From the Guidelines
For an 88-year-old man with a non-healing wound that appears over-granulated after 2 weeks, I recommend thoroughly removing all granulation tissue, as suggested by the most recent study in 2025 1. The use of a degranulation bur is highly recommended for this procedure, as it allows for precise removal of the excess tissue. This approach is supported by the latest guidelines, which emphasize the importance of removing granulation tissue to promote proper wound healing.
- Key considerations for this treatment include:
- Ensuring the wound is free of infection and other complications before proceeding with degranulation
- Using a gentle and precise technique to avoid damaging surrounding tissue
- Providing adequate post-procedure care, including dressing and wound protection, to promote healing and prevent further complications
- It is also essential to monitor the patient's progress closely, with regular follow-up appointments to assess the wound's healing and adjust treatment as needed. Given the patient's advanced age, it is crucial to be vigilant for signs of infection or deterioration, as healing may be naturally delayed. The removal of granulation tissue, as recommended by the 2025 study 1, is a crucial step in promoting wound healing and preventing further complications.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage The treatment option for the 88-year-old man's wound is to clean the affected area and apply a small amount of bacitracin (TOP), an amount equal to the surface area of the tip of a finger, 1 to 3 times daily. The wound may be covered with a sterile bandage 2.
From the Research
Treatment Options for the 88-Year-Old Man's Wound
The patient presents with a 2-week-old wound that has failed to heal, characterized by a raised, rounded, and educated lesion with no signs of infection. Based on the available studies, the following treatment options can be considered:
- Assessment and exclusion of disease processes: As suggested by 3, it is essential to assess the wound and exclude any underlying disease processes that may be hindering the healing process.
- Wound cleansing and dressing change: The study by 3 also emphasizes the importance of wound cleansing and timely dressing change to promote wound healing.
- Appropriate dressing choice: Selecting the right dressing for the wound is crucial, as noted by 3.
- Considered antibiotic prescription: Although there are no signs of infection, antibiotic prescription may be considered if necessary, as mentioned by 3.
- Person-centered care: The study by 4 highlights the importance of person-centered care in wound management, which involves considering the patient's perspectives, beliefs, and autonomy.
- Use of platelet-derived hydrogel: The study by 5 suggests that a platelet-derived hydrogel can improve neovascularization in full-thickness wounds, which may be beneficial for the patient's wound.
- Topical ointments or creams: Bacitracin, an antibiotic ointment, may be used to promote wound healing, as discussed by 6. However, it is essential to consider the potential for allergy to this agent.
Key Considerations
When developing a treatment plan for the patient's wound, it is crucial to consider the following:
- The patient's age and potential comorbidities that may affect wound healing
- The presence of any underlying disease processes that may be hindering wound healing
- The importance of person-centered care in wound management
- The potential benefits and risks of using platelet-derived hydrogel or other topical treatments
- The need for regular wound assessment and adjustment of the treatment plan as necessary, as suggested by 7 in the context of wound healing phases and potential alterations that can impede wound healing.