Wound management guidelines and formulary

Low exudate

• Mepilex Border Comfort Lite – Light bordered foam, soft silicone wound contact layer, absorbent pad with a spreading layer and film backing.
• Effective up to 7 days.
• Mepitel One- silicone wound contact layer on one side transparent and flexible polyurethane mesh. Suitable for eg: skin tears, under NPWT systems, blisters, surgical wounds.

Low to moderate exudate

• Softpore
  Latex-free surgical adhesive dressing.
• Mepilex
  Non-adhesive foam soft silicone wound contact layer.
  Effective up to seven days.
• Mepilex Border Comfort Lite – Light bordered foam, soft silicone wound contact layer, absorbent pad with a spreading layer and film backing.

Moderate to high exudate

• Mepilex Border Comfort
  Bordered comformable foam dressing with soft silicone wound contact layer.
  Effective up to seven days.
• Zetuvit plus
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.
• Kliniderm  Superabsorbent is advised under compression therapy and a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.

Low exudate

• Atraumen (1st line products for leg ulcer pathway)
  Non-adherent polyester mesh wound contact layer.
  Effective up to seven days.
• Mepilex Border Comfort Lite – Light bordered foam, soft silicone wound contact layer, absorbent pad with a spreading layer and film backing.
• Mepitel One- silicone wound contact layer on one side transparent and flexible polyurethane mesh. Suitable for e.g., skin tears, under NPWT systems, blisters, surgical wounds.
• Mepitel dressing- soft silicone wound contact layer, wide range of wounds, skin tears, abrasions, sutured wounds, partial thickness burns, exposed fragile tissue and with negative pressure systems.
• Urgo Start Contact

Low to moderate exudate

• Mepilex – Non-adhesive soft silicone wound contact layer and film backing. Effective up to seven days.
• Mepitel dressing- soft silicone wound contact layer, wide range of wounds, skin tears, abrasions, sutured wounds, partial thickness burns, exposed fragile tissue and with negative pressure systems.
• Mepilex Border Comfort Lite – Light bordered foam, soft silicone wound contact layer, absorbent pad with a spreading layer and film backing.

Moderate to high exudate

• Mepilex border comfort
  Bordered comformable foam dressing with soft silicone wound contact layer. Effective up to seven days.
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.
• Zetuvit plus 
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.
• High exudate
• Exufiber – Use on a range of highly exuding wounds including leg ulcers, foot ulcers and surgical wounds. Requires a secondary dressing.
• Mepilex Border Comfort Bordered conformable foam dressing with soft silicone wound contact layer. Effective up to seven days
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.
• Zetuvit plus 
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.

Products listed should be used unless exceptional circumstances arise when a second line product is required.

Dry to low exudate

• Kerralite Cool Non-Adhesive
  Hydrogel, soothing, debrinding and moisture-balancing dressings.
  If for lower limb use only after assessment.
• DuoDerm Extra Thin
  Hydrocolloid thin adhesive dressing. If for lower limb use only after assessment.
• Tegaderm Hydrocolloid 
  Adhesive does not contain gelatine or animal derivative. If for lower limb use only after assessment.

Moderate to high exudate

• UrgoClean Nonadherent, slough trapping, poly absorbent fibre dressing with TLC- for non-infected sloughy wounds.
• Flaminal Forte- alginate gel containing two antimicrobial enzymes which exert their effect without damaging healthy cells, debrides the wound and manages moisture balance.
• Iodoflex paste- a dark Brown pate dressing comprising of cadexomer, polyethylene, glycol and iodine. To remove excess slough from wound bedand reduce bacteria on the wound surface.
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.
• Zetuvit plus
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.

High exudate

• Exufiber
  Use on a range of highly exuding wounds including leg ulcers, foot ulcers and surgical wounds.
  Requires a secondary dressing.
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.
• Zetuvit plus
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.

Dry to low exudate

• Kerralite Cool Non-Adhesive
  Hydrogel, soothing, debriding and moisture-balancing dressings.
  If for lower limb use only after assessment.
• DuoDerm Extra Thin
  Hydrocolloid thin adhesive dressing. If applying to lower limb, use only after assessment.
• Tegaderm Hydrocolloid – If applying to lower limb, use only after assessment. If suspect wound infection, to look at topical antimicrobials.

Moderate to high exudate

• Tegaderm Hydrocolloid – Adhesive does not contain gelatine or animal derivatives.
• Exufibre – Use on a range of highly exuding wounds including leg ulcers, foot ulcers and surgical wounds. Requires a secondary dressing. If wound infection to look at topical antimicrobial.
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.
• Zetuvit plus
  Second line superabsorbent dressing contains cellulose fluff and fluid retaining superabsorbent particles. Soft consistency for a cushioning effect.

• Inadine
  Non-adherent dressing. Only for mummification of wounds such as diabetic foot wounds.

Dry to moderate exudate

• Medihoney HSC
  Hydrogel Colloidal sheet. Flexible and transparent.Suitable for DFU, leg ulcers, pressure ulcers, burns, graft sites, trauma and gravel wounds. No secondary dressing required.
• Medihoney Wound Gel
  The viscosity of the Gel is higher than 100% pure Manuka Honey improving the ability to maintain at the wound site. Ideal for deep wounds and cavities, sinus, Infected and malodorous wounds, necrotic and sloughy wounds, pressure ulcers, leg ulcers and diabetic foot ulcers and burns. Can also be used around external fixation sites, tracheostomy tubes etc. Not suitable for oral care.
• Medihoney Tube
  Standardised medical grade honey for superficial wounds. Ideal for deep wounds and cavities, sinus, Infected and malodorous wounds, necrotic and sloughy wounds, leg ulcers and diabetic foot ulcers, burns and oral care. Single patient use tube.
• Prontosan Wound Gel X
  Viscous gel that penetrates and disturbs biofilm and wound debris. Single patient use.
• Askina Calgitrol Thin – Thin layer of silver alginate matrix.  For infected wounds – not treatment of biofilm. Will require secondary dressing.

Moderate to high exudate

• Medihoney Tulle Dressing
  Non-adherent wound contact can be cut or moulded.
  Suitable for infected and malodorous wounds, necrotic and sloughy wounds, fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers, donor sites and recipient graft sites and burns.
• Exufibre Ag
• Flaminal Forte- alginate gel containing two antimicrobial enzymes which exert their effect without damaging healthy cells, debrides the wound and manages moisture balance.
• Iodoflex paste- a dark Brown pate dressing comprising of cadexomer, polyethylene, glycol and iodine. To remove excess slough from wound bedand reduce bacteria on the wound surface.

To monitor for signs of spreading infection or deterioration, refer to GP for oral antibiotics and Tissue Viability team for further specialist advice.

Odour control

• Clinisorb – Charcoal cloth. Wound exudate will reduce dressing’s effectiveness. Use as primary or secondary dressing. Can be cut to size.
• Actisorb Silver220 – an activated charcoal dressing encased in a nylon sleeve. Will trap wound malodour and protect wound from infection.

Dry to moderate exudate

• Medihoney HSC
  Hydrogel Colloidal sheet. Flexible and transparent. Suitable for DFU, leg ulcers, pressure ulcers, burns, graft sites, trauma and gravel wounds. No secondary dressing required.
• Medihoney Wound Gel
  The viscosity of the Gel is higher than 100% pure Manuka Honey improving the ability to maintain at the wound site. Ideal for deep wounds and cavities, sinus, Infected and malodorous wounds, necrotic and sloughy wounds, pressure ulcers, leg ulcers and diabetic foot ulcers and burns. Can also be used around external fixation sites, tracheostomy tubes etc. Not suitable for oral care.
• Medihoney Tube
  Standardised medical grade honey for superficial wounds. Ideal for deep wounds and cavities, sinus, infected and malodorous wounds, necrotic and sloughy wounds, leg ulcers and diabetic foot ulcers, burns and oral care, malodorous wounds, necrotic and sloughy wounds, leg ulcers and diabetic foot ulcers, burns and oral care. Single patient use tube.

Moderate to high exudate

• Medihoney Tulle Dressing –  Non-adherent wound contact. Can be cut or moulded. Suitable for infected and malodorous wounds, necrotic and sloughy wounds, fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers, donor sites and recipient graft sites and burns.
• Kaltostat – Alginate fibre dressing. Promotes haemostasis.
• Aquacel Ag extra + 1.2% ionic silver-impregnated hydrofibre, with enhanced anti biofilm technology.
• Kliniderm  Superabsorbent is a 4 layer, protease modulator superabsorbent dressing held together by a hypoallergenic seal. This dressing can be used as a primary or secondary dressing.

If symptoms not controlled or require further wound support to contact Tissue Viability Team.

Retention

• Mollolast – finger and toe bandaging.
• Actiwrap – holding dressing and supporting secondary bandages and dressing.

Tubular

• Actifast 2-way stretch – for abnormally shaped oedematous limbs.

Undercast padding

• Cellona – padding layer for under bandages.

Light-weight (and component of 4-layer system)

• K-Lite – type 2 light support bandage.

Light compression 20MMGHG sub bandage pressume (and components of 4-layer system)

• K-Plus – type 3a
• Ko-Flex – 10cm x 6m, type 3a cohesive.

High compression 25-35mmHg (component of multilayer system for larger ankles 25cm – 30cm)

• K-Three C – type 3c high compression.

Two-layer system

Dressing packs

• FP10 prescription only Nurse It sterile dressing packs
• NHSSC Green formulary -community teams/BDCFT staff 365 sterile dressing pack
• Small/medium gloves.
  Medium/large gloves.

Fixings and tape

• Clinipore – paper based – suitable for sensitive skin and long-term use.

Physical debridement

• UCS debridement wipes – a sterile, pre-moistened cloth that cleanses, moisturises and softens without damaging healthy cells and is effective at removing hyperkeratosis.

Irrigation solution