Canadian
maple
Medical Alliance for the Preservation of the Lower Extremity
Bandaging / Dressings
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If you were to ask an average person,
even the average health care worker,
what we should do with a wound,
applying a bandage is probably going
to be the first answer mentioned.
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And it's not a bad answer, as dressings
certainly play a role in wound care.
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We need to keep the wound clean
and protect it from the dangers of
the outside world.
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We need to protect the wound from
mechanical pressure and abrasion
that can further damage the wound
and prevent it from healing.
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In addition, specialized dressings can
be used for moisture balance.
For example, hydrogels and hydrocolloid dressings can add moisture to wounds that are too dry (near right).
And alginates and foams can absorb
liquid from wounds that are too wet
(far right).
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There are also dressings with silver, iodine, and honey that claim antimicrobial effects.
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And one can add antibiotic ointments and creams into the dressing, in the effort to fight infection, provide nutrition to the wound, or otherwise assist the wound in healing.
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Even more specialized, there are dressings made from the same biological materials cells use in healing.
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There are even bandages with living cells built into them.
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As you might imagine, the more specialized the dressing, the more expensive it may be. And given the fact that many dressings are often changed multiple times per week, it means we spend billions on wound care dressings.
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Wound dressings are big business.
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One could argue that dressing changes is the central pillar of our provincial health plan's prescribed treatment protocol. Because dressings are important, because dressing changes are not overly difficult to perform, and because the dressing changes are usually by the largest health care providers in the province with the largest lobby--it's something our provincial health plans cover.
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While dressings are important in wound care, the question, however, is whether dressings should be the central thrust of our wound care strategy. Do the dressings actually do what they claim to do? And are fancy dressings worth the resources we invest--at the expense of other treatment options?
What's Most Important in Wound Care?
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In the wound care world, there is an expression that it's not so much what you put on a wound that counts, it's what you take off.
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In other words, it probably doesn't matter all that much what dressing or topical medicinal agent is applied to the wound.
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What matters most is:
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"It's not what you put on a wound that counts.
It's what you take off."
-- Wound Care Axiom
Why Do You Say That Dressings Don't Matter So Much?
It's not that dressings are unimportant. It's just that, given what we spend on wound care dressings, if you're looking for unbiased clinical evidence for the use of a specific dressing, there may not be as much evidence as you'd think.
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To make this point, I'll start by providing some overall conclusions on wound dressings by well-known organizations and researchers.
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And we'll then review some objective studies on a variety of different wound care products.
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Cochrane is a UK-based organization that aims to organize medical research in order to make evidence-based choices on health care interventions. To maintain an independent, unbiased perspective, they don't accept corporate funding. So there is no financial interest in reporting their conclusions one way or the other.
Cochrane has also reviewed the evidence on common dressings used in wound care. Here are several of their conclusions, regarding various dressing choices.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Cochrane has examined multiple types of dressings--silver dressings, hydrcolloids, alginates, foams, hydrogels, etc. ​Cochrane's conclusion: "There is currently no robust evidence for differences between wound dressings for any outcome in foot ulcers in people with diabetes (treated in any setting)."​
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They state that dressings support wound environment (keeping the wound clean, moist and protected, but they are not the primary factor in determining whether the wound heals, and that clinicians should base dressings on cost, managing drainage, ease of use. But they support modern guidelines that emphasize:
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Offloading
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Regular Debridement
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Infection Control
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Adequate Circulation
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Citation:
Wu L, Norman G, Dumville JC, O’Meara S, Bell-Syer SEM.
Dressings for treating foot ulcers in people with diabetes:
an overview of systematic reviews.
Cochrane Database Syst Rev. 2015;(7):CD010471.
doi:10.1002/14651858.CD010471.pub2.
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Research
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Let's now look at actual research on the topic of dressings.
In 2008, a UK study was done looking at 2,251 papers. 60 were selected as qualifying for the study.
While some evidence was found to support hydrogels as desloughing agents (adding moisture to help remove necrotic tissue), "no data were found to justify the use of any other topically applied product or dressing, including those with antiseptic properties."
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​Hinchliffe RJ, Valk GD, Apelqvist J, et al.
A systematic review of the effectiveness of interventions
to enhance the healing of chronic ulcers of the foot in diabetes.
Diabetes Metab Res Rev. 2008;24 Suppl 1:S119-S144​
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In 2016, the effort was repeated by two well-known researchers in Britain and contributors to the UK national guidance and diabetic foot working groups. They assessed 5,632 papers produced between 2006 and 2014 on various products available to apply to wounds and selected the 207 best articles that met predefined criteria.
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In reviewing the evidence found in those, they found in the best of these papers, they concluded that "few published studies were of high quality, and the majority were susceptible to bias."
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Game FL, Jeffcoate WJ. Dressings and Diabetic
Foot Ulcers: A Current Review of the Evidence
Plast Reconstr Surg. 2016 Sep;138(3 Suppl):158S-64S.
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In other words, despite examining thousands of scientific papers, neither group of UK researchers could find enough scientific evidence to support the use of any dressing over any other.
Hence, based on these findings, the UK government pays for inexpensive, non-adherent dressings, but little in the way of the higher-priced dressings on the market.
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What about research for individual dressings?
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Let's review studies looking at individuals dressing types.
Silver Dressings
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"There are no Silver Bullets."
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--Axiom
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Silver dressings are some of the most commonly-used
dressings.
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A randomized clinical trial published in 2023 compared
a silver-containing dressing with a similar dressing that
did not contain silver in patients with diabetic foot ulcers.
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The researchers found no meaningful difference in healing rates after 12 weeks, and there was also no reduction in infections or antibiotic use in the group treated with silver. In other words, adding silver to the dressing did not improve the likelihood that the wound would heal. The authors concluded that routine use of silver dressings for uncomplicated diabetic foot ulcers is not supported by the evidence.
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Game FL, Jeffcoate WJ, Tarnow L, et al. A randomized controlled trial of a silver-containing dressing for the treatment of diabetic foot ulcers. Diabetes Care. 2023;46(6):1243-1249. doi:10.2337/dc22-1810.
A randomized clinical trial published in 2023 examined whether silver dressings improved healing of diabetic foot ulcers. In this study, 118 patients with recent diabetic foot ulcers were randomly assigned to receive either a silver-containing dressing or a similar dressing without silver, along with standard wound care. After 12 weeks of treatment, the researchers found no meaningful difference in healing rates between the two groups. About 75% of ulcers healed in the standard dressing group compared with 69% in the silver dressing group, a difference that actually favoured non-silver dressings, but the difference was not found to be statistically significant.
The study also found that of those that did heal, there was no difference in time to healing, development of bone infection, amputation rates, or need for antibiotics. The authors concluded that adding silver to wound dressings did not improve healing outcomes in patients with acute diabetic foot ulcers.
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Lafontaine N, Jolley J, Kyi M, King S, Iacobaccio L, Staunton E, et al.
Prospective randomised placebo-controlled trial assessing the efficacy of silver dressings to enhance healing of acute diabetes-related foot ulcers. Diabetologia. 2023;66(4):768-776. doi:10.1007/s00125-022-05855-7.
The 2010 Cochrane review of Silver dressing concluded: "There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection; some poor quality evidence for SSD suggests the opposite."​
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Storm-Versloot MN, Vos CG, Ubbink DT, Vermeulen H.Topical silver for preventing wound infection.Cochrane Database of Systematic ReviewsMarch 17 2010, Issue 3. Art. No.: CD006478. DOI: 10.1002/14651858.CD006478.pub2
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Silver Dressings
Iodine Dressings
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A multicenter randomized clinical trial published in 2020 compared a povidone-iodine foam dressing with a similar foam dressing that did not contain iodine in patients with diabetic foot ulcers. After eight weeks of treatment, the researchers found that healing rates were nearly identical in both groups, with about 44% of ulcers healed regardless of whether iodine was present in the dressing. Infection rates and adverse events were also similar. The study concluded that the iodine dressing was safe but did not improve healing compared with standard foam dressings.
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Lázaro-Martínez JL, García-Morales E, Beneit-Montesinos JV, Martínez-de-Jesús FR, Aragón-Sánchez J, Álvaro-Afonso FJ, et al. Clinical and antimicrobial efficacy of a povidone-iodine foam dressing versus a standard foam dressing in diabetic foot ulcers: a multicentre randomized controlled trial. Int Wound J. 2020;17(2):545-554. doi:10.1111/iwj.13312.
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Cadexomer Iodine and Bacterial Biofilm (Randomized Trial)
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A randomized study published in 2019 examined cadexomer iodine in chronic diabetic foot ulcers suspected of containing bacterial biofilm. The treatment reduced the amount and diversity of bacteria present in the wounds, suggesting iodine may help control microbial burden. However, the study did not demonstrate an improvement in healing outcomes, and the authors noted that reducing bacteria in a wound does not necessarily lead to faster healing.
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Malone M, Johani K, Jensen SO, Gosbell IB, Dickson HG, Hu H, et al. Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers: a randomized controlled trial. Wound Repair Regen. 2019;27(6):669-677. doi:10.1111/wrr.12769
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Cadexomer Iodine vs Standard Care (Earlier Randomized Study)
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An earlier randomized study examined cadexomer iodine in diabetic foot cavity ulcers. The dressing was effective at absorbing exudate and reducing bacteria in the wound, but the study did not clearly demonstrate that it significantly improved overall healing compared with standard treatment.
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Apelqvist J, Ragnarson Tennvall G, Persson U, Larsson J. Diabetic foot ulcers in a multidisciplinary setting: an economic analysis of primary healing and healing with amputation. J Intern Med. 1994;235(5):463-471.
Iodine Dressings
Hydrocolloid Dressings
Regarding Hydrocolloid dressings to promote foot ulcer healing in people with diabetes when compared with other dressing types, the author's conclude:
"Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing or a topical cream containing plant extracts. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management."
Dumville JC, Deshpande S, O'Meara S, Speak K.
Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database of Systematic Reviews August 6, 2013, Issue 8. Art. No.: CD009099. DOI: 10.1002/14651858.CD009099.pub3
Hydrocolloid Dressing
Alginate Dressings
Alginate dressings are absorbant, biodebreadable dressings derived from brown seaweed or kelp.
Regarding Alginate dressings for healing foot ulcers in people
with diabetes mellitus, the author's conclude: "Currently there is no research evidence to suggest that alginate wound dressings are more effective in healing foot ulcers in people with diabetes than other types of dressings however many trials in this field are very small. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management."
Alginate dressing
Dumville JC, O'Meara S, Deshpande S, Speak K.Alginate dressings for healing diabetic foot ulcers.Cochrane Database of Systematic ReviewsJune 25, 2013, Issue 6. Art. No.: CD009110. DOI: 10.1002/14651858.CD009110.pub3
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Foam Dressings
Foam dressings are also designed to absorb moisture.
Regarding Foam dressings for healing foot ulcers in people with diabetes, the author's conclude: "Currently there is no research evidence to suggest that foam wound dressings are more effective in healing foot ulcers in people with diabetes than other types of dressing however all trials in this field are very small. Decision makers may wish to consider aspects such as dressing
cost and the wound management properties offered by each dressing type e.g. exudate management."
Dumville JC, Deshpande S, O'Meara S, Speak K.
Foam dressings for healing diabetic foot ulcers.
Cochrane Database of Systematic Reviews
June 6, 2013, Issue 6. Art. No.: CD009111.
DOI: 10.1002/14651858.CD009111.pub3
Foam Dressing
Hydrogel Dressings
Hydrogels are designed to put moisture back into a wound.
Regarding Hydrogel dressings to promote diabetic foot ulcer healing, the author's conclude: "There is some evidence to suggest that hydrogel dressings are more effective in healing (lower grade) diabetic foot ulcers than basic wound contact dressings however this finding is uncertain due to risk of bias in the original studies.
There is currently no research evidence to suggest that hydrogel is more effective than larval therapy or platelet-derived growth factors in healing diabetic foot ulcers, nor that one brand of hydrogel is more effective than another in ulcer healing. No RCTs comparing hydrogel dressings with other advanced dressing types were found."
Dumville JC, O'Meara S, Deshpande S, Speak K.
Hydrogel dressings for healing diabetic foot ulcers.
Cochrane Database of Systematic Reviews
July 12, 2013, Issue 7. Art. No.: CD009101. DOI: 10.1002/14651858.CD009101.pub3
Hydrogel Dressing
Honey Dressings
Honey is one of the only foods that does not spoil.
Due to its low moisture, high acidity and natural antibacterial properties, honey does not expire and can remain preserved for thousands of years. This means you can theoretically eat honey stored in a pyramid.
"Pour a little sugar on it, honey
(Honey Honey)"
-- Sugar, Sugar
The Archies
Regarding Honey as a topical treatment for acute and chronic wounds, the author's conclude: "It is difficult to draw overall conclusions regarding the effects of honey as a topical treatment for wounds due to the heterogeneous nature of the patient populations and comparators studied and the mostly low quality of the evidence.
The quality of the evidence was mainly downgraded for risk of bias and imprecision. Honey appears to heal partial thickness burns more quickly than conventional treatment (which included polyurethane film, paraffin gauze, soframycin-impregnated gauze, sterile linen and leaving the burns exposed) and infected post-operative wounds more quickly than antiseptics and gauze.
Beyond these comparisons any evidence for differences in the effects of honey and comparators is of low or very low quality and does not form a robust basis for decision making."
Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds.
Cochrane Database of Systematic Reviews
March 6, 2015, Issue 3. Art. No.: CD005083. DOI: 10.1002/14651858.CD005083.pub4
A 2026 review combining the results of 16 randomized studies involving 1,423 patients with diabetic foot ulcers compared honey dressings with standard wound dressings. The authors reported that wounds treated with honey were somewhat more likely to heal during the study period and that healing occurred slightly faster. However, the actual difference in healing time was small—about four days on average.
The researchers judged the evidence for faster healing to be low quality, meaning the true benefit could be smaller than reported. In practical terms, this study suggests honey dressings may provide a modest benefit in some cases, but the evidence is not strong. As with most wound care research, factors such as proper offloading of pressure, regular debridement, and control of infection remain far more important in determining whether a wound heals.
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Yao L, Zhou Y, Dai J, et al. Honey dressing for diabetic foot ulcers: a systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2026;17:1759703. doi:10.3389/fendo.2026.1759703
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Aloe Vera
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Regarding Aloe vera for treating acute and chronic wounds, the author's conclude: "There is currently an absence of high quality clinical trial evidence to support the use of Aloe vera topical agents or Aloe vera dressings as treatments for acute and chronic wounds."
Dat AD, Poon F, Pham KBT, Doust J. Aloe vera for treating acute and chronic wounds. Cochrane Database of Systematic Reviews
February 15, 2012, Issue 2. Art. No.: CD008762. DOI: 10.1002/14651858.CD008762.pub2
Topical Antibiotics
Topical antibiotic creams and ointments are sometimes applied to wounds in an effort to control bacteria. However, clinical studies have not shown that these topical antibiotics consistently improve healing of diabetic foot ulcers.
Because of this, several wound care guidelines advise that topical antibiotics should not be used routinely in chronic wounds. In addition to limited evidence of benefit, their frequent use can contribute to antibiotic resistance and may also cause allergic contact dermatitis, which can further irritate the wound.
When a diabetic foot ulcer is truly infected, systemic antibiotics taken orally or intravenously are generally far more effective than antibiotic ointments applied to the surface of the wound.
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Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-e173. doi:10.1093/cid/cis346.
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Bus SA, Armstrong DG, Gooday C, et al. Guidelines on interventions to enhance healing of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2023;39(S1):e3644. doi:10.1002/dmrr.3644.
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O’Meara S, Cullum N, Majid M, Sheldon T. Systematic review of antimicrobial agents used for chronic wounds. Br J Surg. 2001;88(1):4-21. doi:10.1046/j.1365-2168.2001.01634.x.
Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009;49(10):1541-1549. doi:10.1086/644732.
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Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009;49(10):1541-1549. doi:10.1086/644732.
Honey Dressings
Antibiotic
Aloe
Antibiotic
Healing Rates With Bandages
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What about healing rates with bandages?
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If a wound is treated with the primary focus on dressings--just 1/4 to 1/3 of ulcers will heal within 12 weeks (citations below). Compare this to total contact casts at about 85% and felt padding at about 80%.
Healing Rates at 12 Weeks
​Evidence for healing rates of dressings cited in the chart above
For the chart above, we used the top two sources that used the standard 12 week timespan.
In 1999 a meta-analysis was done of control groups--in other words the standard treatment arm when other methods were used as a comparison.
In the papers examined, the control patients received good wound care, but standard dressings like gauze or placebo gel and gauze.
The key finding was that only 24.2% by 12 weeks and 30.9% by 20 weeks. In other words, less than a third of wounds healed within five months.
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Margolis DJ, Kantor J, Berlin JA. Healing of diabetic neuropathic
foot ulcers receiving standard treatment. A meta-analysis.
Wound Repair Regen. 1999;7(2):106-16.
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In 2020, a meta-analysis was performed using 16 randomized trials. Analysis found somewhat better results: 14.9% of wounds healed at 6 weeks, 33.4% at 12 weeks and 43% healed at 20 weeks (5 months)
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Parks VE, Crisologo PA, Lavery LA, Banks J, Liette MD, Johnson L. 39-LB:
Progress in diabetic foot ulcer healing with standard of care therapy alone: a meta-analysis. Diabetes. 2020;69(Suppl 1):39-LB. doi:10.2337/db20-39-LB​
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Another meta-analysis from 2015 found healing used 16 weeks as a cut off, with 32% healing with standard of care dressings within 16 weeks. This implies a slower healing rate.
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Driver VR, et al. Meta-analysis of standard care outcomes in diabetic
foot ulcer trials. Wound Repair Regen. 2015
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In a 2025 publication, a meta-analysis of 32 randomized control trials found a pooled healing rate of 33.15% in 50 days (7 weeks). This implies a somewhat faster healing rate.
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Coye TL, Crisologo PA, Lavery LA, et al. Healing of diabetic neuropathic
foot ulcers receiving standard treatment in randomised controlled trials:
a random effects meta-analysis. Wound Repair Regen. 2025
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Regardless, all studies appear to show that relying on dressings alone to heal a neuropathic wound is the least likely path to success compared to any offloading technique, with about a quarter to a third of ulcers healing within three months.
These findings are consistent with our views.​​​
And it makes sense that dressings don't heal ulcerations when you consider the cause of ulcerations.
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The cause of neuropathic ulcerations is a combination of:
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a) Neuropathy (a loss of protective sensation), and
b) Pressure / Shear
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To correct an ulcer you need to correct one of those causes.
And as we cannot, at present, cure neuropathy, wound healing needs to be centered on addressing pressure and shear. We do that with debridement and, particularly, with offloading.​
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Why Do You Say Debridement Helps Wounds Heal?
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We discuss debridement in greater depth and cite several studies on the topic here.
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But pPerhaps the best study is a huge retrospective study from 2013, ​looking at data between 2008 and 2012 compiled from 525 wound care clinics. 312,744 wounds in 154,664 individual patients were treated, and the efficacy of debridement was assessed.
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The authors found that healing time was 21 days if debridement was performed weekly. Healing time was three times slower (64 days) if debridement was performed every two weeks, and slower still (76 days) if debridement was performed every three weeks.
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Wilcox JR, Carter MJ, Covington S Frequency of debridements and time to heal:
a retrospective cohort study of 312,744 wounds JAMA Dermatol. 2013; 149(12):1441
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There are some limits to retrospective studies, but given the huge number of wounds examined across hundreds of wound care facilities, the evidence is rather compelling that regular debridement performed weekly is highly effective in helping wounds heal.
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Why Do You Say Offloading Is Important in Wound Care?
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There's quite a bit of evidence that--assuming the patient is able to heal (enough blood supply, sufficient nutrition, and no infection)--offloading is of the utmost importance in treating wounds, achieving closure rates of up to 90% within 6-8 weeks. We discuss offloading in more detail on this webpage, but here are three studies:
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Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP III, Drury DA, Rose SJ: Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 12:384–388, 1989
Caravaggi C, Faglia E, De Giglio R, Mantero M, Quarantiello A, Sommariva E, Gino M, Pritelli C, Morabito A: Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care 23:1746–1751, 2000
Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB: Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 24:1019–1022, 2001
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It is unfortunate that this is not the primary emphasis of our provincial health plans.
For the most part, provincial plans do not pay for offloading devices, and most medical personnel have little training in biomechanics.
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And most wounds in a hospital are not regularly debrided because few physicians are trained in either debridement, and even fewer are interested in actually doing so.
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But there are lots of people who can put a bandage on a wound. So this is what's emphasized.
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So how do manufacturers of special wound care dressings make claims that don't have a lot of evidence?
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Most people involved in wound care know what works--debridement and offloading. So most of the research produced by the manufacturers of dressings produce papers explaining the purported effect of the dressing, and make conclusions that the evidence shows their dressing works when combined with debridement and offloading.
In other words, the study is often performed with a new wound care product--a dressing or cream of some sort--used in combination with debridement and offloading. They will frequently conclude that when the researchers used this new product in combination with debridement and offloading, they had a 90% closure rate within just two months.
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The suggestion is then that clinicians should use that new wound care product.
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What's not mentioned is that debridement and offloading work most of the time at that rate, with or without the fancy, expensive dressing.
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​So what should we be putting on wounds?
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It is the position of the Medical Alliance for the Preservation of the Lower Extremity (MAPLE) that dressings' primary role is to keep the wound clean and protect it from mechanical forces like pressure and shear that can cause further damage. This can often be done with simple, non-adherent dressings.
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In some wounds, specialized dressings can be useful to remove excessive moisture from a draining wound, or to hydrate a dry wound.
Other dressings and medications may be appropriate in some cases, but they are probably indicated much less frequently.
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For most people, what matters most in treating uninfected wounds, however, is offloading and debridement.
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When infection is present, antibiotics become the single most important treatment. And if an infection is present, delivering an antibiotic via IV or orally is more efficacious than applying an antimicrobial dressing.
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Our provincial governments should focus funding upon debridement and offloading.
Large, independent, non-profit groups around the world agree.​​​
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​Dressings don't heal wounds!
The International Working Group on the Diabetic Foot (IWGDF) is an independent international panel of multidisciplinary experts that develops evidence-based guidelines for the prevention and treatment of diabetic foot disease.
The group includes physicians, surgeons, podiatrists, researchers, and other specialists from many countries. Its guidelines are widely used around the world and are updated periodically after systematic reviews of the medical literature. The goal of the IWGDF is to reduce diabetic foot complications—particularly ulcers and amputations—by providing clear, scientifically based recommendations for clinicians.
The IWGDF guidelines state that there is insufficient high-quality evidence to recommend one type of wound dressing over another for healing diabetic foot ulcers.
Because of this, clinicians should select dressings primarily based on their practical function—for example, controlling wound drainage, keeping the wound moist, protecting the ulcer, and maintaining patient comfort—rather than expecting a specific dressing to significantly accelerate healing.
The guidelines emphasize that the key drivers of healing for diabetic foot ulcers are:
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removal of pressure (offloading)
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regular debridement
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treatment of infection
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adequate blood supply
Dressings are considered supportive, helping create a suitable wound environment, but they are not the main determinant of whether a wound heals.
Citation:
Bus SA, Armstrong DG, Gooday C, et al. Guidelines on interventions to enhance healing of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2023;39(S1):e3644. doi:10.1002/dmrr.3644.
Wounds Canada is a Canadian non-profit organization dedicated to improving wound prevention and treatment through education, research, and clinical guidelines. It publishes national best-practice recommendations used by Canadian healthcare providers for managing wounds, including diabetic foot ulcers, and promotes evidence-based care across hospitals, clinics, and community settings.
Wounds Canada's position is that dressings should be selected primarily to maintain moisture balance, manage exudate, and protect the wound, rather than because one dressing type has been proven superior for healing.
Dressing choice should therefore be guided by the condition of the wound and patient factors, while core treatments such as offloading, debridement, infection management, and vascular assessment remain the primary determinants of healing.
Citation:
Wounds Canada. Best Practice Recommendations for the Prevention and Management of Diabetic Foot Ulcers. Toronto: Wounds Canada; 2021.
The European Wound Management Association is an international professional organization that brings together physicians, nurses, researchers, and other specialists involved in wound care across Europe and beyond. EWMA develops educational resources, promotes research, and publishes evidence-based guidance on wound management, including diabetic foot ulcers, with the goal of improving clinical practice and patient outcomes.
EWMA guidance notes that wound dressings are primarily used to maintain an appropriate wound environment, manage exudate, and protect the wound bed, and that the available evidence does not clearly demonstrate that one dressing type consistently improves healing outcomes compared with others. Dressing choice should therefore be based mainly on wound characteristics and practical considerations, while treatment focuses on addressing the underlying causes of the ulcer.
Citation:
Wounds Canada. Best Practice Recommendations for the Prevention and Management of Diabetic Foot Ulcers. Toronto: Wounds Canada; 2021.
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This page written by Dr. S A Schumacher
Podiatric Surgeon
Surrey, British Columbia Canada
Unless otherwise indicated, all clinical photographs are owned and provided
by Dr. S A Schumacher. They may be reproduced for educational purposes with attribution to:
Dr. S A Schumacher, Surrey, BC Canada