Dressings

Dressings are not drugs; but medical devices. They therefore do not need a Marketing Authorisation but they only have to conform to European standards (CE marking). In France, the LPPR (Liste des Produits et Prestations Remboursables), is a list of products that health insurance companies will reimburse patients for. It indicates whether a product is covered, and prices for dressings are based on a flat rate per cm². Not all dressings are covered by the LPPR and they are all sold to the public in pharmacies at prices that may be equal to or exceed the LPPR rate. The Social Security in France covers 65 - 100% of the LPPR rate, depending on the patient’s level of coverage. The patient’s top-up health insurance company will cover the rest, but they may not always pay any mark-up made by the pharmacy. Patients are therefore advised to shop around between pharmacies.

We will discuss here primary dressings, which are those that have a direct contact with the wound. Some of these require a secondary dressing, in the form of gauzes, pads, adhesive or bandage, while some do not. There is no medical value in layering up primary dressings and it increases costs. 

Although randomised controlled efficacy studies are available for each dressing, there have not been a large number of them and the quality is often poor (most providing level C evidence: the studies available are of questionable methodology or the overall results lack coherence). In short, in spite of systematic literature reviews carried out regularly, few differences in terms of efficacy are found between the different classes of dressings and between dressings of the same class [1-8, 10]. The indications for the various dressings are therefore based on their physicochemical properties, vitro assessments (in particular their absorption capacity), cost, and studies available. A systematic literature review has formed the basis for French health authority’s (HAS) recommendations (Table I et Figure 1), that are very close to other european or international guidelines. In comparison to petrolatum gauze or saline-soaked gauzes, modern dressings are easier to use and more comfortable for the patient, they allow dressing changes to be spaced out, and they can reduce the cost of care, although few studies have been carried out to assess modern dressings against their objectives. Modern dressings are therefore used for a wider range of applications than those that studies and meta-analyses have identified for them. As a result, we have specified both the indications based on the recommendations from HAS and the usual uses for each dressing. The various types of dressing currently on the market are listed together in Table II.