for chronic wounds. This began with comments on the definition of a chronic wound, which she shared is one not healing at the expected rate. There are multiple types of wounds that can become chronic and many causes that can contribute. However, there is significant prevalence of chronic wounds, which, in turn, carry a significant clinical and financial impact. She added that these wounds typically stall in the inflammatory phase of healing, and that wound professionals need to address the underlying causes, such as biofilm, and implement proper wound care principles. 

She went on to review the role of the extracellular matrix (ECM) and matrix metalloproteinases (MMPs) in wound healing, noting that under ideal circumstances, they work together to move wounds toward healing. However, if MMPs are too elevated, they can break down too much ECM and other cellular structures. Wound professionals can combat this overexuberant action via interventions like debridement, surfactants, moisture control, and others. Accordingly, she stressed the importance of wound bed preparation to create an ideal healing environment, using algorithms such as TIMERS (tissue management, infection/inflammation, moisture balance, wound edge/epithelialization, repair/regeneration, and social/patient-related factors) and DIMES (debridement, infection, moisture balance, environment, and supportive products).¹ 

An Overview of Dressing Selection Considerations

Ms. Martin then outlined the general framework for choosing a dressing for chronic wounds, which includes considerations such as²:

• Level of exudate/absorptive capacity;
• wear time;
• dressing comfort;
• rate of water vapor transmission;
• ease or difficulty of application;
• comfort with removal;
• any debridement properties;
• any antimicrobial properties; and 
• cost.

Any dressing chosen, however, must be supported by evidence, she added.

Key Concepts in Moist Wound Healing and Primary Versus Secondary Dressings

Before moving into a dressing-specific discussion, the speaker touched on several benefits and features of moist wound healing, reminding the audience about potential to promote autolytic debridement, activation of collagen synthesis, nutrient support, cell migration, pain control, better scar formation, and potentially faster healing. She then went on to clarify the differences between primary and secondary dressings. Primary dressings are placed directly on top of the wound and are applied first. Secondary dressings secure that primary dressing in place but may also assist with excess drainage. Some dressings can be used as primary or secondary dressings, but others can only be used as one or the other. 

Choosing a Dressing That Maintains Moisture

Ms. Martin shared several examples of dressings within each category, including key features and potential precautions. 

Films.² This type of dressing is available in a variety of shapes and sizes and generally protects a wound from outside contaminants. Usually transparent, films will maintain—but do not absorb—moisture. Often used for intravenous catheter sites or lacerations, films can prove problematic for infected wounds, fluid pooling, or fragile skin. Ms. Martin advocated for pulling this type of dressing away from itself while applying light pressure to the center of the dressing upon removal. 

Bordered Gauze or Island Dressings.² This dressing type also comes in a variety of sizes and absorbencies. Most find these dressings easy to use and inexpensive. They require frequent dressing changes and usually have a nonadherent pad with an adhesive border. They may serve as primary or secondary dressings.

Waterproof Composites.² Available in varying sizes and absorbencies, this type of dressing is multifunctional and can be used on infected wounds. These composites are usually easy to apply and remove, are moisture-vapor permeable, and can be used with topical ointments. They require frequent changes and can be a primary or secondary dressing. Not all available forms promote moist wound healing, however, and they may dry out the wound bed. Additionally, they may not be indicated for use in stage 4 pressure injuries.

Hydrocolloids.² Also available in varying sizes and absorbencies, hydrocolloids may come in sheets or a paste, and may come in with multiple thicknesses. They typically absorb low to moderate amounts of fluid and do not adhere to a moist wound bed. This dressing type promotes autolytic debridement and gels on contact with exudate. It can remain in place for up to 7 days as a primary or secondary dressing. However, professionals should note a risk of encouraging overgranulation or maceration. One should not use this type of dressing for burns, dry wounds, heavy exudating wounds, infected wounds, or wounds with exposed bone. 

When A Wound Needs a Dressing That Adds Moisture

Hydrogels.^2,3 This dressing type is usually a gel, an impregnated gauze, or a sheet. It works to rehydrate a dry wound bed, promotes autolytic debridement, and can potentially provide pain relief. The sheet form can absorb some drainage, and antimicrobial options exist. Dressing change frequency is usually between 1 and 5 days. Hydrogels are a primary dressing only and require a secondary dressing. They are not a good choice for heavy exudate or anaerobic infections, and one should note that the dressing itself can dry out. 

Dressing Choices to Absorb Moisture

Alginates.^2,3 These dressings are usually ropes or pads, available in many sizes, and include silver options. They provide moisture control, act as a cavity filler, and promote autolytic debridement. Alginates form a moist gel when absorbing fluid and are best used for moderate to heavy exudate and wounds with tunneling. Requiring a dressing change every 3-7 days, alginates are a primary dressing and require a secondary dressing. They are not for use in dry wounds, can cause bleeding in friable tissue, and should not be remoistened.

Gelling Fiber Dressings.^2,3 Available in ropes or pads, they come in a variety sizes, including silver options. Gelling fiber dressings have many similarities to alginates but are more absorbent and are made with carboxymethyl cellulose (CMC). They require a dressing change every 1-3 days.

Foams.^2,3 Found in multiple sizes and shapes, including some anatomically specific for the sacral area or heel, these dressings may be adhesive or nonadhesive and have silver-impregnated options. Foams maintain moisture while absorbing exudate, provide thermal insulation and cushioning, and are usually comfortable for patients. They can serve as a primary or secondary dressing. They are not appropriate for use on dry wounds, and professionals should consider the impact for patients with silicone allergies. 

Super Absorbents.^2,3 This dressing type can be adhesive or nonadhesive and comes in multiple sizes. They absorb high levels of exudate, can be used under compression, and are easy to remove. Serving as a primary or secondary dressing, they are not to be used on dry wounds. 

Negative Pressure Wound Therapy (NPWT).⁴ This dressing system comes in multiple forms, all with varying features, centered around a vacuum pump with a dressing. NPWT absorbs high exudate levels, has different pressure settings, is suitable for most wound types, provides thermal insulation, and improves cellular migration. Dressing changes usually occur every 3 days for foam-based systems or longer for gauze-based. NPWT can be a primary or secondary dressing. It acts through angiogenesis, works against a pro-inflammatory response, and removes cellular waste. It cannot be used with large amounts of necrotic tissue, and professionals must take care to protect exposed bone. The construct can potentially decrease mobility, and clinicians should avoid applying to deeper structures like intestine or any vasculature. Use is not appropriate in the context of untreated infection. Patients with concerns related to hemostasis or coagulation warrant close monitoring. 

What Are Some Other Dressings That Can Support Wound Healing?

Collagen.⁵ Collagen dressings may be available in powders, gels, or sheets, and are derived from bovine, equine, porcine, or avian sources. They encourage collagen fiber deposition and organization, along with promoting granulation tissue. Collagens are nonadherent and can be used with other topicals. Some can be used for infected wounds, and they are suitable for minimal-to-moderate exudate. They are a primary dressing and require a secondary. Professionals should consider patient sensitivity to collagen or bovine products, along with religious preferences, when choosing this type of dressing.

Cadexomer Iodine.^6,7 Found in gels or pads, this dressing type is bactericidal, removes exudate and debris, and reduces bioburden. It is a primary dressing that requires a secondary dressing. Cadexomer iodine is contraindicated in thyroid disorders, Hashimotos thyroiditis, pregnancy, or lactation. Iodine is absorbed systemically, so clinicians should limit time of use. 

Medical Grade Honey.⁸ This option lowers pH, promotes autolytic debridement, reduces edema, reduces wound odor, and has use for a variety of exudate levels (depending on the exact product). One should note that it may cause slight stinging, and professionals should consider any allergy to honey or bee stings. Frequency of use can vary based on the product and exudate level. It is a primary dressing that requires a secondary dressing. 

Methylene Blue/Gentian Violet.^2,3 Available in a variety of forms and sizes, with or without adhesive, this dressing type may also have silver options. It works to reduce bioburden, is used for most wound types, can be used with enzymatic debridement, and promotes autolytic debridement. It is not for use in third-degree burns. Frequency of dressing change depends on the specific product but is usually up to 3-7 days. Primary and secondary dressing options are available. 

Enzymatic Debridement Ointments.^2,3 These provide selective debridement of necrotic tissue in all wound types. They are not for use with silver products. Some cleansers can impact the effectiveness of enzymatic debriders. These ointments are for daily use as a primary dressing that requires a secondary dressing.  

Ms. Martin then concluded the session by sharing a few clinical pearls related to wound dressings, dispelling myths related to scab formation, exposure to air, dry dressings, wet-to-dry dressings, and more.

Disclosure: The faculty member discloses a role as Clinical Quality Lead for Tissue Health Plus.

References

1. Kerr A. Suprasorb® Liquacel Pro and Suprasorb® Liquacel Ag: preparing wounds to heal. J Community Nurs. 2024;38(4):30-35.
2. Nuutila K, Eriksson E. Moist wound healing with commonly available dressings. Adv Wound Care (New Rochelle). 2021;10(12):685-698. 
3. Types of wound dressings: features, indications, and contraindications. WoundSource. Published 2018. Accessed March 22, 2025. 
4. Gefen A, Russo S, Ciliberti M. Revisiting negative pressure wound therapy from a mechanobiological perspective supported by clinical and pathological data. Int Wound J. 2024;21(12):e70098. 
5. Mathew-Steiner SS, Roy S, Sen CK. Collagen in wound healing. Bioengineering (Basel). 2021;8(5):63. 
6. Watson F, Chen R, Percival SL. In vitro prevention and inactivation of biofilms using controlled-release iodine foam dressings for wound healing. Int Wound J. 2024;21(1):e14365. 
7. Woo K, Dowsett C, Costa B, Ebohon S, Woodmansey EJ, Malone M. Efficacy of topical cadexomer iodine treatment in chronic wounds: systematic review and meta-analysis of comparative clinical trials. Int Wound J. 2021;18(5):586-597. 
8. Deane G. Manuka honey: why this multiaction antimicrobial is a valid alternative to silver. Wounds UK. 2020;16(4):72-77.