Table 2. Multiple dressings are available for the treatment of venous ulcers, some with antimicrobial properties, to provide exudative control, patient comfort, and optimal healing environment.

Dressing type	Exudate level	Notes
Alginates	High	• Derived from seaweed to form a soft gel when exposed to exudate; can be hemostatic after biopsy or debridement  • Promotes autolytic debridement  • Preferred for deep cavities or sinus tracts
Foam	Moderate	• Provide cushioning with polyurethane foam  • Preferred for flat wounds
Hydrocolloid sheet	Variable a	• Allows a moist environment and promotes autolytic debridement  • Preferred for flat wounds
Hydrocolloid fibrous	High	• Useful for both flat wounds and deep cavities or sinuses
Hydrogel sheet	Dry/Low	• High water content polymer that provides wound moisture and promotes autolytic debridement  • High moisture can lead to skin maceration
Low adherence	Dry/Low	• Protective layer impregnated with paraffin to reduce damage during dressing changes  • Preferred for flat wounds
Soft polymer	Low/Moderate	• Nonadherent silicone polymer  • Preferred for fragile or macerated skin
Protease modulating matrix	Variable a	• Collagen based to remove protease from the wound bed to promote tissue granulation and epithelialization
Semipermeable	Dry/Low	• Permeable to oxygen and water vapor but barrier for liquid and bacteria  • Preferred for flat wounds
Antimicrobial options	Notes	Evidence
Iodine	• Free iodine is antiseptic and released when exposed to wound exudate  • Contraindicated in pregnancy, breast feeding, concomitant lithium use, or in patients with thyroid disorders	Cadexomer-iodine has also been shown to absorb exudate, promote debridement, and has improved healing outcomes compared with standard dressings 19
Silver	• Many dressing types impregnated with silver ions, which are antimicrobial	Has not been shown to improve wound healing over standard dressings and may not be cost-effective 26 36
Manuka honey	• Contains natural antimicrobial and anti-inflammatory properties and its osmotic behavior allows autolytic debridement  • Wound deodorizer	Has not been shown to improve wound healing over standard dressings 37 38
Chlorhexidine	• Low adherence and must be combined with absorbent dressing for higher exudate wounds	Single RCT did not show improved wound healing compared with usual care and no RCT exists for infected ulcers 39
DACC	• DACC binds bacteria with high cell surface hydrophobicity (i.e., Staphylococcus aureus , Pseudomonas aeruginosa , Enterococcus faecalis, Candida albicans ), allowing bacterial removal with each dressing change 40	Biofilms have been shown to be removed with DACC-coated fibers 41

Abbreviations: DACC, dialkylcarbamoylchloride; RCT, randomized control trial.

^aAbsorbency is dressing-specific.