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Leg ulcer - venous - Management
Which wound contact dressings should I prescribe?

  • For ulcers with low amounts of exudate, use a low-adherent dressing such as a knitted viscose primary dressing (e.g. NA dressings®, Tricotex®).
  • For ulcers with heavy exudate, use an alginate dressing (e.g. Kaltostat®, Sorbsan®), polyurethane foam dressing (e.g. Allevyn lite®, Lyofoam®), or a hydrocolloid dressing (Aquacel®, ActivHeal Hydrocolloid®).
  • For ulcers that require desloughing use a ready-mixed hydrogel (e.g. ActivHeal Hydrogel®, Granugel®).
  • Occlusive hydrocolloid (ActivHeal Hydrocolloid®) may be useful for painful ulcers.
  • Low-adherent, alginate, and foam dressings may be preferred because they can be left in place for 7 days. Hydrogel and hydrocolloid dressings require more frequent changes (every 3 days).
  • Dressings which are not recommended include:
    • Adhesive bordered dressings.
    • Dressings that contain topical antibiotics or lanolin.
Basis for recommendation
  • These recommendations are based on published expert opinion, systematic reviews, and randomized controlled trials [Simon et al, 2004; Jones et al, 2006; RCN, 2006].
  • There is no evidence that dressings such as hydrogel, hydrocolloid, alginate, or polyurethane foam have an additional effect on wound healing over that achieved by low-adherent dressings under multilayer compression bandaging [Simon et al, 2004; RCN, 2006].
  • Low adherent dressings (e.g. NA dressings®, Tricotex®):
    • Low-adherent dressings remain on the surface of a wound for several days, allowing exudate to pass through to an absorbent secondary dressing. Underneath high compression bandages, a knitted viscose dressing will suffice in producing a microenvironment that promotes granulation. The absorbent layer above the dressing can be easily changed with minimal disturbance to the wound surface [Jones et al, 2006].
  • Hydrogel dressings (e.g. ActivHeal Hydrogel®, Granugel®):
    • Hydrogel dressings consist of a matrix of insoluble polymers with up to 96% water content, enabling them to donate water molecules to the wound surface and to maintain a moist environment at the wound bed. They promote wound debridement by rehydration of non-viable tissue thus facilitating autolytic debridement of the wound, and may be useful for maintaining a moist wound environment in dry, sloughy wounds [Jones et al, 2006].
  • Hydrocolloid dressings (e.g. ActivHeal Hydrocolloid®):
    • Hydrocolloid dressings consist of a wafer constructed from a thin layer of polyurethane film (which is impermeable to water and microorganisms) with an adhesive that contains gelatine, pectin, and carboxymethylcellulose. Wound exudate combines with the ingredients of the adhesive to form a gel, which promotes moist wound healing [Jones et al, 2006].
    • Aquacel® is a hydrofibre dressing made from modified carmellose fibres that resemble alginate dressings. It is not occlusive.
  • Foam dressings (e.g. Allevyn lite®, Lyofoam®):
    • Foam dressings transmit moisture vapour and oxygen and provide thermal insulation to the wound bed. Polyurethane foams consist of two or three layers, including a hydrophilic wound contact surface and a hydrophobic backing, making them highly absorbent. They facilitate uniform dispersion of exudate throughout the absorbent layer and prevent exterior leakage (strike-through) due to the presence of a semi-permeable backing [Jones et al, 2006].
  • Alginate dressings (e.g. Kaltostat®, Sorbsan®):
    • Alginate dressings are produced from alginic acid found in a family of brown seaweed (Phaeophyceae). They partly dissolve on contact with wound fluid to form a hydrophilic gel, as a result of the exchange of sodium ions (in wound fluid) for calcium ions (in the dressing). Alginates can absorb 15–20 times their own weight of fluid, making them suitable for highly exuding wounds. They should not be used, however, on wounds with little or no exudate as they will adhere to the healing wound surface, causing pain and damaging healthy tissue on removal [Jones et al, 2006].
  • Dressings not recommended:
    • People with venous leg ulcers are prone to contact sensitivity particularly from lanolin and topical antibiotics.
    • Dressings with adhesive borders are not recommended because dressings under high-compression multilayer bandages do not tend to slip.

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