When the cavity is bigger than one standard dressing, the XL puts a wider, double-layer strip of the same kaolin gauze into the wound from a single pouch.
At a glance
12 things to know about Combat Gauze XL
What the XL adds, what it shares with standard Combat Gauze, and what the one XL-specific study found.
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01
The large format of Combat Gauze
Combat Gauze XL is a 2-ply strip, 4 in. wide and 4 yd long (10.2 cm × 3.7 m).4 Standard Combat Gauze is 3 in. × 4 yd.15 Same length, a third wider, and doubled into two plies — more gauze from one pouch when the wound is big.
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02
Same kaolin, same FDA clearance
Teleflex describes the XL exactly as it describes standard Combat Gauze: sterile, soft white, nonwoven gauze impregnated with kaolin.3 The FDA device records for both items — and for Combat Gauze LE — sit under 510(k) K072474, cleared in October 2007 for temporary external use to control traumatic bleeding.5,6
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03
How kaolin works
Kaolin is an inorganic mineral that activates Factor XII, which accelerates the body's own clotting where the gauze meets blood.3 It works by contact, so the gauze has to be packed hard against the bleeding source to do its job.
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04
Built for the big cavity
The directions on the pouch: pack the XL into the wound and use it to press directly over the bleeding source — and more than one XL may be required.4 On a narrow wound track, the 3 in. standard dressing is the easier fit.
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05
The one study that tested the XL
In a swine femoral-artery model with a 3-minute hold, the XL achieved immediate hemostasis in 80% of animals against 30% for standard Combat Gauze, and survival of 70% against 60%. Neither difference was statistically significant, and the authors found no clear superiority of any dressing tested.8 Read it as parity, not proof of an advantage.
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06
evidence-based standard
The TCCC Guidelines dated 1 May 2026 name Combat Gauze the evidence-based hemostatic dressing of choice for compressible bleeding a tourniquet cannot control.1 The XL is that dressing in its large format and carries its own NSN, 6510-01-600-4705; the Evidence-Based Standard Devices & Adjuncts list carries the 3 in. Z-fold under NSN 6510-01-562-3325.2,4
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07
Three minutes on the label, three minutes in TCCC
Teleflex labels the XL for 3 minutes of continued pressure, or until bleeding stops.4 The TCCC Guidelines set at least 3 minutes of direct pressure for any hemostatic dressing.1 Both are minimums — a wound that is still bleeding keeps your hands on it.
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08
No heat
In U.S. Army Institute of Surgical Research testing of Combat Gauze, wound temperature did not rise by more than 1 °C after treatment.9 That study used the 3 in. dressing; the XL carries the same kaolin.
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09
It holds under hard conditions
In acidotic, coagulopathic swine, Combat Gauze stopped arterial bleeding on the first application 93% of the time, while standard gauze failed every first application.10 In a groin-wound model with limb movement, Combat Gauze had the lowest re-bleeding of the dressings tested — but re-bleeding hit 25–58% across all groups at 30 minutes.11 Both studies tested Combat Gauze, not the XL. Reassess after every move.
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10
A consistent field record
Hemorrhage control in 88.3% of documented uses on casualties in Afghanistan;12 success in 88.6% of junctional and 91.9% of extremity applications by the Israel Defense Forces Medical Corps.13 Both series report Combat Gauze and neither isolates the XL — real patients, no comparison group.
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11
A field dressing, not a long-term one
The package carries removal directions for the hospital team: gently remove the gauze, then irrigate the wound thoroughly.4 In a 24-hour swine study, embolic material reached the pulmonary artery in every dressing group, Combat Gauze included14 — one more reason to hand the casualty off with the dressing declared.
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12
Packed for the kit
Z-folded and vacuum-sealed, with eight tear points on the pouch,3 a five-year shelf life,3 made in the USA,4 DAPA listed and NSN-assigned.3 The sealed pouch measures 6.5 × 6.5 × 0.75 in. and weighs 1.75 oz.7
How to pack Combat Gauze XL
The package directions, in the packing order taught in TCCC, TECC and public bleeding-control courses.
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1Tourniquet first on a limb. Life-threatening limb bleeding that a tourniquet can control gets a tourniquet first.1 Pack the wounds a tourniquet cannot reach.
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2Find the source. Expose the wound and find where the blood is actually coming from. Keep direct pressure on it while you open the pouch at a tear point — and keep the empty package.4
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3Start with a tight wad. Make the first folds into a firm ball — the "power ball" — and press it directly onto the bleeding vessel.
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4Fill every corner. Feed the gauze in one or two folds at a time and pack tightly to the source, leaving no empty space. Open a second XL if the first is not enough.4
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5Hold firm pressure. At least 3 minutes, per the package directions and the TCCC Guidelines1,4 — and until the bleeding has stopped. Do not lift your hands to look.
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6Lock it in. Wrap and tie a pressure bandage over the packed wound to maintain pressure.4
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7If it keeps bleeding, repack. Remove the packing and pack again with a fresh dressing, the same type or another hemostatic.1 Piling more gauze on top of a failed pack does not fix it.
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8Hand it off. Tell the receiving team a kaolin hemostatic is in the wound and show them the product-removal directions on the empty package.4
Where it fits
- Large junctional wounds — groin and armpit — where a limb tourniquet cannot be applied
- Deep limb cavities where a tourniquet is not possible, or as an adjunct when a trained provider converts a tourniquet1
- Gunshot wounds, stab wounds and mass-casualty incidents — Teleflex's own use list3
- Neck wounds only with care so the airway is not compressed; the lower neck above the collarbone can be packed, and the 3 in. standard dressing is the narrower option
- The chest or abdomen — never pack into the chest or abdominal cavity
- Life-threatening limb bleeding a tourniquet can control — tourniquet first1
- Narrow wound tracks a 4 in. strip cannot fill tightly — use standard Combat Gauze
- The eyes — keep the dressing away from the eyes4
- Practice — train with inert trainers, not live dressings
The evidence
The one study of the XL itself, the studies of the standard dressing that shares its kaolin, and how strong each is.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| Rall et al., J Trauma Acute Care Surg 2013 | Animal · comparative | Combat Gauze XL vs standard Combat Gauze, Celox Gauze, Celox Trauma Gauze and ChitoGauze; swine femoral artery puncture, 3-minute hold | Immediate hemostasis 80% XL vs 30% standard; survival 70% vs 60%; not statistically significant; no dressing clearly superior |
| Kheirabadi et al., J Trauma 2009 | Animal · randomized | Combat Gauze (3 in.) vs three other dressings and placebo gauze; 6 mm femoral arteriotomy in swine | Stable hemostasis in 8 of 10 Combat Gauze animals; longest survival time; no wound temperature rise above 1 °C |
| Causey et al., J Surg Res 2012 | Animal · randomized | Combat Gauze vs standard gauze; femoral artery injury in 17 acidotic, coagulopathic swine | Hemostasis on first application 93% with Combat Gauze; standard gauze failed every first application |
| Landers et al., Mil Med 2021 | Animal · randomized | Combat Gauze, ChitoGauze, NuStat Tactical and Kerlix; 48 swine, groin injury, limb movement over 4.5 hours | Lowest re-bleeding with Combat Gauze; re-bleeding 25–58% across all groups at 30 minutes |
| Schauer et al., J Spec Oper Med 2017 | Human · combat registry | 118 casualties treated with Combat Gauze out of 705 in the DoD Prehospital Trauma Registry, Afghanistan | Hemorrhage control in 88.3% of uses where the outcome was documented |
| Shina et al., J Trauma Acute Care Surg 2015 | Human · combat series | 133 Combat Gauze dressings in 122 patients, Israel Defense Forces Medical Corps, 2009–2014 | Success in 88.6% of junctional and 91.9% of extremity applications |
| Otrocka-Domagała et al., Pol J Vet Sci 2016 | Animal · safety | Combat Gauze, ChitoGauze PRO and Celox Gauze left 24 hours in femoral artery wounds, 9 swine | Embolic material in the pulmonary artery in every group; authors judged all three unsuitable for long-term use |
Strongest to weakest: human registries and series, then animal studies. Only Rall et al. tested the XL by name; every other row tested Combat Gauze, which shares the XL's kaolin agent and FDA clearance. Animal results depend heavily on the injury model, the hold time and the endpoint chosen.
How it compares
The XL against its two Combat Gauze siblings and the evidence-based standard chitosan alternative.
| Combat Gauze XL | Combat Gauze | Combat Gauze LE | ChitoGauze XR PRO | |
|---|---|---|---|---|
| Active agent | Kaolin (mineral) | Kaolin (mineral) | Kaolin (mineral) | Chitosan coating |
| Strip | 4 in. × 4 yd, 2-ply, Z-fold | 3 in. × 4 yd Z-fold | 3 in. × 4 yd Z-fold | 3 in. × 4 yd Z-fold |
| X-ray detectable | Yes — strip | Yes — strip | Yes — strip | Yes — thread |
| Pressure hold | 3 min, or until bleeding stops (label) | 3 min, or until bleeding stops (label) | 3 min, or until bleeding stops (label) | At least 3 min (TCCC) |
| Manufacturer item | Teleflex #345 | Teleflex #200 | Teleflex #350 | Tricol 1090 |
| Pouch | Olive, NSN printed | Olive, NSN printed | Black, marked for police, EMS and fire | Heat-sealed foil pouch |
| FDA 510(k) | K072474 | K072474 | K072474 | K102546 |
| evidence-based standard | Yes — Combat Gauze | Yes — hemostatic dressing of choice | Yes — Combat Gauze | Yes |
| Shellfish-derived | No | No | No | Yes |
Combat Gauze data from Teleflex labeling and FDA device records;3,4,6,15 ChitoGauze XR PRO from its FDA clearance and device record.16 The TCCC Guidelines set at least 3 minutes of direct pressure for any hemostatic dressing.1
Build the system
The standard and law-enforcement Combat Gauze, the chitosan alternative, the bandage that locks the packing in, the tourniquet that comes first, and trainers.
Questions buyers ask
Package & specifications
Specifications coming soon. Contact us for detailed product information.
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