Traditionally wet-to-dry gauze has been used to dress wounds. Dressings that create and maintain a moist environment, however, are now considered to provide the optimal conditions for wound healing. Moisture under occlusive dressings not only increases the rate of epithelialisation but also promotes healing through moisture itself and the presence initially of a low oxygen tension (promoting the inflammatory phase). Gauze does not exhibit these properties; it may be disruptive to the healing wound as it dries and cause tissue damage when it is removed. It is not now widely used in the United Kingdom. Occlusive dressings are thought to increase cell proliferation and activity by retaining an optimum level of wound exudate, which contains vital proteins and cytokines produced in response to injury. These facilitate autolytic debridement of the wound and promote healing. Concerns of increased risk of infection under occlusive dressings have not been substantiated in clinical trials. This article describes wound dressings currently available in the UK. Low adherent dressings Low adherent dressings are cheap and widely available. Their major function is to allow exudate to pass through into a secondary dressing while maintaining a moist wound bed. Most are manufactured in the form of tulles, which are open weave cloth soaked in soft paraffin or chlorhexidine; textiles; or multilayered or perforated plastic films. They are designed to reduce adherence at the wound bed and are particularly useful for patients with sensitive or fragile skin.

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Most wounds, of whatever aetiology, heal without difficulty. Some wounds, however, are subject to factors that impede healing, although these do not prevent healing if the wounds are managed appropriately. A minority of wounds will become chronic and non-healing. In these cases the ultimate goal is to control the symptoms and prevent complications, rather than healing the wound. It is important that the normal processes of developing a diagnostic hypothesis are followed before trying to treat the wound. A detailed clinical history should include information on the duration of ulcer, previous ulceration, history of trauma, family history of ulceration, ulcer characteristics (site, pain, odour, and exudate or discharge), limb temperature, underlying medical conditions (for example, diabetes mellitus, peripheral vascular disease, ischaemic heart disease, cerebrovascular accident, neuropathy, connective tissue diseases (such as rheumatoid arthritis), varicose veins, deep venous thrombosis), previous venous or arterial surgery, smoking, medications, and allergies to drugs and dressings. Appropriate investigations should be carried out. Wounds are not just skin deep, and accurate assessment is an essential part of treatment