AQUACEL AG EXTRA

Managing wound infection and exudate simultaneously is a central challenge in chronic wound care. AQUACEL Ag Extra is the enhanced absorbency version of AQUACEL Ag from Convatec. It uses a two-layer CMC hydrofiber construction that significantly increases the absorbent capacity compared with standard AQUACEL Ag, making it suited to heavily exuding wounds where the standard product would reach capacity too quickly. It retains the ionic silver antimicrobial activity, vertical wicking, and cohesive gel properties of AQUACEL Ag while providing greater fluid handling for more demanding wound conditions. No prescription is required.

AQUACEL Ag Extra is a regulated Class IIb medical device from Convatec. It is the enhanced absorbency version of AQUACEL Ag. While standard AQUACEL Ag uses a single layer of sodium CMC hydrofiber fibres impregnated with ionic silver, AQUACEL Ag Extra adds a second layer of CMC hydrofiber beneath the standard layer. This two-layer construction approximately doubles the absorbent capacity, making it appropriate for wounds that produce more exudate than the standard product can effectively manage.

The key distinguishing property of CMC hydrofiber is vertical wicking. When AQUACEL Ag Extra contacts wound exudate, the CMC fibres absorb fluid vertically upward into the dressing structure rather than spreading it laterally across the wound surface and onto the surrounding periwound skin. Lateral spread of exudate is a significant cause of periwound maceration in heavily exuding wounds. The vertical wicking mechanism of AQUACEL Ag helps contain exudate within the footprint of the dressing, reducing the risk of maceration and skin damage around the wound margins.

As the CMC fibres absorb exudate, they swell and form a soft cohesive gel. This gel conforms to the wound surface and maintains close wound contact throughout the wear period. Unlike some alginate dressings which may fragment during removal, the cohesive nature of the AQUACEL Ag gel means the dressing generally holds together as a single piece, simplifying removal. The ionic silver within the fibres is released as the gel forms, providing sustained local antimicrobial activity throughout the wear period.

AQUACEL Ag Extra is indicated for use on infected or at risk heavily exuding wounds where standard AQUACEL Ag does not provide sufficient absorbent capacity. It is suitable for chronic wounds including venous leg ulcers, pressure ulcers, and diabetic foot ulcers with heavy exudate, as well as partial thickness burns, acute wounds, and skin graft sites with high fluid output.

AQUACEL Ag Extra is applied dry to the wound. The wound exudate activates the gelling and silver release mechanisms. Do not pre-wet or soak the dressing before application. A gel residue will remain in the wound when the dressing is removed. This is normal and expected. Irrigate the wound with sterile saline after removal to clear gel residue before applying the next dressing.

Two Layer Construction and Enhanced Absorbency

AQUACEL Ag Extra has two layers of CMC hydrofiber. The upper layer is the standard AQUACEL Ag construction, sodium CMC fibres with ionic silver. The lower layer is an additional CMC hydrofiber layer that significantly increases the total fluid absorption capacity of the dressing. This increased capacity means AQUACEL Ag Extra can manage higher volumes of wound exudate before reaching saturation, allowing it to remain effective in heavily exuding wounds over a full wear period. Choose AQUACEL Ag Extra when standard AQUACEL Ag would need to be changed too frequently due to exudate volume.

CMC Hydrofiber Technology and Vertical Wicking

Sodium carboxymethylcellulose is a highly absorbent material with the capacity to absorb many times its own weight in fluid. The CMC fibres in AQUACEL Ag are oriented to absorb wound exudate vertically, drawing it upward into the dressing structure. This vertical wicking action keeps absorbed exudate contained within the dressing footprint rather than allowing it to spread sideways onto the periwound skin. In standard wound dressings, lateral spread of exudate can macerate and damage the skin immediately surrounding the wound, which can increase wound size and delay healing. The vertical wicking property of CMC hydrofiber addresses this risk.

Gel Formation

As the CMC fibres absorb wound exudate, they undergo a transformation from dry fibres to a soft, cohesive moist gel. This gel maintains close contact with the wound surface throughout the wear period and creates a moist wound healing environment. The cohesive nature of the gel means the dressing remains intact as a single mass rather than fragmenting, which simplifies removal and reduces the risk of retained dressing material in the wound.

Ionic Silver Antimicrobial Action

Ionic silver is released from the CMC fibres as the gel forms. Silver ions act on wound pathogens through multiple mechanisms: disrupting bacterial cell membranes, interfering with the enzyme systems bacteria require to function, and preventing bacterial DNA replication. This broad mechanism provides antimicrobial activity against a wide range of wound pathogens including Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Escherichia coli, and Candida species. The silver is released locally at the wound surface rather than being absorbed systemically in clinically significant amounts.

How AQUACEL Ag Extra Differs From AQUACEL Ag and ALGISITE Ag

Both AQUACEL Ag and ALGISITE Ag use ionic silver for antimicrobial activity and both gel on contact with wound exudate. The key difference is the fibre material. ALGISITE Ag uses calcium alginate fibres derived from seaweed. AQUACEL Ag Extra uses synthetic CMC fibres. The CMC fibres provide stronger vertical wicking and produce a more cohesive gel that holds together more reliably at removal. Both are applied dry and both require gel residue to be irrigated away after removal.

Before Application

• Wash hands and use appropriate gloves.
• Clean the wound with sterile saline or as directed by a healthcare professional.
• Dry the periwound skin and apply a skin barrier or protectant to any macerated periwound skin.
• Remove AQUACEL Ag Extra from its sterile packaging immediately before use. Do not pre-wet the dressing.

Application

• For flat wounds: place the dry dressing over the wound, ensuring it covers the wound bed and extends slightly beyond the wound margin.
• For cavity wounds: loosely fill the cavity with the dry dressing. Do not pack tightly. Leave space for gel expansion as the dressing absorbs exudate. Ensure the dressing can be fully retrieved at the next change.
• Apply an appropriate secondary dressing over AQUACEL Ag Extra to secure and provide additional absorbency as needed.
• Label with the date and time of application.

Removal

• AQUACEL Ag will have gelled at the time of removal. Irrigate the wound with sterile saline to soften the gel and assist removal.
• The cohesive gel should come away as a single piece in most cases. Remove gently.
• Irrigate the wound after removal to clear any remaining gel residue before assessing the wound and applying the next dressing.
• Gel residue after removal is normal and expected. Always irrigate the wound with sterile saline after removing AQUACEL Ag to clear the residue before applying the next dressing. Do not mistake gel residue for slough or wound tissue. The cohesive CMC gel is a different appearance from calcium alginate gel and holds together more firmly.

AQUACEL Ag Extra 5cm x 5cm

Suitable for small to moderate heavily exuding wounds where the enhanced absorbency of the two layer construction is needed within a compact format.

AQUACEL Ag Extra 10cm x 10cm

A versatile medium size suitable for heavily exuding moderate-sized wounds including pressure ulcers, venous leg ulcer areas, and diabetic foot wounds with high exudate output where standard AQUACEL Ag would require too frequent changes.

AQUACEL Ag Extra 15cm x 15cm

A larger size for more extensive heavily exuding wound areas. Provides broad antimicrobial enhanced absorbency hydrofiber coverage for larger chronic wounds and burns with significant fluid output.

AQUACEL Ag Extra 20cm x 30cm

The largest size, suitable for extensive heavily exuding wound areas including large burns, large pressure ulcers, and significant wound areas with high exudate. Primarily for clinical settings. Can be cut to fit with sterile scissors.

When selecting a size, choose a dressing that covers the entire wound bed and extends slightly beyond the wound margin.

Contraindications

• Do not use on patients with a known sensitivity or allergy to silver or to CMC hydrofiber.
• Do not use on dry or minimally exuding wounds. CMC hydrofiber requires wound exudate to activate the gel. On dry wounds the dressing will not gel and may adhere to the wound surface.
• Do not use in conjunction with oil-based topical products directly under the dressing as these impair silver ion release.

Precautions

• AQUACEL Ag is a single use product. Do not reuse or resterilise.
• Ensure all dressing material is removed at each change. Irrigate thoroughly. Retained dressing can act as a foreign body.
• Silver containing dressings may cause grey or blue grey discolouration of the wound bed and periwound skin due to silver deposition (argyria). This is expected, localised, and generally reversible. Inform patients in advance.
• Do not use MRI scanning with AQUACEL Ag in place. Remove before MRI procedures.
• Silver dressings are not a substitute for systemic antibiotic therapy where there is spreading cellulitis, systemic infection, or sepsis.
• Use with caution in patients who are pregnant or breastfeeding. Seek clinical advice.

Adverse Effects

• Localised skin sensitivity or irritation. Discontinue if persistent.
• Grey or blue grey wound and periwound discolouration from silver deposition. Expected and reversible.
• Dressing adherence if exudate falls and the dressing does not gel adequately. Irrigate before removal.

AQUACEL Ag Is Suitable For Use On

• Infected or at risk moderately to heavily exuding chronic wounds including venous leg ulcers, pressure ulcers, and diabetic foot ulcers
• Cavity wounds and irregular wound beds where the gelling and conforming properties of CMC hydrofiber provide better contact than a flat sheet dressing
• Partial thickness burns with moderate to heavy exudate
• Skin graft donor and recipient sites with significant exudate
• Wounds where periwound maceration is a concern and the vertical wicking property of CMC hydrofiber is clinically beneficial
• Adults and children under healthcare professional supervision

AQUACEL Ag Extra uses ionic silver within CMC hydrofiber. ALGISITE Ag uses ionic silver within calcium alginate. The ACTICOAT range uses nanocrystalline silver on polyethylene mesh or polyester fabric. AQUACEL Ag and ALGISITE Ag both gel on contact with exudate and are applied dry. The CMC hydrofiber of AQUACEL Ag provides stronger vertical wicking and a more cohesive gel than calcium alginate. The ACTICOAT range maintains a sheet structure and requires moistening with sterile water during wear. Product selection depends on wound type, exudate level, location, and clinical preference.

AQUACEL Ag Extra is a regulated medical device and does not require a prescription. It can be purchased directly through Pharmacy Planet without a clinical consultation. It is available in four sizes: 5cm x 5cm, 10cm x 10cm, 15cm x 15cm, and 20cm x 30cm.

Pharmacy Planet stocks AQUACEL Ag alongside ALGISITE Ag, the full ACTICOAT range, and a comprehensive selection of primary and secondary wound care products. Our pharmacists can advise on product selection for specific wound types and clinical requirements.

For complex wounds or wounds not healing as expected, seek clinical assessment from a tissue viability nurse, district nurse, or GP alongside your dressing purchases.

• Store in a cool, dry place away from direct sunlight and moisture.
• Store below 25°C.
• Keep in the original sealed packaging until immediately before use.
• Each dressing is individually sterile packed. Do not use if the packaging is damaged or compromised.
• Check the expiry date before use. Do not use after the expiry date.
• Once opened, apply immediately.
• Keep out of the reach of children.
• Dispose of used dressings as clinical waste in accordance with local guidelines.

Pharmacy Planet is a GPhC registered online pharmacy providing access to AQUACEL Ag in all four available sizes alongside a comprehensive range of wound care products. All products are genuine and sourced through regulated supply chains.

Our pharmacists are available to advise on AQUACEL Ag versus other silver dressings and on complementary secondary dressings and wound care products.

References

1. Convatec. AQUACEL Ag Antimicrobial Dressing — Instructions for Use. Convatec Ltd. https://www.convatec.com. Accessed May 2026.
2. Wounds UK. Best Practice Statement: Wound exudate — effective assessment and management. https://www.wounds-uk.com. Accessed May 2026.
3. World Union of Wound Healing Societies (WUWHS). Antimicrobials and non-healing wounds: evidence, controversies and suggestions. https://wuwhs.net. Accessed May 2026.
4. National Institute for Health and Care Excellence (NICE). Wound care products — Drug Tariff prescribing and selection. https://www.nice.org.uk. Accessed May 2026.