best practice guidelines: wound management in diabetic foot ulcers

DFU WOUNDMANAGEMENTTABLE 5: Types of wound dressings availableType Actions Indications/use Precautions/contraindicationsAlginates/CMC*FoamsHoneyHydrocolloidsHydrogelsAbsorb fluidPromote autolyticdebridementMoisture controlConformability to wound bedAbsorb fluidMoisture controlConformability to wound bedRehydrate wound bedPromote autolyticdebridementAntimicrobial actionAbsorb fluidPromote autolyticdebridementRehydrate wound bedMoisture controlPromote autolytic debridementCoolingModerate to high exuding woundsSpecial cavity presentations in the form of ropeor ribbonCombined presentation with silver forantimicrobial activityModerate to high exuding woundsSpecial cavity presentations in the form ofstrips or ribbonLow adherent versions available for patientswith fragile skinCombined presentation with silver or PHMB forantimicrobial activitySloughy, low to moderate exuding woundsCritically colonised wounds or clinical signs ofinfectionClean, low to moderate exuding woundsCombined presentation with silver forantimicrobial activityDry/low to moderate exuding woundsCombined presentation with silver forantimicrobial activityIodine Antimicrobial action Critically colonised wounds or clinical signs ofinfectionLow to high exuding woundsLow-adherentwound contactlayer (silicone)Protect new tissue growthAtraumatic to periwound skinConformable to body contoursLow to high exuding woundsUse as contact layer on superficial low exudingwoundsDo not use on dry/necrotic woundsUse with caution on friable tissue (maycause bleeding)Do not pack cavity wounds tightlyDo not use on dry/necrotic wounds orthose with minimal exudateMay cause 'drawing' pain (osmoticeffect)Known sensitivityDo not use on dry/necrotic wounds orhigh exuding woundsMay encourage overgranulationMay cause macerationDo not use on highly exuding woundsor where anaerobic infection is suspectedMay cause macerationDo not use on dry necrotictissueKnown sensitivity to iodineShort-term use recommended (risk ofsystemic absorption)May dry out if left in place for too longKnown sensitivity to siliconePHMB Antimicrobial action Low to high exuding woundsCritically colonised wounds or clinical signs ofinfectionMay require secondary dressingDo not use on dry/necrotic woundsKnown sensitivityOdour control(eg activatedcharcoal)ProteasemodulatingOdour absorptionActive or passive control ofwound protease levelsMalodorous wounds (due to excess exudate)May require antimicrobial if due to increasedbioburdenClean wounds that are not progressing despitecorrection of underlying causes, exclusion ofinfection and optimal wound careSilver Antimicrobial action Critically colonised wounds or clinical signs ofinfectionLow to high exuding woundsCombined presentation with foam and alginates/CMC for increased absorbency. Also in paste formPolyurethane filmMoisture controlBreathable bacterial barrierTransparent (allowvisualisation of wound)Primary dressing over superficial low exudingwoundsSecondary dressing over alginate or hydrogelfor rehydration of wound bedDo not use on dry woundsDo not use on dry wounds or those withleathery escharSome may cause discolourationKnown sensitivityDiscontinue after 2 weeks if noimprovement and re-evaluateDo not use on patients with fragile/compromised periwound skinDo not use on moderate to high exudingwoundsOther more advanced dressings (eg collagen and bioengineered tissue products) may be considered for wounds that are hard to heal 94 .*Wound dressings may contain alginates or CMC only; alginates may also be combined with CMC.314 BEST PRACTICEBEST PRACTICEGUIDELINESGUIDELINES:FOR SKINWOUNDAND WOUNDMANAGEMENTCARE ININEPIDERMOLYSISDIABETIC FOOTBULLOSAULCERS