From the Guidelines
The treatment for an unstageable pressure ulcer on the heel that has been debrided involves a comprehensive wound care approach, prioritizing sharp debridement, dressing selection based on exudate control, comfort, and cost, and considering adjunctive treatments like systemic hyperbaric oxygen therapy or sucrose-octasulfate impregnated dressings for non-infected, neuro-ischaemic ulcers. After debridement, the wound should be cleansed with normal saline or a wound cleanser, followed by application of an appropriate dressing based on the wound characteristics. For a debrided heel ulcer, options include dressings that control exudate and maintain a moist environment, as recommended by the IWGDF guidelines 1. The dressing should be changed every 1-3 days depending on exudate levels. Pressure offloading is crucial - a heel suspension device, pillows arranged to float the heel, or specialized boots should be used to completely eliminate pressure on the affected heel. Nutritional support with adequate protein, hydration, and vitamins promotes healing, although the use of supplements to correct nutritional status is not recommended as a primary intervention for wound healing 1. Infection control is essential, with topical antimicrobials or systemic antibiotics used judiciously based on clinical infection. Pain management should be addressed with appropriate analgesics. The wound should be reassessed regularly, typically weekly, to monitor healing progress and adjust the treatment plan as needed.
Key considerations in the treatment plan include:
- Sharp debridement as the preferred method for removing slough, necrotic tissue, and surrounding callus 1
- Dressing selection based on exudate control, comfort, and cost, avoiding antimicrobial dressings unless clinically indicated 1
- Adjunctive treatments like systemic hyperbaric oxygen therapy for non-healing ischaemic ulcers or sucrose-octasulfate impregnated dressings for non-infected, neuro-ischaemic ulcers 1
- Regular reassessment and adjustment of the treatment plan to promote healing and prevent complications.
Given the most recent and highest quality evidence, the approach outlined above prioritizes the patient's morbidity, mortality, and quality of life, focusing on evidence-based wound care practices and adjunctive treatments as recommended by current guidelines 1.
From the Research
Treatment for Unstageable Pressure Ulcer on the Heel
The treatment for an unstageable pressure ulcer on the heel that has been debrided involves several steps, including:
- Offloading: reducing pressure on the affected area to promote healing 2
- Wound care: using dressings and topical agents to promote healing and prevent infection
- Monitoring: regularly assessing the wound for signs of improvement or deterioration
Dressing Options
Several dressing options are available for treating pressure ulcers, including:
- Hydrogel dressings: may promote healing and reduce pain, but evidence is limited 3
- Foam dressings: may be effective in promoting healing, but evidence is uncertain 4
- Protease-modulating dressings: may increase the probability of healing, but evidence is moderate-certainty 5
Considerations
When treating an unstageable pressure ulcer on the heel, it is essential to consider the following:
- The ulcer's size, depth, and location
- The patient's overall health and mobility
- The presence of any underlying conditions, such as diabetes or vascular disease
- The need for regular monitoring and adjustment of treatment as needed
Clinical Practice Recommendations
Experts strongly endorse the following recommendations for treating heel pressure injuries: