CHAPTER 17 WOUND MANAGEMENT - NHS Devon

CHAPTER 17 WOUND MANAGEMENT 

Reviewed: August 2011 

Introduction 

The aim of these guidelines is to assist clinicians and patients in making decisions about 

appropriate and effective treatment. This chapter contains some products that are not 

prescribable on FP10. These products are marked NHS 

Guidelines should always be accompanied by a comprehensive training and 

education programme and clinical practice audits to ensure both clinical and cost 

effective care. 

Page 

17.1 Wound Cleansing / Irrigation 17-2 

17.2 Antibacterial preparations 17-3 

17.3 Skin Barriers 17-3 

17.4. Wound dressings 17-4 

17.4.1 Alginate dressings 17-4 

17.4.2 Foam dressings 17-5 

17.4.3 Hydrogel dressings 17-6 

Capillary action dressing 17-6 

17.4.4 Hydrocolloid dressings 17-7 

17.4.5 Vapour-permeable films and membranes 17-7 

17.4.6 Low adherence dressing and wound contact materials 17-8 

17.4.8.1 Alternative products for complex wounds 17-10 

17.4.8.2 Manuka honey dressing 17-11 

17.4.8.3 Nanocrystalline silver dressing 17-11 

17.4.9 Dressings packs 17-11 

17.4.10 Surgical absorbents 17-11 

17.4.10.1 Non-woven fabric swab 17-11 

17.4.11 Bandages and adhesives 17-11 

17.4.11.1 Light-weight conforming bandages 17-11 

17.4.11.2 Tubular bandages 17-12 

COMPRESSION THERAPY 17-13 

17.4.11.3 Support bandages 17-13 

17.4.11.4 High compression bandages 17-13 

17.4.11.5 Multi-layer compression bandaging 17-14 

17.4.11.6 Surgical adhesive tapes 17-14 

17.4.12 Elastic hosiery 17-14 

Appendix 1 Dressings included in the formulary - Quick reference guide 17-16 

First line drugs Second line drugs Specialist drugs Hospital only drugs 

17-1

Introduction 

The key to successful wound management is high quality, evidence based, 

consistent management and treatment by trained and skilled practitioners 

A variety of sizes of dressing that will be suitable for most patients have been included, 

please try to ensure you order and use the most appropriate size for the patient’s wound to 

reduce wastage. 

Please ensure you order only what the patient requires and do not change the type of 

product used frequently to prevent large stocks building up in the patient’s home. 

Commonly used sizes of first line dressings are shown in green and are more likely to be 

readily obtainable from community pharmacy. These sizes should suffice for the majority of 

wounds and should be selected where possible. 

Heel and sacral dressings have not been included as it is usually possible to get a better 

dressing fit for most patients by cutting and moulding flat dressings to the correct shape. 

In Torbay, a Dressings Request form has been produced to assist healthcare workers in 

providing appropriate information to prescribers of dressings. 

17.1 Wound Cleansing / Irrigation 

Refer to Chapter 13 for disinfectants and cleansers section 

Drinking water (Tap) ♦ (see note below) 

Sterile water 

Sodium chloride ♦ Irripod ® 

♦ Irriclens ® 

Notes: 

1. Wounds that are healthy and free from debris do not require cleansing. Routine 

cleansing of a healthy wound removes the beneficial chemicals, can damage delicate 

tissue, will delay wound healing and can be painful. 

2. However, all traumatic wounds are considered contaminated and should be cleaned 

thoroughly, rinsing the wound under running warm water is very effective. 

3. Good quality, warm drinking water (including tap water) is suitable for irrigating the 

majority of wounds. An appropriately clean container should be used. 

4. Warm isotonic saline may help where the wound cleansing process is painful or 

uncomfortable. 

5. For acute post-operative wounds and for immunocompromised patients, sterile water 

or saline should be used. [Nice CG74] 

6. Antiseptics may be appropriate in heavily contaminated wounds or immunosuppressed 

patients. 

7. Do not use antiseptics containing cetrimide as it has been shown to have a toxic effect 

on fibroblasts. Its use should be restricted to A&E only, where a detergent effect is 

useful for removing foreign material, such as dirt or tar from wounds. 

8. It is not necessary to dry the wound bed following cleansing as this will cause trauma 

to the wound bed and damage delicate tissue. 



17.2 Antibacterial preparations 

Refer to Chapter 13 for antibacterial preparations section 

♦ 0.75% Gel 40g 

Metronidazole (Metrogel ® ) 

Silver sulfadiazine ♦ 1% Cream 20g, 50g 

♦ 250g, 500g Jars for hospital use only 

Notes: 

1. Topical antibiotic preparations are used to reduce levels of bacteria within the wound 

bed and in burns to prevent infection. They are frequent sensitisers, can encourage 

the development of resistant bacteria and have no effect on healing. Therefore their 

use should be carefully restricted. 

2. Wound swabs should be taken only when there is clinical evidence of infection. Refer 

to Wound Management policy. 

3. Metronidazole gel can be useful in the management of malodorous fungating tumours 

depending on the levels of exudate. 

4. Silver sulfadiazine is a prescription only medicine and must be prescribed for single 

patient use only. It is used to prevent Gram negative sepsis in patients with extensive 

burns. Use with caution in patients with renal or hepatic impairment. Silver 

sulfadiazine antimicrobial effect can last for up to 72 hours, however, for optimal 

performance the cream should be applied daily in a layer 0.5-1cm deep. Following 

application, the treated area should be covered with a secondary dressing to hold the 

cream in contact with the wound bed. It is not necessary to use a non-adherent 

product between the cream and secondary dressing. Silver sulfadiazine tubes (20g, 

50g) should be discarded after 7 days of opening and the jars (250g, 500g) must be 

discarded after 24 hours of opening. 

17.3 Skin Barriers 

Refer to Chapter 13 for skin preparations 

Cavilon ® 

Durable Barrier Cream 

♦ 28g tube 

♦ 92g tube 

♦ 2g sachet. Box of 20 

Cavilon ® 

No Sting Barrier Film 

Notes: 

♦ 

♦ 

♦ 

28ml Pump Spray 

1ml x 5 Foam applicators 

3ml x 5 Foam applicators 

1. Skin barriers are used where the skin is being damaged by fluid from a wound, fistula 

or stoma or the epidermis is being stripped by frequent changing of adhesive 

products. 

2. Cavilon® durable barrier cream provides an effective moisturiser, barrier and 

emollient in one application. It is recommended to prevent skin breakdown on intact 

skin. 

3. Cavilon® No Sting Barrier Film provides a protective film between skin and bodily 

fluids or adhesive dressings. It also protects skin around stoma sites. It will help 

prevent maceration of surrounding skin, exudate burns and skin stripping when 

removing adhesive dressings from fragile skin at risk of damage. It can also be 

applied to broken skin. 



17.3.1 Adhesive remover 

Appeel ® ♦ 

♦ 

Spray 

Wipes 

♦ Sachet 

Appeel Sterile Sachet ® 

Notes: 

1. Appeel is a silicone based medical adhesive remover that contains a moisturiser. The 

no sting formula dries quickly allowing adhesion of replacement dressings. There is 

no need to wash off during dressing changes. It should be reserved for use in patients 

undergoing repeated dressings changes, children or patients having Topical Negative 

Pressure therapy. 

2. Appeel Sterile Sachet can be used on extremely sensitive or broken skin or where 

there is a very high risk of infection e.g. SCBU. 

17.4 Wound dressings 

Wound dressings are further divided into primary or contact layers and secondary 

dressings. It is important to remember that the majority of wound management products 

are not interactive and have no influence on the wound healing process. Dressing 

selection should be based on the type of tissue present in the wound bed and the needs of 

the wound e.g. exudate management. 

Primary dressings are applied directly to the wound surface and many are designed to 

influence the wound surface environment, protect the delicate wound bed and reduce the 

risk of infection. Some, but not all, primary dressings require a secondary dressing. Careful 

consideration must be given to the selection of the secondary dressing since it will alter the 

function of the primary dressing. 

Consider carefully the function and action of wound management products before using 

them in combination on a single wound, for example the use of a gel and alginate in 

combination is inappropriate as the gel is absorbed by the alginate. If using wound 

management products in combination it is advisable to use product from the same 

manufacturer as they will have been tested for any possible antagonist effects. 

Care should be taken when using adhesive dressings as primary or secondary layers and 

careful consideration should be given to the methods of securing non adhesive dressings 

to the patient. 

17.4.1 Alginate dressings 

Flat sheet 

Sorbsan ® ♦ 5cm x 5cm, 10cm x 10cm 

Sorbsan Plus ® ♦ 7.5cm x 10cm, 10cm x 15cm, 

10cm x 20cm 

Kaltostat ® ♦ 5cm x 5cm, 7.5cm x 12cm, 

10cm x 20cm 

Notes: 

1. Alginate dressings absorb only small quantities of exudate, hold the moisture next to 

the wound bed and provide a moist environment at the wound surface. If used on very 

wet wounds the product will very quickly become saturated and leak out of the wound 

increasing the risk of maceration of surrounding tissue. 

2. Kaltostat ® has been included as it performs well as a haemostat e.g. where 



malignancy has been diagnosed and the tissue bleeds easily when disturbed. 

3. A secondary dressing is required for Sorbsan® and Kaltostat®. As the amount of 

exudate decreases, a semi-permeable film should be considered as this will conserve 

moisture and prevent the dressing from drying out. 

4. Sorbsan Ribbon® has been removed from this edition of the formulary due to issues 

with inappropriate use in sinus and cavity wounds leading to the product being retained 

and causing infection. See SDHFT Policy and guidance on management of cavity 

wounds (under review). 

Cavity Wounds 

The aim of managing a cavity wound or sinus is to prevent the wound from healing at the 

surface before the cavity is filled with granulation tissue. However many cavity wounds are 

not in danger of closing prematurely and the principles of wound management will be the 

same as for a flat wound e.g. to manage excess exudate, protect delicate granulation 

tissue etc. 

Conversely it is vital to insert a product into a sinus to prevent the wound closing over 

prematurely. Current recommendations for products which will help are Aquacel ribbon®, 

or Silflex® and Advadraw®. These products are described elsewhere in the Formulary. 

Sorbsan ribbon is no longer recommended for cavity wounds. 

17.4.2 Foam dressings 

Flat sheet 

Tegaderm ® Foam ♦ 

♦ 

Square: 8.8cm x 8.8cm, 10cm x 10cm, 

Rectangular: 10cm x 20cm, 

Tegaderm ® foam adhesive ♦ 

♦ 

Mini oval 6.9cm x 7.6cm, 

Mini wrap 6.9cm x 6.9cm 

Biatain ® non-adhesive ♦ 

♦ 

Square:10cm x 10cm, 15cm x 15cm 

Rectangular: 10cm x 12cm, 

10cm x 20cm 

Biatain ® adhesive ♦ 10cm x 10cm, 12.5cm x 12.5cm, 

18cm x 18cm, 

Advazorb Silflo ® ♦ 7.5cm x 7.5cm, 10 x 10 cm, 15 x 15cm 

Advazorb Silfix Lite ® Notes: 

♦ 7.5cm x 7.5cm, 10 x 10cm, 10 x 10cm 

1. Foam dressings are designed to absorb exudate, lock it in and therefore hold it away 

from the wound bed and the surrounding skin. 

2. Foam dressings should not be used as pressure relieving devices. 

3. Tegaderm foam adhesive mini oval and mini wrap provides high absorbency, fast 

wicking for small, difficult-to-dress wounds with challenging contours and curves and 

up to seven day wear time. 

4. Advazorb Silflo® and Silfix Lite® are soft, conforming self-adherent absorbent 

hydrophilic polyurethane foam/film dressing. The soft silicone border will adhere to 

surrounding dry skin but not to a moist wound and provides gentle release so is ideal 

for fragile skin. Advazorb Silfix Lite® can be cut to size and shape as necessary. 



17.4.3 Hydrogel dressings 

Intrasite ® ♦ 8g, 15g, 

Actiform Cool ® ♦ 10cm x 10cm, 10cm x 15cm 

Notes: 

1. Hydrogel dressings are generally used to donate water to dry sloughy wounds and 

facilitate autolytic debridement. They should not be used where there are high levels 

of exudate due to the risk of maceration to the surrounding tissue and will result in 

more frequent dressing changes. 

2. The dressings can be left in place for 3 days on non-infected wounds but daily 

changes of gel are recommended where the wound needs maximum hydration. 

3. Hydrogel dressings are for single use only. 

4. Actiform Cool is a flat sheet hydrogel presented between 2 layers of plastic sheeting, 

for maximum rehydration of tissue remove one plastic sheet and place the gel directly 

on the wound bed. Actiform cool reduces the risk of maceration of surrounding tissue 

5. Hydrogels require a secondary dressing – choice dependent on the level of exudate: 

♦ No exudate / dry wounds: semi-permeable film to reduce moisture loss 

♦ Light exudate: non-adherent dressing secured with tape 

♦ Moderate exudate: absorbent dressing eg adherent or non adherent foam secure 

with tape. 

6. An absorbent dressing will inevitably absorb some of the Hydrogel so the dressing may 

need to be changed more frequently. 

Purilon ® Gel ♦ 8g, 15g 

Note: 

Preservatives in other gel products have an adverse effect on the larvae. Purilon® is the 

only hydrogel that does not contain propylene glycol, however, any of the above can be 

used but the wound must be washed out adequately prior to the introduction of the larvae. 

Capillary action dressing 

Advadraw ® 

♦ Flat sheet: 5cm x 7.5cm, 10cm x 10cm 

♦ Spiral: 0.5cm x 40cm 

Notes: 

1. Capillary action dressings are generally used in cavity wounds with or without 

undermining, fistulas and sinuses to actively wick the exudate away from the base of 

the wound into a secondary dressing or wound management bag. 

2. Advadraw is an absorbent, non-adherent primary wound contact layer with a wicking 

effect. Fluid from the wound bed is rapidly absorbed into the pad and distributed by 

the central layer resulting in sustained movement of exudate from a wound bed. 

Sustained movement of fluid from the wound bed can assist with the desloughing and 

debriding process and help remove bacteria. 

3. Advadraw can be cut to size but ensure that sharp scissors are used. 

4. Advadraw Spiral is a capillary action ribbon which can be used in small sinuses to 

keep the wound open, aid removal of exudate and debris from the base. 



17.4.4 Hydrocolloid dressings 

Granuflex ® Bordered ♦ 10cm x 10cm, 15cm x 15cm 

Comfeel Plus ® ♦ 10cm x 10cm, 15cm x 15cm, 

Notes: 

1. Hydrocolloid dressings create a hypoxic, acid environment within the wound which 

stimulates the inflammatory process and angiogenesis. They facilitate autolytic 

debridement of sloughy or necrotic wounds. They are also suitable for promoting 

granulation. 

2. Hydrocolloid dressings are suitable for most wound types except heavily exudating 

wounds, where the dressing may require too frequent changes and therefore are not 

cost-effective. 

3. Granuflex bordered® may be left in situ for up to 7 days. 

4. Granuflex® may be contra-indicated in strict vegans as it contains gelatin. 

5. Care needs to be taken when using Granuflex® on delicate skin as the skin may tear 

when it is removed. The use of an adhesive remover such as Appeel can help reduce 

the pain and risk of skin tears when removing this product where the patient has very 

fragile skin. Alternatively, Comfeel Plus® may be more suitable in these circumstances 

as it has a less aggressive adhesive. 

DuoDERM ® Extra Thin 

♦ Rectangular: 5cm x 10cm, 

9cm x 15cm, 

♦ 

Note: 

Square: 7.5cm x 7.5cm, 10cm x 10cm, 

DuoDERM ® Extra Thin is used for minimally exuding wounds, to protect the skin when 

using TNP and to protect the skin from exudate burns. 

Aquacel ® ♦ 5cm x 5cm, 10cm x 10cm, 

15cm x 15cm 

Aquacel ribbon ® Notes: 

♦ 2cm x 45cm 

1. Aquacel ® 2. 

can be used in the management of moderate to heavily exudating wounds. 

A secondary dressing is required when Aquacel ® is used. 

3. Aquacel is a chemically and physically altered hydrocolloid so will stimulate 

inflammation and angiogenesis but can be used where there are higher levels of 

exudate. 

4. Aquacel ribbon can be used in sinus and cavity wounds as it absorbs exudate but 

holds its shape and can be removed in one piece. 

17.4.5 Vapour-permeable films and membranes 

Tegaderm 


17-7 

® ♦ 6cm x 7cm, 12cm x 12cm, 

15cm x 20cm 

Notes: 

1. Vapour-permeable films and membranes assist in providing a moist wound bed and 

protect fragile granulation tissue. They allow the passage of water vapour and oxygen 

but not of liquid water or micro-organisms and can allow observation of the wound 

without causing disturbance to the ongoing healing process. They are suitable for low 

exuding wounds. 

2. These dressings can be used as a secondary dressing eg to secure an Inadine 

dressing.

OpSite ® Post-op 

NHS 

♦ 6.5cm x 5cm, 9.5cm x 8.5cm, 

12cm x 10cm, 15.5cm x 8.5cm, 

20cm x 10cm, 25cm x 10cm, 

30 x 10cm, 35cm x 10cm 

Notes: 

OpSite Post-op combines a film with the cushioning and absorbency of a low adherent pad 

together with an easy application carrier system waterproof. 

It is used for post-operative wounds, lacerations, cuts, abrasions, minor burns, wounds 

where levels of exudate are low/moderate. Totally impervious to bacteria including MRSA. 

17.4.6 Low adherence dressing and wound contact materials 

Absorbent perforated dressing with adhesive border 

Cosmopor E ® 

♦ 5cm x 8.2cm, 8cm x 10cm, 

8cm x 15cm, 10cm x 20cm, 

10cm x 25cm, 10cm x 35cm 

Notes: 

A simple low adherent dressing that can either be used as a primary contact layer eg 

sutured wounds with low exudate or as a secondary dressing eg to hold Mepitel inplace 

Knitted viscose primary dressing 

N-A Ultra 

First line drugs Second line drugs Specialist drugs 

17-8 

Hospital only drugs 

® Notes: 

♦ 9.5cm x 9.5cm, 19cm x 9.5cm 

1. These dressings are used as low-adherent wound contact dressing for granulating 

wounds. 

2. Frequently the preferred choice under compression bandaging. 

3. They can on occasions stick to the wound bed and need to be soaked off using warm 

water. 

Soft silicone wound contact material 

Silflex ® ♦ 5cm x 7cm, 8cm x 10cm, 

12cm x 15cm 

Mepitel One ® Notes: 

♦ 5cm x 7.5cm, 7.5cm x 10cm, 

10cm x 18cm 

1. Soft silicone dressings are be used when a simple non adherent contact layer is 

required. 

2. Useful for fragile, delicate skin and painful wounds as they do not stick to moist tissue. 

3. Can be left in place for 7 - 14 days changing only the secondary dressing. 

4. On rare occasions where a wound has been bleeding silicone dressing may be 

adhered to the wound bed by dried clots. Copious quantities of water irrigated 

underneath the Silflex/Mepitel will help release the dressing. 

5. Mepitel One is ideal for use with TNP as only one side of the dressing is coated with 

silicone reducing accidental wastage and making dressing changes more efficient. 

Povidone-iodine fabric dressing 

Inadine ® Notes: 

♦ 5cm x 5cm, 9.5cm x 9.5cm 

1. Inadine is a medicated product which has antibacterial and when used on the 

appropriate wound will provide sustained release of Iodine into the wound bed for a 

period of time, however Iodine is rapidly deactivated by wound exudate. Inadine

2. 

dressings should only be used in acute wounds where there is a high risk of 

secondary infection or chronic wounds where there are signs of a low grade infection. 

Refer to wound management policy. 

Clinical evidence indicates that Inadine ® 3. 

is not suitable for dry or necrotic wounds. 

Inadine ® dressing should be changed when the dressing goes white in colour as the 

Iodine is released into the wound bed. A transparent secondary dressing should 

facilitate this observation without disturbing the wound bed. 

4. CAUTION: Iodine based products are contra-indicated with thyroid disease, in those 

receiving lithium, in pregnancy and breast-feeding, and use in children under 2 years 

old; caution in patients with severe renal impairment. Patients may develop 

sensitivity to iodine preparations. Systemic absorption may occur, particularly if the 

treated area is large. 

Super absorbent dry dressing 

Eclypse ® ♦ 10cm x 10cm, 15cm x 15cm, 


Eclypse adherent ® ♦ 10cm x 10cm, 10cm x 20cm 

Mesorb ® 

Notes: 

♦ 10cm x 10cm, 10cm x 15cm, 

20cm x 30cm 

1. Super absorbent dressings are designed to absorb large quantities of exudate and 

hold it away from the wound and surrounding skin. Consider carefully why the 

patient’s wound is producing very high levels of exudate that are difficult to manage 

with conventional foam dressings. The wound may be infected, a fistula has 

developed, the patient has uncontrolled heart failure or the area of tissue loss is very 

extensive. Seek advice from the TV service of medical team. 

2. Eclypse® dressings is a superabsorbent low adherent dressing composed of several 

layers which enable exudate to be locked into the dressing and retained under 

pressure with a breathable water resistant barrier which will prevent strike-through. 

3. Mesorb® is a soft highly absorbent dressing intended for use on moderately to heavily 

exuding wounds. The fluid-repellent strike-through backing barrier helps preventing 

wound fluids to soil clothing and bed linen. 

4. Eclypse® and Mesorb® can be used as a primary dressing (directly on the wound) or 

as a secondary dressing, where high absorbency is required. 

5. Highly absorbent dressings should not be used under compression as they may 

increase sub-bandage pressures to unacceptable levels. 

17.4.7 Odour absorbent dressing 

CliniSorb ® Notes: 

♦ 10cm x 10cm, 10cm x 20cm, 

15cm x 25cm 

1. Charcoal dressings neutralise volatile fatty acids which cause wound odour. 

2. Significant unpleasant wound odour can be caused by infection, exudate from a fistula 

or sinus, necrotic or sloughy tissue. The cause/source of the odour should be identified 

and corrected wherever possible. 

3. Charcoal is inactivated once wet so should be used as a secondary dressing and 

replaced when wet. 



17.4.8.1 Alternative products for complex wounds 

NOT AVAILABLE on FP10 prescription 

Larval Therapy 

♦ Sterile larvae (maggots) free range 

♦ Biofoam dressing containing sterile 

larvae 

Notes: 

Larval therapy may be useful for rapid removal of sloughy and necrotic tissue and bacterial 

load where surgical debridement is not possible. It is a cost effective alternative to multiple 

applications of standard wound management products. 

Larvae are not available on FP10 prescription but can be ordered as an unlicensed 

product. 

Free range larvae or Biofoam dressings containing maggots can be ordered from 

Biomonde before 12.00 Tuesday – Thursday for next day delivery. 

Biofoam dressings ensure that he maggots are safely contained within the dressing and 

come in a variety of sizes. 

Information regarding larval therapy can be obtained from the Tissue Viability Service or via 

www.biomonde.com [formerly Zoobiotic]. 

Topical Negative Pressure 

NHS 

TNP/VAC therapy is not available on FP10 perscription however within SDHCFT and 

Torbay Care Trust TNP/VAC equipment, dressings and clinical support is provided via the 

Tissue Viability Service. Therapy should only be applied by qualified nurses who have had 

some training and experience with regular support of the TV service. 

• Topical Negative Pressure can be used on a variety of wounds. 

• When used on the appropriate wound and suitable patient by a skilled practitioner TNP 

has been demonstrated to reduce time to healing, reduce frequency of dressing 

change and improve the patient experience. A growing body of evidence suggests 

there may be economic as well as clinical benefits. 

• A sponge or gauze dressing is applied to the wound and attached to a suction pump 

24 hours a day which applies the negative pressure. The therapy is used to assist with 

angiogenesis, production of granulation tissue, exudate management in some cases, 

assist with wound contraction and improve quality of life. 

Contraindications 

1. Untreated osteomylitis 

2. Malignancy within the wound 

3. Unprotected blood vessels 

4. Wound bed more than 30% covered with adherent slough 

5. Non enteric and unexplored fistula 

Adverse Events 

1. Infection 

2. Excessive bleeding particularly following surgical procedures 

3. Severe pain 

4. Too rapid closure of the wound and retained sponge 

5. Imbedded fragments of sponge in the wound 

6. Severe damage to the surrounding skin 



17.4.8.2 Manuka honey dressing 

Activon Tulle ® ♦ 5cm x 5cm, 10cm x 10cm 

Notes: 

1. Manuka honey can provide optimal conditions at the wound bed to allow the wound 

healing process to continue. 

2. Manuka honey is used in the presence of infection in conjunction with a clear rational 

for treatment. 

3. Patients often request honey dressings but they need to be aware that whilst they will 

provide optimal conditions at the wound bed they are not a cure for any underlying 

conditions that may ultimately prevent the wound from healing e.g. severe arterial 

disease. 

4. Some patients may experience a transient drawing or stinging when the dressing is 

first applied. 

17.4.8.3 Nanocrystalline silver dressing 

Acticoat ® Flex 3 ♦ 5cm x 5cm, 10cm x 10cm, 


Acticoat ® Absorbent ♦ 5cm x 5cm, 10cm x 12.5cm 

Notes: 

1. Acticoat products are used in chronic wounds where a low grade or chronic infection 

is present. 

2. Evidence suggests Acticoat releases a high loading dose of silver into the wound bed 

and a higher continuous level over a period of time than other silver products. 

3. Most other dressings containing silver do not release ionic silver out of the dressing 

so do not treat the wound bed. 

17.4.9 Dressings packs 

Sterile Dressings Pack ♦ Brand to be confirmed dependent on 

wholesaler availability 

Notes: 

1. An aseptic non-touch technique is recommended for changing or removing surgical 

wound dressings NICE CG74. 

2. Non sterile gloves can be used to remove dressings as long as there is no contact 

with the wound bed. 

3. All products that come into contact with the wound and the immediate surrounding 

skin should be sterile to prevent introduction of bacteria and subsequent infection. 

17.4.10 Surgical absorbents 

17.4.10.1 Non-woven fabric swab 

Gauze woven swab ♦ 4-ply, 7.5cm x 7.5cm x 5 sterile 

♦ 4-ply, 10cm x 10cm x 100 non-sterile 

17.4.11 Bandages and adhesives 

17.4.11.1 Light-weight conforming bandages 

Polyamide and cellulose contour bandage 

K-Band ® ♦ 5cm, 7cm, 10cm, 15cm x 4m stretched 

Note: Light-weight conforming bandages are used for dressing retention. 



17.4.11.2 Tubular bandages 

Tubular bandages do not provide graduated compression as the tubular structure 

has the same diameter throughout. 

Elasticated tubular bandaging 

Comfigrip ® ♦ (6.25cm, 6.75cm, 7.5cm, 8.75cm, 

10cm, 12cm) x (0.5m, 1m) (size B, C, 

D, E, F, G) 

Notes: 

1. Comfigrip® is available in 0.5 and 1m lengths. Where the quantity is not stated on the 

prescription the 0.5m size will be supplied. 

2. Comfigrip® is used for support for soft tissue injuries. It can also be used to retain 

dressings on difficult parts of the body. 

3. Comfigrip® may be used for the following areas: 

♦ Size B for small wrist or small elbow. 

♦ Size C for medium wrist, medium elbow or small ankle. 

♦ Size D for large wrist, large elbow, medium ankle or small knee. 

♦ Size E for large ankle, medium knee or small thigh. 

♦ Size F for large knee or medium thigh. 

♦ Size G for large thigh. 

Elasticated viscose stockinette 

Comfifast ® ♦ 3.5cm x 1m (Red Line) 

♦ 5cm x 1m, 3m, 5m (Green Line) 

♦ 7.5cm x 1m, 3m, 5m (Blue Line) 

♦ 10.75cm x 1m, 3m, 5m (Yellow Line) 

♦ 17.5cm x 1m (Beige Line) 

Notes: 

1. Comfifast® is suitable for retaining dressings on difficult parts of the body and for wet 

wraps in eczema. 

2. Comfifast® may be used for the following areas: 

♦ Red Line for small limb. 

♦ Green Line for medium limb. 

♦ Blue Line for large limb. 

♦ Yellow Line for trunk (child). 

♦ Beige Line for trunk (adult). 

Elasticated viscose stockinette-garments 

Comfifast Easywrap ® ♦ Clavicle 

♦ Vest Long sleeve 

♦ Tights 

♦ Leggings 

♦ Socks 

♦ Mittens 



COMPRESSION THERAPY 

AETIOLOGY DIAGNOSIS MANAGEMENT 

AIMS 

VENOUS Full assessment Reverse venous 

should be carried hypertension, 

out using 

increase venous 

appropriate tools return and reduce 

and a Doppler 

assessment. 

ABPI = 0.8 – 1.2 

oedema. 

ARTERIAL Full assessment 

should be carried 

out using 

appropriate tools 

and a Doppler 

assessment. 

ABPI less than 0.6 

MIXED Full assessment 

should be carried 

out using 

appropriate tools 

and a Doppler 

assessment. 

ABPI = 0.6 – 0.8 

To provide 

symptom control, to 

prevent infection 

and provide 

optimum local 

conditions for 

wound healing. 

As for arterial 

ulcers plus 

addressing the 

venous component. 

TREATMENT REGIMES 

♦ High compression 

bandaging. 

♦ Multilayer compression 

bandaging. 

♦ Short stretch bandaging. 

♦ Intermittent pneumatic 

compression. 

♦ Elastic hosiery 

♦ Pain relief 

♦ Skin care regime 

♦ Topical treatment, 

according to needs of 

wound 

♦ Maintain asepsis 

♦ Vascular referral 

♦ Reduce compression i.e. 

14-23mm Hg at ankle 

with Class 3a or 3b 

bandages. 

♦ Short stretch bandages 

♦ Referral for vascular 

opinion. 

17.4.11.3 Support bandages 

Knitted Elastomer and viscose bandage 

Type 3A for light compression 

K-Plus ® ♦ 10cm x 8.7m 

17.4.11.4 High compression bandages 

Compression bandages are used to apply pressure, either to control oedema or in the 

treatment of venous leg ulceration. The use of graduated compression bandaging, properly 

applied, and combined with exercise, is the treatment of choice in venous ulceration. A 

diagnosis of venous ulceration must be confirmed by Doppler studies before compression 

bandaging is applied. Compression bandaging should never be used in the treatment of 

arterial leg ulcers. 

Short stretch compression bandage 

Actico ® ♦ 10cm x 6m, 12cm x 6m 

Actiban ® ♦ 10cm x 5cm, 12cm x 5cm 

Notes: 

1. Short stretch compression bandaging is used to help reduce oedema and promote 

healing of venous leg ulcers. They are also used to reduce swelling associated with 

lymphoedema. 

2. These dressings are applied at full stretch over padding, which protects areas of high 



pressure and sites at high risk of pressure damage. 

3. Actiban® appears more expensive but is washable and is be preferable for patients 

who are self bandaging as it is easier to use and create the necessary tension. 

Sub-compression wadding bandage 

K Soft ♦ 10cm x 3.5m 

Advasoft ♦ 10cm x 3.5m 

17.4.11.5 Multi-layer compression bandaging 

K- Plus ® ♦ 10cm x 8.7m, 10cm x 10.25m 

K-Lite ® ♦ 5cm x 4.5m, 7cm x 4.5m, 10cm x 4.5m, 

15cm x 4.5m 

Ko-Flex ® ♦ 2.5cm x 4.5m, 5cm x 4.5m, 10cm x 6m, 

15cm x 4.5m 

17.4.11.6 Surgical adhesive tapes 

• Adhesive tapes are useful for retaining dressings on joints or awkward body parts. 

Care is needed not to apply these tapes under tension, to avoid creating a tornique 

effect. 

• If the tapes are applied over joints, they need to be orientated so that the area of 

maximum extensibility of the fabric is in the direction of movement of the limb. 

Permeable adhesive tapes 

Scanpor ® ♦ 1.25cm x 5m, 2.5cm x 5m, 5cm x 5m 

Mefix ® ♦ 2.5cm x 5m, 5cm x 5m, 10cm x 5cm 

Notes: 

1. Mefix shoud not be applied at tension as it can cause blistering of the skin 

17.4.12 Elastic hosiery 

Not available through Hospital Pharmacy Department but is supplied by the Appliance 

department when prescribed by the medical team 

The patient’s limb must be measured and the hosiery fitted by a clinician who has had the 

appropriate training. 

Before elastic hosiery can be dispensed, the quantity (single or pair), article (including 

accessories) and compression class and manufacturer must be specified by the 

prescriber. European Guidelines suggest that a Doppler assessment must be completed 

prior to a patient being put in compression of any kind. 

17.4.12.1 Graduated compression hosiery 

Light support Class 1 (14-17mmHg) 

Circular knit ♦ Below knee, thigh length 

Elastic net ♦ Made to measure below knee 

Light weight ♦ Made to measure thigh length 



Medium support Class 2 (18-24mmHg) 


♦ Made to measure below knee, thigh 

length 

Net knit ♦ Made to measure below knee, thigh 

length 

Flat bed ♦ Made to measure below knee, thigh 

length 

Strong support Class 3 (25-35mmHg) 


♦ Made to measure below knee, thigh 

length 

Flat bed ♦ Made to measure below knee, thigh 

length 

Notes: 

1. Before prescribing elastic hosiery a Doppler assessment must be carried out. 

2. Below knee stockings should be prescribed for all patients unless it is clearly indicated 

that thigh length would be of additional benefit. Thigh length stockings have a 

tendency to roll down the leg and therefore offer no additional benefit to knee length 

when this occurs. 

CLASS INDICATION 

Class 1 superficial or early varices, varicosis during pregnancy 

(14-17 mmHg) 

Class 2 varices of medium severity, ulcer treatment and prophylaxis, mild 

(18-24 mmHg) oedema, varicosis during pregnancy 

Class 3 gross varices, post thrombotic venous insufficiency, gross oedema, 

(25-35 mmHg) ulcer treatment and prophylaxis 

3. For patients experiencing difficulty putting on class 3 hosiery, wearing a class 1 plus a 

class 2 stocking will provide the same level of support. 

4. In cases where stock sizes are not suitable for patients, owing to irregular limb 

dimensions, surgical stockings in the prescribed compression class, to be made to the 

patient’s individual measurements, should be specified. 



Appendix 1 Dressings included in the formulary - Quick 

reference guide 

Commonly used sizes, which are more likely to be readily available from community 

pharmacies, are listed for first line formulary dressings. 

17.4.1 Alginate dressings 17.4.6 Low adherence dressing and 

Flat sheet 

wound contact materials 

Sorbsan ® 5cm x 5cm, 10cm x 10cm 

Sorbsan ® Plus 7.5cm x 10cm 

Kaltostat ® 

Absorbent perforated dressing with 

adhesive border 

Cosmopor E ® 5cm x 8.2cm, 8cm x 10cm 

17.4.2 Foam dressings Knitted viscose primary dressing 

Flat sheet N-A Ultra ® 9.5cm x 9.5cm 

Tegaderm ® Foam 10cm x 10cm 

Tegaderm ® Foam adhesive 

Biatain ® non adhesive 10cm x 10cm 

Biatain ® adhesive 10x10cm 

Advazorb Silflo ® 

Advazorb Silfix Lite ® 

Soft silicone wound contact material 

Silflex ® 5cm x 7cm, 8cm x 10cm 

Mepitel One ® 

Povidone-iodine fabric dressing 

Inadine ® 

Super absorbent dry dressing 

17.4.3 Hydrogel dressings Eclypse ® 10cm x 10cm 

Intrasite ® 8g Eclypse adherent ® 10cm x 10cm 

Actiform Cool 10cm x 10cm Mesorb ® 

Purilon ® Gel 

Capillary Action Dressing 

17.4.7 Odour absorbent dressing 

Advadraw ® Clinisorb ® 

17.4.4 Hydrocolloid dressings 17.4.8.1 Alternative products 

Granuflex ® bordered 10cm x 10cm Larval therapy 

Comfeel ® Plus 10cm x 10cm Topical Negative Pressure 

DuoDERM ® Extra Thin 5cm x 10cm 17.4.8.2 Manuka honey dressing 

Aquacel ® 5cm x 5cm, 10cm x 10cm Activon Tulle ® 

Aquacel ribbon® 17.4.8.3 Nanocrystalline silver dressing 

17.4.5 Vapour-permeable films and Acticoat Flex 3 

membranes 

® 

Acticoat Absorbent ® 

Tegaderm ® 6cm x 7cm, 12cm x 12cm 

Opsite Post-op ®

CHAPTER 17 WOUND MANAGEMENT - NHS Devon

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