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Wound Dressing for Chronic Wounds: A Deep Dive
If you're caring for someone with a leg ulcer that hasn't healed in months, or a diabetic foot ulcer that keeps reopening, the dressing choice matters more than most people realise. Around 450,000 Australians live with a chronic wound at any given time, and chronic wounds cost the health system around $6 billion a year. Most are venous leg ulcers, diabetic foot ulcers, or pressure injuries, and most don't close with a basic adhesive dressing.
The dressing has to match the wound, and the wound usually changes as it heals. Choosing the right product, and changing it at the right time, is one of the most practical things a carer or patient can do.
Chronic wound dressings are advanced wound care products made for wounds that haven't healed within four to twelve weeks. They include foam, alginate, hydrocolloid, silicone, hydrofiber, and antimicrobial dressings. The right one is chosen for the wound's exudate level, infection risk, and tissue state, and the goal is the same in every case: hold moisture at the right level, support debridement, and keep bacteria in check, without sticking to the wound bed.
Our wound care hub sits behind this article as the broader reference. If you're new to dressing selection generally, our beginner's guide to wound dressings covers the basics before getting into chronic wound specifics.
Why chronic wounds need a different approach
A chronic wound is one that hasn't healed within roughly four to twelve weeks of standard care. Wounds get stuck in early healing because of poor circulation, diabetes, prolonged pressure, or a compromised immune system. The skin around the wound is fragile, exudate volumes vary day to day, and the risk of infection sits well above what a clean cut would carry.
Dressing decisions for these wounds are about more than covering and protecting. The dressing has to manage moisture, support the body's own clean-up process, and keep bacteria in check, without sticking to the wound bed or damaging surrounding skin. It's also one part of a longer treatment plan that includes pressure offloading, compression, glucose control, or vascular review, depending on the cause.
Dressing choice in four principles
Four principles guide every chronic wound dressing decision. The clinical TIME framework (Tissue, Infection, Moisture, Edge) is the structured version. The everyday version is below.
Moisture balance
Moist wounds heal faster than dry ones. Winter's 1962 research, published in Nature, showed wounds kept moist under a dressing closed nearly twice as fast as wounds left to dry out. The clinical rule is "if it's wet, absorb it; if it's dry, wet it."
A wound that's too wet macerates the surrounding skin. A wound that's too dry forms a scab and stalls. The dressing's job is to hold the wound at the right level.
Exudate management
Chronic wounds often produce more fluid than acute wounds. The dressing needs absorbency that matches the wound's output.
Light exudate suits a hydrocolloid or film. Moderate exudate calls for a foam or silicone dressing. Heavy exudate needs an alginate or hydrofiber that locks fluid away from the skin edge.
Infection control
All open wounds carry bacteria, but chronic wounds are at higher risk of clinical infection. Antimicrobial dressings, including silver-based, iodine-based, PHMB, and medical-grade honey, bring bacterial burden down rather than treat established infection. International consensus is the two-week challenge: use an antimicrobial dressing for two weeks, then reassess.
If signs of infection clear, switch back to a standard dressing. If they don't, the wound needs a clinical review, not more silver.
Debridement
Dead tissue, whether dry black eschar or yellow slough, prevents healing and feeds bacteria. Autolytic debridement uses the body's own enzymes under a moist dressing such as a hydrogel or hydrocolloid. The other types of debridement, sharp, mechanical, and enzymatic, are done by a clinician, not at home.
Dressing types you'll see in Australia
The Australian market carries the full range of advanced wound care products. FAD stocks more than 300 wound care lines across 25 categories, supplied by manufacturers including Smith & Nephew, Mölnlycke, Urgo Medical, ConvaTec, 3M Solventum, and Hartmann.
Hydrocolloids. Adhesive, gel-forming, suited to light to moderate exudate. The yellow gel and slight odour on removal are normal and not signs of infection.
Foam dressings. Absorbent and protective. Cushion bony areas and handle moderate to heavy exudate. Bordered foams stay in place longer; non-bordered foams are kinder to fragile skin around the wound.
Hydrogels. Water-based gels and sheets for dry or sloughy wounds. They rehydrate the wound bed and support natural debridement. Not for wounds that are already wet.
Alginates. Made from seaweed-derived fibres. High absorbency. Form a gel on contact with wound fluid and ease off without trauma at the next change.
Antimicrobial dressings. Used when infection or critical colonisation is suspected. Silver dressings are the most familiar example. Other options include PHMB-based foam products such as Hydrofera Blue, and medical-grade Manuka honey products listed on the ARTG. Honey from the kitchen isn't the same product and should never be used on a wound.
Hydrofiber. Highly absorbent and vertical-wicking, so fluid is drawn away from the skin edge rather than pooling sideways.
Negative pressure wound therapy (NPWT). A sealed dressing connected to a low-pressure pump. Reserved for large, deep, or complex wounds and supplied under clinician supervision. Our overview of advanced wound care technologies covers NPWT and other newer options in more detail.
For a closer look at named products, our review of specialty wound dressings covers Zetuvit, Allevyn Life, and Bactigras.
Practical principles for ongoing care
The dressing is one piece of the plan. Healing also depends on the basics.
- Reassess at every dressing change. Wound size, exudate volume, smell, and the look of the wound bed all guide whether the current dressing is still the right choice.
- Protect the skin around the wound. Barrier films, careful adhesive choices, and atraumatic removal protect periwound skin from breakdown.
- Address the cause, not just the wound. Compression for venous ulcers, offloading and glucose control for diabetic foot ulcers, regular repositioning for pressure injuries. Without these, the dressing alone won't heal the wound.
- Get a clinical review when something changes. Increased pain, spreading redness, fever, or a sudden change in exudate are reasons to call the GP, wound clinic, or community nurse. Telehealth wound consults are increasingly available for NDIS participants and people outside metro areas. A clear photo and a phone call can save a long drive.
If you've been changing the same dressing on the same wound for months, the work itself can feel heavier than the wound. That's normal. The reassessment at each change isn't only about the wound, it's about checking whether the current dressing is still doing its job, or whether it's time to call the wound nurse and try something different.
Questions worth asking the wound nurse
When you next see the wound nurse, GP, or community nurse, a few direct questions usually surface the most useful information:
- What stage is this wound at right now, and what should it look like in a fortnight?
- Is the current dressing still the right class, or should we try something different?
- What infection signs should I watch for between visits?
- How often should I be changing this dressing, and what brings the change forward?
- If something goes wrong out of hours, who do I call?
Where the CWCS fits
Since June 2025, the federal Chronic Wound Consumables Scheme has fully subsidised wound care consumables for eligible patients with a chronic wound and diabetes. Eligibility is age 65 and over, or 50 and over for First Nations people. The scheme covers around 20,000 patients a year and is delivered through enrolled health professionals. NDIS participants receiving wound care consumables under their plan are excluded to avoid double-funding.
For Australians outside CWCS eligibility, consumables are paid privately or covered through NDIS plans where they're listed as a reasonable and necessary support. Wounds Australia data shows out-of-pocket spend on dressings averages over $4,000 a year for many patients with a chronic wound.
Where to get supplies
FAD supplies wound care products to NDIS participants, aged care facilities, community nursing services, GPs, and private buyers across Australia. You can browse the full wound care range online, or call the team at our East Bendigo store on 03 5443 2239 for help matching a product to a specific wound type. Real people answer the phone, which matters more in this category than in most.
Frequently asked questions
Can I use the same dressing on a chronic wound for the whole healing process?
Rarely. Most chronic wounds change as they heal: exudate falls, dead tissue clears, infection resolves. The dressing has to change with the wound. A foam might be right at week two and a thinner film right at week ten.
How often should a chronic wound dressing be changed?
It depends on the dressing and the wound. Foam and silicone dressings often hold for several days; alginates and hydrofiber products handling heavier exudate may need changing sooner. Heavy exudate, leakage, or odour brings the change forward. Daily changes are usually a sign the wrong dressing is in place.
Is medical-grade honey safe to use on a chronic wound?
Yes, where it's appropriate. Medical-grade Manuka honey products listed on the ARTG are a recognised antimicrobial option for some chronic wounds, particularly wounds with slough or low-grade infection. They sit alongside silver and PHMB options rather than replacing them, and the choice between them is best made by the wound nurse or GP based on the wound's specific characteristics. Raw kitchen honey isn't the same product and should never be put on a wound.
Will Medicare cover my dressings?
Medicare doesn't cover dressings as a separate benefit. The Chronic Wound Consumables Scheme covers eligible patients (diabetes, chronic wound, aged 65+ or 50+ if First Nations) through enrolled health professionals. NDIS participants may have wound consumables in their plan. Outside these schemes, consumables are paid privately.