Wound care: triage, dressings and chronic wounds

Wound care is among the oldest and most everyday tasks of community pharmacy: from a fall in the school playground to a chronic venous leg ulcer, from a burn blister caused by an iron to postoperative follow-up. What has changed fundamentally over the past two decades is the scientific basis — «modern, moist wound care» with interactive dressings has replaced the model of dry wound healing with gauze and plaster that dominated for decades. [1,2] At the same time the Swiss care structures have become more complex: pharmacy, family practice, home care services with SAfW-certified wound experts, wound clinics at hospitals, diabetes counselling, phlebologists — the pharmacy is a central node, because it sees patients in every phase: at the acute triage question at the counter, in the self-medication of smaller injuries, in supplying material for home wound care, in initiating a medical consultation or home care advice. This article summarises the most important regulatory, clinical and pharmaceutical-practical aspects of wound care in the Swiss pharmacy — with a particular focus on triage competence, modern dressings, antiseptics and the list of medical aids and appliances (MiGeL) updated as of 1 January 2026.

Clinical and epidemiological background: types of wound in Swiss care reality

Wounds are a frequent and epidemiologically significant clinical picture in Switzerland — with two very different care realities: the acute minor injury treated in the pharmacy without a medical consultation, and the chronic wound that sometimes demands interdisciplinary care over months or years.

Acute wounds arise through mechanical, thermal or chemical action: cuts, abrasions, lacerations, burns, crush injuries, surgical wounds. With intact healing biology and without complications they heal completely within a few days to weeks. Studies on the frequency of acute minor injuries in everyday life are lacking for Switzerland, but typical pharmacy figures from the German-speaking area assume that each person has pharmacy contact for a wound about once a year (advice or supply of material). [11]

Chronic wounds, by contrast, are a defined clinical picture with their own care logic. The most common forms are:

• Venous leg ulcer (an «open leg» in chronic venous insufficiency, CVI): by far the most common chronic wound of the lower extremity, about 50–80% of all leg ulcers. Swiss lifetime prevalence: around 1%, over 3% in those aged over 80. Pathophysiologically central: disturbed venous return with increased hydrostatic pressure, oedema, skin changes and ulceration mostly at the medial malleolus. [4,5,12]
• Arterial leg ulcer in peripheral arterial occlusive disease: ulcers at the extremities and pressure points, characteristically painful (typically at night, when lying down). Where the component is purely arterial, compression therapy is contraindicated — this point is central for the pharmacy, because inadvertent compression in peripheral arterial disease can cause severe complications. [6,12]
• Mixed leg ulcer (both venous and arterial): a frequent finding in multimorbid older patients; the compression pressure must be reduced and individually adjusted, and determination of the ankle–brachial index is mandatory.
• Diabetic foot syndrome: about one in three people with diabetes mellitus develops it in the course of their life; the point prevalence of foot ulcers in the diabetes population is 2–10%. Pathophysiologically, neuropathy (sensory, motor, autonomic) and angiopathy are central; the «malum perforans» on the sole or forefoot pad is the typical location. The Swiss Diabetes Society recommends annual podiatric checks, appropriate footwear and consistent glucose control as secondary prevention. [12,13]
• Pressure ulcers: in immobile, weakened or malnourished patients, typically over bony prominences (coccyx, sacrum, trochanter, heel, back of the head). Staged according to the EPUAP/NPIAP/PPPIA classification (1–4 plus «unstageable» and «deep tissue pressure injury»). [14]

Behind these clinical pictures lie underlying diseases (chronic venous insufficiency, peripheral arterial disease, diabetes, immobility, malnutrition), the treatment of which is more decisive for wound healing than the local wound treatment itself. The pharmacy’s role here is: first, to ask the triage question («Is this trivial or does it belong in specialist hands?»); second, to ensure the supply of dressing material; third, to support patient education — particularly on adherence topics such as compression therapy or wound checks in diabetes.

Physiology of wound healing: four phases, one logic

Wound healing is a highly regulated biological process staggered in time. The classic four-phase model is clinically useful, even though the phases overlap and merge into one another.

Phase 1 – haemostasis (seconds to minutes after the injury): vasoconstriction of the injured vessels, platelet aggregation and activation of the coagulation cascade. The platelet plug becomes a stable clot through fibrin polymerisation. Platelet growth factors (PDGF, TGF-β, VEGF) initiate the next phase. Relevant from the pharmacy’s perspective: with heavily bleeding wounds, a pressure dressing, elevation of the affected limb and, where bleeding cannot be stopped, emergency medical care. [6]

Phase 2 – inflammation/exudation (day 0 to 3): migration of neutrophil granulocytes and later macrophages into the wound area; phagocytosis of cell debris and pathogens; release of cytokines (IL-1, IL-6, TNF-α). Clinically visible as the «cardinal signs of inflammation» — redness, heat, pain, swelling, loss of function. This physiological inflammation is a necessary part of healing, not a wound infection. A true wound infection is diagnosed by clinical signs (increasing pain, purulent coating, odour, warmth, redness >2 cm around the wound margin) and where applicable general symptoms (fever, lymphangitis). [2,6]

Phase 3 – proliferation/granulation (day 3 to 21): angiogenesis with formation of a rich capillary network, migration and proliferation of fibroblasts, build-up of a collagenous extracellular matrix, beginning wound contraction through myofibroblasts. Clinically visible as a red, fleshy, granular wound bed. This phase is particularly sensitive to local disturbing factors: drying out, cooling of the wound, mechanical stress, antiseptic toxicity, malnutrition (particularly protein, vitamin C, zinc, iron). [1,2,6]

Phase 4 – maturation/epithelialisation (day 21 to months, sometimes up to a year): migration of keratinocytes from the wound margin towards the centre of the wound (epithelial advance), remodelling of the collagen matrix (collagen type III → type I), regression of the capillaries. The final resilience of the scar reaches about 70–80% of intact skin. [6]

In chronic wounds this orderly sequence is disturbed: the wound remains «stuck» in the inflammatory phase, persistent inflammation with elevated proteases hinders granulation, the wound margins are hyperkeratotic or undermined, and the wound bed is covered with fibrin or necrosis. Modern wound therapy aims, with the TIME concept (see below), to address these disturbances specifically. [1,7]

Acute wound triage in the pharmacy: what to treat, what to refer

Triage of acute wounds in the pharmacy: the pharmacy decides daily which wound can be treated with self-medication and material advice and which belongs in medical hands. A pragmatic triage heuristic is oriented on the following criteria:

Self-medication in the pharmacy is defensible for:

• superficial abrasions or cuts, up to about 2–3 cm in length, without heavy bleeding;
• small first-degree burns (redness, no blistering) or small-area superficial second-degree burns (superficial blistering, <1% of body surface, not located on hand, face, genitals or a joint);
• blunt injuries without a wound (contusions, haematomas);
• small blistering friction injuries («blisters» on the foot or hand);
• small insect stings without a risk of anaphylaxis.

A medical consultation (or emergency care) is indicated for:

• deep, gaping or heavily bleeding wounds (requiring closure by suture or adhesive);
• wounds on the face, hand, over a joint or in the genital area (cosmetic or functional relevance, a higher risk of complications);
• bite wounds (human, dog, cat — a general risk of infection, where the origin is unclear possibly rabies prophylaxis);
• stab and impalement injuries, cuts with glass or metal with a suspicion of a foreign body;
• second-degree deep or third-degree burns, burns covering ≥1% of the body surface, all burns of the hand, face, genitals or a joint, all burns in children or older patients;
• wounds with clinical signs of infection (redness >2 cm, swelling, pus, increasing pain, fever, lymphangitis);
• all wounds in patients with diabetes mellitus, peripheral arterial disease, immunosuppression, steroid therapy or anticoagulation — including superficial ones;
• unclear tetanus protection: the Swiss vaccination schedule 2026 recommends a booster in adults aged 25–64 with a clean wound after >20 years / a contaminated wound after >10 years; in children and those aged ≥65, >10 years / >5 years since the last vaccination. [15]

Initial care of small acute wounds in the pharmacy: (a) cleaning with sterile Ringer’s or saline solution or under clean running tap water, (b) mild antisepsis (e.g. an aqueous polyhexanide or octenidine solution — not alcoholic solutions into the wound bed, as these are tissue-toxic and painful), (c) a sterile moist or hydroactive dressing (hydrocolloid with little exudate, foam with more), (d) secondary fixation, (e) observation and a wound check after 24–48 hours. [2,6,11]

What is no longer recommended: repeated alcohol-based disinfection of the wound (tissue-toxic); dry gauze compresses directly on granulating wounds (they stick and traumatise at the dressing change); powders, ointments or home remedies on open wounds; hydrogen peroxide (cytotoxic, without clinical benefit); dye antiseptics such as gentian violet or mercurochrome (obsolete today, no longer marketable in Switzerland). [2,7]

The TIME concept: structured assessment of chronic wounds

The TIME concept was developed in 2003 by an international expert group (Schultz et al., Wound Repair Regen 2003) and updated in 2021 by Sibbald et al. as «Wound Bed Preparation 2021» (Adv Skin Wound Care 2021). It is today the internationally recognised framework for the structured assessment of chronic wounds, the basis of the Swiss SAfW wound compendium recommendations and of the updated German S3 guideline on local therapy of poorly healing and/or chronic wounds (AWMF 091-001, as at 11.9.2023, valid until 10.9.2028). [1,7]

T – tissue (wound bed, tissue): assessment of the wound base for proportions of granulation tissue (red, good), epithelium (pink, very good), fibrin/coatings (yellow, disruptive) and necrosis (black, requiring treatment). With fibrin or necrotic coatings, debridement is required — that is, the removal of non-viable tissue. Options: mechanical (irrigation, compresses), surgical/sharp (by a doctor or wound specialist), autolytic (hydrogels, hydrocolloids), enzymatic (e.g. collagenase — little used in Switzerland), biological (sterile maggot therapy, Lucilia sericata — in specialised wound centres). Which method is suitable depends on the wound’s condition, the perception of pain, the setting and the available expertise. [1,7,8]

I – inflammation / infection: differential diagnosis between physiological inflammation, critical colonisation (subclinical bacterial burden with delayed healing) and manifest wound infection (classic signs of inflammation plus general symptoms). With critical colonisation or infection: antiseptic local therapy with polyhexanide (PHMB) or octenidine as first choice, where appropriate supplemented by antimicrobial dressings (silver, honey, DACC, hydrophobic dressings). Important: only one antimicrobial product per wound, treatment duration as a rule limited to 14 days, then reassessment. [2,7,8]

M – moisture (moisture balance): both dry and excessively moist wounds heal less well. The gold standard of «moist wound healing» (Winter 1962) means a physiologically balanced microclimate: the wound base not dried out (otherwise keratinocyte migration is inhibited), the wound margins not macerated (otherwise the skin softens and the wound secondarily enlarges). Tools: hydrogels for dry wounds, hydrocolloids / foams / hydrofibres / alginates / superabsorbents depending on the degree of exudation. [1,6,16]

E – edge (wound margin, epithelialisation): a healthy wound margin shows a flat, vital, pink-appearing epithelium moving from the periphery towards the centre of the wound. Pathological are: hyperkeratotic margins, undermined (pocket-like, lifted from the wound base) margins, livid discoloration (congestion), maceration. Therapeutic options: skin care of the wound surroundings with barrier-forming products (zinc paste, skin protective films such as Cavilon, silicone skin protection creams), regular cleaning of the wound margin and, in non-healing wounds, reassessment for underlying causes (causal therapy insufficient). [1,7]

The SAfW wound compendium recommendation is: document a TIME assessment at every dressing change of chronic wounds, ideally with wound photography and standardised documentation tools. The ICW wound record (Initiative Chronische Wunden) and the Swiss SwissDOC are widespread structured documentation instruments. [1,7]

Wound antiseptics: polyhexanide, octenidine, silver, honey

Wound antiseptics are a central tool of modern wound therapy — but not a routine product for every wound. The indication for antiseptic local therapy is the clinically infected or critically colonised wound, not the clean granulating wound. The most frequent error in practice: too long or undifferentiated use of antiseptics, which itself delays wound healing through cytotoxic action. [2,7,8]

Polyhexanide (PHMB, polyhexamethylene biguanide) is the current first choice in wound therapy. Spectrum of action: gram-positive and gram-negative bacteria, fungi, many viruses. Very good biocompatibility (low cell toxicity), no known resistance, no risk of sensitisation. Use: preserved wound irrigation solutions (0.04% or 0.1%), incorporated in hydrogels or dressings. The minimum contact time as a solution is 10–15 minutes, which is why in practice a drug-loaded dressing is preferred. Not to be used: on exposed cartilage, in the inner ear, in the central nervous system. [2,7,8]

Octenidine (octenidine dihydrochloride), frequently combined with phenoxyethanol: second choice, an early option in critically infected wounds and with multi-resistant pathogens. A very broad spectrum of action and rapid effect. Caution: not in the inner ear, not in deep closed wound cavities (a risk of severe tissue damage where drainage is lacking — documented cases with irrigation of puncture channels). [7,8]

Iodine-containing antiseptics (povidone-iodine as a solution — Betadine®, Braunoderm®, Braunol® — or as a tulle dressing, Inadine®): classically broad-spectrum antimicrobial, but with risks: absorption with an effect on thyroid hormones (caution in pregnancy, breastfeeding, thyroid disease, newborns), allergic skin reactions, possible iodine allergies. Today used sparingly in modern wound care; Inadine®, however, remains in use as a cost-effective tulle variant for superficial colonised wounds. [7,12]

Sodium hypochlorite / hypochlorous acid (NaOCl/HOCl): a newer, very well tolerated class of antiseptic with good effectiveness and very low cell toxicity. Available in Swiss pharmacies as a wound irrigation solution (e.g. ActiMaris®, Granudacyn®). Used as an irrigation solution; no contact time is necessary. Indication: as a supplement to PHMB/octenidine, particularly for repeated wound irrigation in home care. [7]

Silver-containing dressings (e.g. Aquacel® Ag/Ag+, Mepilex® Ag, Allevyn® Ag, Suprasorb® A+Ag): silver ions as a broad-spectrum antimicrobial. Indication: critically colonised to infected wounds with medium to heavy exudation. An important Swiss practice rule (MiGeL revision 2022): the use of silver-containing dressings has been restricted in the list of medical aids and appliances to infected and critically colonised wounds and the reimbursed duration of use limited to 30 days. In justified cases the insurer may, on prior cost approval and the recommendation of a medical adviser, reimburse a longer duration. In 2014 international dressing manufacturers additionally agreed a consensus limiting continuous use as a rule to 14 days — after this time the wound situation is to be clinically reassessed. Silver only works in an aqueous environment — moisten dry wounds beforehand with an irrigation solution. [2,7,8,11,20]

Medical honey (manuka or multiflora honey, medically processed and sterile, e.g. Medihoney®, Activon®, L-Mesitran®): antimicrobial (osmotically through a high sugar content, plus formation of hydrogen peroxide through enzymatic glucose oxidation, plus methylglyoxal in manuka), debriding, odour-binding. Indication: chronic infected wounds, fibrin coatings, malodorous wounds. [7,12]

Hydrophobic dressings with DACC (dialkylcarbamoyl chloride) (e.g. Cutimed Sorbact®): not a chemical antiseptic but the physical binding of micro-organisms to the hydrophobic fibre surface, which are removed with the dressing. No development of resistance, no cytotoxicity, usable in pregnancy and in children. Indication: critically colonised or infected wounds. [7,11]

An important practical rule on the use of antiseptics: use at most one antimicrobial product per wound at a time — «a germ can only die once». Combining several antimicrobial products is not more effective, but more expensive and possibly more cytotoxic. Routine use of antiseptics on clean, granulating wounds is not indicated. [11]

Modern dressings: classes, indications, selection

Modern dressings for moist wound care are interactive materials that actively influence the wound environment: absorbing exudate, donating moisture, binding bacteria, distributing pressure. The most important product classes for Swiss pharmacy practice:

Film dressings (e.g. Tegaderm™, OpSite™, Mepore Film®, Hydrofilm®): thin, transparent, semi-permeable polyurethane films. Permeable to gases (O₂, CO₂, water vapour), water-repellent from outside. Indication: superficial, minimally exuding wounds, secondary fixation of other dressings, protection of vulnerable skin areas. Advantage: visual wound inspection without a dressing change. Disadvantage: no absorption of exudate. [11]

Hydrocolloids (e.g. Comfeel®, DuoDerm®, Granuflex®, Suprasorb® H, Hydrocoll®): self-adhesive, polymer-based dressings with hydrocolloid-forming components (mostly sodium carboxymethylcellulose). Interaction with wound exudate: gel formation on contact with moisture. Indication: superficial to deep wounds with low to moderate exudation, the granulation and epithelialisation phase. Dressing change every 3–7 days depending on exudate. Caution: odour formation in the gel is normal and not a sign of infection. [11,16]

Hydrogels (e.g. IntraSite Gel®, Suprasorb® G, Hydrosorb®, NU-Gel®): amorphous gels or gel-forming woven dressings with a high water content. Indication: dry, necrotic or fibrinous wounds for autolytic cleansing (rehydration of the coating), pain relief in the granulation phase. Caution: not for heavily exuding wounds (risk of maceration). [11,16]

Hydrofibres (e.g. Aquacel® Extra, Suprasorb® Liquacel): made of sodium carboxymethylcellulose fibres, high absorbency (up to 30 times their own weight), gel formation on wound contact, vertical wicking. Indication: moderately to heavily exuding wounds, wound cavities (including deep ones). A very atraumatic dressing change. [11,16]

Alginates (e.g. Kaltostat®, SeaSorb®, Suprasorb® A, Algisite®): made of calcium alginate (obtained from brown algae), forming a gel on contact with exudate; additionally haemostatic through the release of Ca²⁺. Indication: heavily exuding, bleeding or superficial wound cavities, postoperative rebleeding, ulcerating tumour wounds. Good for packing wound cavities. Caution: not for dry wounds (they stick). [11,16]

Foams (e.g. Mepilex®, Allevyn®, Cutimed® Siltec, Biatain®, DracoFoam®, Suprasorb® P): hydrophilic polyurethane foams, often with a silicone wound contact layer (atraumatic dressing change). Very high absorption capacity, good cushioning. Indication: moderately to heavily exuding wounds in the granulation and epithelialisation phase — probably the most versatile product of modern wound care. Available in various shapes (sacrum, heel, anatomical) and with or without an adhesive border. [11,16]

Superabsorbents (e.g. Zetuvit® Plus, Vliwasorb® Pro, Cutimed® Sorbion): multi-layered dressings with superabsorbent polymers of the kind also used in babies’ nappies. Very high and lasting absorption capacity, suitable for a dressing change every 3–7 days. Indication: very heavily exuding wounds (e.g. a venous leg ulcer in the cleansing phase, lymphorrhoeic wounds). [11,16]

Antimicrobial dressings (silver, PHMB, honey, DACC — see the antiseptics section): specialist products for critically colonised or infected wounds, for a maximum of 14 days continuously, then reassessment. [2,7]

A practical pharmacy tip: when advising on materials at the counter it helps to clarify a few questions — (1) the location and type of wound (superficial, deep, location), (2) exudation (dry, little, moderate, heavy, very heavy), (3) the wound phase (cleansing, granulation, epithelialisation) and (4) who is treating (the patient themselves, relatives, home care). The choice of dressing follows from this. [7,11]

Chronic wounds: leg ulcers, diabetic foot syndrome, pressure ulcers

Three clinical pictures dominate the Swiss reality of chronic wound care — and depending on the origin, the therapy differs fundamentally.

The venous leg ulcer is by far the most common chronic wound of the lower extremity: around 80% of all leg ulcers are venous in origin, a further 10–15% purely arterial, and the rest mixed or caused by other conditions (vasculitis, pyoderma gangrenosum, tumour ulcers). [12,17] Pathophysiologically central: chronic venous insufficiency with disturbed venous return through valve insufficiency and/or post-thrombotic syndrome; increased hydrostatic pressure → oedema → trophic skin changes (stasis dermatitis, atrophie blanche, hyperpigmentation through haemosiderin) → ulceration, typically at the medial malleolus. Causal therapy: compression therapy (the gold standard) — without compression there is no healing. Dressings are supportive; what is decisive is the compression pressure and compliance. [12,17]

The arterial leg ulcer arises through peripheral arterial occlusive disease with reduced perfusion. Clinically: sharply demarcated, often painful (particularly when lying down) ulceration at the extremities and pressure points, a cool and pale limb, absent foot pulses. Before any compression therapy for a leg ulcer: determination of the ankle–brachial index is mandatory. Compression is contraindicated in advanced peripheral arterial disease: an index below 0.5 or an ankle artery pressure below 60 mmHg or a toe pressure below 30 mmHg (S3 guideline). With an index between 0.5 and 0.9, modified (reduced) compression under medical supervision is possible; mild peripheral arterial disease (index 0.6–0.9) is not an absolute contraindication. With an index ≥0.9 normal compression is possible; with an index above 1.3, medial sclerosis is to be suspected (falsely high values, further diagnostics required). [12,17] With a purely arterial leg ulcer, revascularisation (interventional or surgical) takes priority.

Diabetic foot syndrome is the most common chronic wound in patients with diabetes mellitus. The pathophysiology is multifactorial: (a) sensory neuropathy leads to an absent perception of pressure and pain and thus to unnoticed micro-injuries; (b) motor neuropathy leads to deformities and pressure peaks; (c) autonomic neuropathy reduces sweat production → dry skin with a risk of fissures; (d) angiopathy (both micro and macro) reduces perfusion and wound healing. The Swiss Diabetes Society recommends annual podiatric checks, appropriate footwear and consistent glucose control. The pharmacy’s role: skin care (urea-containing creams, e.g. 5–10% for hyperkeratosis), advice on self-examination (the «mirror test» of the sole of the foot), referral of every finding, even a superficial one, to the family doctor or diabetes counselling. The Wagner–Armstrong classification of diabetic foot syndrome is the clinical standard for documenting the course — it combines Wagner grades 0–5 (severity/depth: 0 pre-/post-ulcerative lesion or foot at risk → 1 superficial wound → 2 wound to tendon or capsule → 3 wound to bone or joint → 4 necrosis of parts of the foot → 5 necrosis of the entire foot) with the Armstrong stages A–D (A: without infection or ischaemia, B: with infection, C: with ischaemia, D: with infection and ischaemia). [12,13]

Pressure ulcers arise through localised pressure (with or without shear forces) on the skin over bony prominences, classically in immobile patients. Staged according to EPUAP/NPIAP/PPPIA (European Pressure Ulcer Advisory Panel / National Pressure Injury Advisory Panel / Pan Pacific Pressure Injury Alliance, 3rd edition, November 2019, ed. Emily Haesler — agreed by 168 international experts from 14 associate organizations): stage 1 (non-blanchable erythema with intact skin) → 2 (skin loss to partial dermal depth, a superficial wound) → 3 (skin loss into the subcutis) → 4 (skin loss to muscle, tendon, bone), plus «unstageable pressure injury» (loss with the wound base not visible because of coatings or eschar) and «deep tissue pressure injury» (a persistently discoloured, non-blanchable area). Prevention is more decisive than any wound treatment: repositioning every 2 hours (or more often), pressure-relieving aids (an anti-decubitus mattress — reimbursed where indicated), skin care, mobilisation, addressing malnutrition. [14] The pharmacy’s role: advising relatives and carers on prevention, skin care products (urea, dexpanthenol, barrier-forming film sprays such as Cavilon®), referral of skin changes before stage 2 to the family doctor or home care — early intervention pays off greatly.

Four typical counselling situations

Four typical wound care counselling situations in the Swiss pharmacy — with concrete triage decisions and material recommendations.

1. Kitchen cut — a deep cut to the finger

Ms A., 38, comes in with the index finger of her right hand roughly wrapped: «I cut myself chopping onions. It’s still been bleeding for half an hour. What can I do?» — The triage question (an open question): «May I take a quick look?» On removing the improvised dressing, an approximately 1.5 cm long, gaping cut is visible through the skin and presumably into the subcutis, still bleeding. A clear indication for a medical consultation: a deep, gaping wound on the hand with persistent bleeding — closure by suture or adhesive by a doctor is necessary; furthermore the location (the hand, functionally and cosmetically relevant), the tetanus status to be checked and, where appropriate, nerve function to be evaluated. Pharmacy first aid until medical care: (a) elevate the hand above heart level, (b) a pressure dressing with a sterile compress and an elastic bandage, (c) a calm referral to emergency care (a family practice walk-in or hospital emergency department). «Ms A., this belongs in the family practice or the emergency department — the wound is deep and has to be closed professionally. I’ll bandage it firmly now, you hold your hand up and drive straight to the practice.» A tetanus booster in line with the Swiss vaccination schedule 2026 is indicated in adults aged 25–64 with a contaminated or deep wound if the last vaccination was more than 10 years ago.

2. A child’s graze — a fall from a bicycle

Ms B. with Tim, 8 years old, who has an approximately 3 × 4 cm graze on his knee after falling off his bicycle. It is contaminated with soil and grit, bleeding little, but Tim is crying and does not want to be touched. — Open question: «How bad is it, can you show me, Tim?» History: a fall 30 minutes ago, Tim is vaccinated according to the Swiss vaccination schedule (tetanus with Boostrix two years ago). Triage: no deep or gaping wound, no problem involving the hand, face or a joint, no severe bleeding, no unusual accompanying symptoms → pharmacy self-medication is defensible. Wound care: (a) gentle cleaning with sterile Ringer’s solution or Octenisept® spray (child-friendly, low in pain), (b) removal of visible foreign bodies with sterile tweezers, where superficial and possible without pain (otherwise the family doctor), (c) an atraumatic, cushioning dressing — with children, a hydrocolloid (e.g. Comfeel® Plus Transparent) or a silicone foam dressing (e.g. Mepilex® Border) is proven. The advantage: it stays on for several days, protects against contamination and can be changed with little pain. (d) Advice: «Tim, this dressing stays on for 3–5 days now, and you can shower with it too. We’ll change it when the edges soften or it comes off. If the area becomes warm or red, or if it hurts, come back.» The mother receives written instructions for wound checks.

3. A burn at the stove — hot cooking fat

Mr C., 54, has burned himself with hot cooking fat — the left forearm, about 4 × 8 cm reddened, with a blister about 2 cm across. The injury occurred 45 minutes ago; he immediately held his arm under hand-warm water for 10 minutes. History: no pre-existing conditions, tetanus status current. — Clinical classification: erythema with blistering = a superficial partial-thickness burn. Located on the forearm, not the face, hand or a joint, small in area (<1% of body surface) → in principle treatable in the pharmacy. Care in the pharmacy: (a) do not open the blister (natural protection, prevents infection), (b) cleaning with sterile saline or polyhexanide solution, (c) a hydrogel burn dressing (e.g. Burnshield®, possibly Suprasorb® G) — cooling, pain-relieving, ideally with a silicone adhesive surface for atraumatic application; alternatively silicone foam (Mepitel® One plus a secondary dressing), (d) loose secondary fixation, without pressure on the blister, (e) pain therapy: paracetamol 1 g orally or ibuprofen 400 mg orally (an NSAID is also anti-inflammatory). Clear criteria for coming back: «If the pain becomes very severe despite painkillers, if the redness spreads or pus appears, or if you develop a fever, go to the doctor immediately.» In case of escalation: a deep partial-thickness or full-thickness burn (deeper dermal damage, whitish and blotchy, less painful) or an unusual location → the family doctor or emergency department.

4. A chronic venous leg ulcer — an older patient with compliance concerns

Ms D., 76, has been coming for months to reorder material for her venous leg ulcer on the left medial malleolus. Today she asks: «You know, the compression stocking the doctor prescribed — I can hardly get it on by myself in the morning any more. And in the evening everything hurts. I think I’ll just leave it off now. Is that all right?» — Open question: «Tell me how you experience the day with the stocking at the moment.» Reflective listening: «Putting it on is exhausting, and you feel it would be easier without — that is understandable.» Professional classification: compression therapy is the causal therapy of a venous leg ulcer — without compression, wound healing is practically impossible, because the increased venous pressure continues to produce oedema and microcirculatory disturbance. Adherence problems with compression stockings are very common and one of the main reasons for recurrent or non-healing leg ulcers. Practical pharmacy solutions: (a) application aids (e.g. Easy-Slide, Magnide, Doff’n Donner — reimbursed where indicated), which drastically ease the morning procedure. (b) An alternative: a multi-component short-stretch compression bandage (e.g. UrgoK2®, Coban® 2-Layer), applied by home care or the family practice and left on for 7 days — this could be a marked relief for Ms D. (c) The point: «Ms D., before you leave the stocking off — that would really be bad for your leg — let’s look together with your family practice and home care at what we can adjust in the care concept. I’ll call your family doctor today, if you agree.» The pharmacy arranges the consultation and, where appropriate, an appointment at the wound clinic and a home care wound visit with an SAfW-certified wound expert. This mediating role of the pharmacy between the patient, the family practice and home care is one of the most valuable contributions of community pharmacy to the care of chronic wounds.

Practice tool: dressings by wound phase and exudation

The following matrix supports the choice of dressing at the counter. It does not replace structured assessment by a wound specialist but helps with initial orientation. With chronic wounds that do not heal, adjusting the therapy belongs in expert hands (family doctor, SAfW wound expert, wound clinic).

Swiss tariff: MiGeL 1.1.2026 and pharmacy counselling

The economic and tariff framework of wound care in the Swiss pharmacy is regulated through several mechanisms.

The list of medical aids and appliances (MiGeL): the central basis for reimbursement of wound care material in Switzerland. The current edition is the MiGeL of 1 January 2026 (Federal Office of Public Health); it covers around 20 groups of medical devices with reference to more than 55,000 articles. Wound care is listed above all under chapter 35 «Dressing material», with the sub-positions 35.01 «Conventional wound preparations without wound-active or antibacterial ingredients» (e.g. 35.01.01 folded/non-woven compresses, 35.01.02 impregnated/coated wound compresses) as well as further positions for modern dressings with wound-active components. [9,10]

MiGeL structure since February 2022 (three categories by reimbursement logic — not by product class):

• Category A: products reimbursed within self-application (by the insured person or a non-professional helper) at the maximum reimbursement amount for self-application; where applied by nursing professionals, reimbursement follows the rules of care financing under articles 25 and 25a of the health insurance act.
• Category B: products billed to the health insurers (typical dressing material, incontinence aids, compression therapy products, stoma articles and so on).
• Category C: highly specialised products such as negative pressure wound therapy systems, home ventilation and port cannulas; since 1 October 2022 likewise billed through the health insurers.

The maximum reimbursement amount: corresponds to the maximum amount reimbursed by compulsory health insurance (art. 24 para. 3 of the health care benefits ordinance). Patients may choose any suitable product within this amount; where the product price exceeds it, patients bear the difference themselves. The pharmacy’s duty to inform: patients must be informed about the share they will bear themselves before dispensing takes place. [9,10]

Differentiation between the amount for self-application and for nursing care: for products that can be applied both by the patient themselves and within a nursing service under art. 25a, the reduced nursing amount applies where the product is billed by a nursing professional or a home care organisation, or in a nursing home — a relevant constellation for the pharmacy, because double billing must be excluded. [9]

Wound care within medical treatment: aids and appliances used by providers under art. 35 para. 2 of the health insurance act (doctor, hospital, physiotherapy and so on) in the course of their activity — not for nursing services under art. 25a — are not contained in the MiGeL; their reimbursement is regulated in the respective tariff agreements (e.g. TARMED, from 1.1.2026 largely replaced by TARDOC). [9]

The pharmacy tariff LOA V (from 1.1.2026): the new Swiss pharmacy tariff reimburses the pharmaceutical counselling service — including advice on wound care — as a separate position. Pharmacists who regularly offer wound counselling can bill this as an advisory service, provided the conditions (duration of counselling, documentation) are met. [9]

Self-medication outside the MiGeL: plasters, small sterile dressings, OTC antiseptics and first aid material are sold in the pharmacy without a prescription; these products are not reimbursed by compulsory health insurance (self-payment). Private or supplementary insurance may reimburse these costs to a limited extent.

Safety, hygiene, allergies, pain

General safety rules in wound care:

Hygiene and asepsis: hand disinfection before and after every dressing change, sterile materials (compresses, dressings, irrigation solutions), single-use gloves; on contact with wound secretion or potentially infectious material, consider an FFP mask and protective goggles as well. Reusable instruments (scissors, tweezers) must be sterilised — in the pharmacy context, when helping with acute injuries, single-use material is generally used. [11]

Irrigation solutions: sterile 0.9% saline solution, sterile Ringer’s solution or body-warm antiseptics (PHMB, octenidine, NaOCl/HOCl). Tap water is largely accepted in studies on the cleaning of acute wounds in industrialised countries, but is not recommended for chronic wounds in Swiss home care and wound clinic practice (a risk of Pseudomonas contamination from pipe systems, particularly with faulty filtration). [7]

Wound swabs: only where infection is clinically suspected and with a specific question in mind; routine swabs of every wound are not indicated (every chronic wound is colonised with skin flora without this being clinically relevant). Where a swab is indicated: from the wound base after cleaning; ideally a deep biopsy or curettage rather than a surface swab. [7]

Tetanus prophylaxis (Swiss vaccination schedule 2026): check the vaccination status with every acute wound injury. The Swiss recommendation differs between middle-aged adults and risk groups: adults aged 25–64: with clean superficial wounds a booster is indicated if the last tetanus vaccination was more than 20 years ago; with contaminated, deep, infected or impalement/bite wounds, a booster if more than 10 years. Children and people aged 65 and over: for clean superficial wounds a booster if more than 10 years, for contaminated or deep wounds if more than 5 years. In those not vaccinated or of uncertain status, consider additional passive immunisation with tetanus immunoglobulin (e.g. Tetagam®). Boosters in Switzerland are typically given with dT or dTpa combination vaccines (e.g. Boostrix®, Boostrix Polio). [15]

Allergies and sensitisation: frequent sensitisers in wound care are: latex (today mostly replaced by nitrile), wool wax alcohols (in many ointment bases), preservatives (parabens, methylisothiazolinone), fragrances, antibiotics (neomycin), iodine compounds, silver, hydrocolloid adhesives. With repeated rash around dressings: suspect contact allergy, where appropriate switch to silicone-based or collagen-containing products, and arrange dermatological allergy assessment with patch testing. [7,11]

Pregnancy and breastfeeding: PHMB and DACC can be used safely; octenidine can be used (data in pregnancy are limited but it is regarded as unproblematic); iodine compounds are to be used sparingly in pregnancy, breastfeeding and in newborns (a thyroid risk); silver is unproblematic with short use. With medical honey: no specific contraindications in pregnancy.

Pain management: wound pain is common and under-addressed. Treat acute wound pain with paracetamol or an NSAID (ibuprofen 400 mg orally); with chronic wound pain, follow the WHO step plan (NSAID → weak opioids → strong opioids). Pain specific to the dressing change can be reduced by atraumatic dressings (silicone wound contact), a moist dressing change (moistening the dressing beforehand), local anaesthetics (lidocaine gel; with caution in chronic wounds — a risk of methaemoglobinaemia, absorption) and pre-medication (a painkiller 30 minutes before the change). [7,12]

Outlook: cold plasma, NPWT, digital wound care, a new pharmacy role

Wound care continues to change — technologically as well as in its care concept. Five developments will shape the next years:

First: cold plasma technology. The AWMF S2K guideline on the rational therapeutic use of cold physical plasma (published in 2022) has established the treatment of chronic wounds with cold plasma devices as an evidence-based option. Cold plasma generates reactive oxygen and nitrogen species that act antimicrobially, increase skin perfusion and show proliferative effects. Various certified cold plasma devices are established in specialised wound centres in the German-speaking countries. In Switzerland they are used predominantly in wound clinics and specialised dermatology practices; broad availability in pharmacies is not to be expected, but the pharmacy can inform patients about the treatment option. [18,19]

Second: negative pressure wound therapy (NPWT). The wound vacuum system is increasingly used on an outpatient basis; in Switzerland provision is regulated through specialised MiGeL category C providers (renting out NPWT devices and consumables). NPWT improves healing in deep, heavily exuding, chronic or complex wounds — also possible in the home setting if home care takes over the treatment. The pharmacy’s role: advising on patient questions and, where appropriate, referral to the responsible providers.

Third: digital wound care and telemedicine. Tele-wound consultations with wound photography and progress tracking have been piloted in several Swiss cantons. With the electronic patient record and new digital wound documentation tools (e.g. SwissDOC, the MyAvatar® wound tool), structured wound documentation is becoming easier and interprofessional exchange between pharmacy, family practice, home care and wound clinic is becoming simpler. AI-based wound image analysis tools (wound size, tissue type classification, healing prognosis) are increasingly in clinical use from 2026 — their role in pharmacy practice will develop.

Fourth: bioactive dressings and new materials. Collagen-based dressings, dressings impregnated with growth factors, hyaluronic acid-containing products and «smart bandages» with sensors for pH, temperature and degree of exudation are increasingly reaching market maturity in 2026/2027. Swiss market authorisation and inclusion in the MiGeL follow step by step.

Fifth: expanded pharmacy competences. With the health insurance act reform, the pharmacy services reimbursed by compulsory health insurance in Switzerland are being expanded step by step (vaccination, medication review, screening programmes, and in future possibly dedicated wound counselling consultations in pharmacies with the corresponding qualification). Pilot projects on pharmacy-based wound consultations are running in several cantons; nationwide establishment would markedly improve low-threshold initial advice. The precondition: pharmaceutical further training in wound management (e.g. an SAfW course, an FPH module) and networking with local care structures.