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 in the most recent study from 2025 1. The use of a degranulation bur is highly recommended for this purpose, as outlined in the study published in Periodontology 2000 1. Key considerations for treatment include:
- Thorough debridement of excess granulation tissue to promote wound healing
- Avoiding infection and maintaining a clean wound environment
- Potential use of topical treatments to support wound healing, although the most recent evidence prioritizes degranulation 1 Some important aspects of wound care to keep in mind:
- Cleaning the wound with normal saline or mild antiseptic solution before each dressing change
- Applying a non-adherent dressing to protect the wound and promote healing
- Considering moderate compression with a bandage if the wound is on an extremity to reduce edema It is essential to reassess the wound after 7-10 days of treatment and consider further investigation, such as biopsy, if no improvement occurs, particularly given the patient's advanced age and the raised appearance of the lesion 1.
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
Wound Assessment and Treatment Options
The patient's wound appears to be an over-granulated wound, which can be a challenge to treat. According to 3, wound healing consists of four overlapping phases, and a holistic assessment of the wound is essential to determine the best course of treatment.
Treatment Considerations
Some potential treatment options for the patient's wound include:
- Debridement to remove excess tissue and promote healing
- Topical dressings to protect the wound and promote a moist environment
- Platelet-derived hydrogels, which have been shown to improve neovascularisation in full thickness wounds 4
- Patient education and person-centered care, which can improve patient outcomes in wound care 5
Wound Healing Phases
As noted in 6, wound healing is an intricate process that can be influenced by a variety of factors. The classical wound healing phases include inflammation, proliferation, and remodeling. Alterations in any of these phases can promote chronic wound development and may impede wound healing.
Topical Antibiotics
Topical antibiotics such as bacitracin may be used to prevent infection, but it is essential to be aware of the potential for allergy 7. The incidence of allergy to bacitracin has been increasing, and patch testing may be necessary to determine if the patient is allergic to this agent.