Is hydrogel an appropriate treatment for a friction wound with a gray/blue tint and non-blanchable tissue?

Management of Friction Wound with Gray/Blue Tint and Non-Blanchable Tissue

Hydrogel without silver is an appropriate treatment for this friction wound with gray/blue tissue discoloration, especially since the wound is showing signs of healing with decreasing size and healthy granulation tissue.

Assessment of Current Wound Status

The wound presents with:

• Friction wound with dry eschar at center
• Gray/blue tint around wound (localized to new epithelial tissue)
• Decreasing wound size (positive sign)
• Beefy red granulation tissue (healthy)
• Capillary refill <3 seconds (adequate perfusion)
• Non-blanchable discolored tissue
• Discoloration developed over two weeks
• History of previous cellulitis

Treatment Rationale

Appropriate Use of Hydrogel

1. Hydrogel for Wound Type:

   • Hydrogels are specifically recommended for dry and necrotic wounds to facilitate autolysis 1
   • They provide moisture to the wound bed, which promotes epithelialization and reduces pain 1
   • The presence of dry eschar makes hydrogel an ideal choice for this wound

2. Removal of Silver Component:

   • Discontinuing silver hydrogel was appropriate as:
     • The wound shows signs of healing (decreasing size)
     • The initial cellulitis appears resolved
     • Silver products should be used primarily for active infection control
     • Patient reported discomfort with previous medihoney application

Wound Bed Preparation Principles

The T.I.M.E. framework supports your approach 1:

• Tissue debridement: Continue serial debridement of eschar
• Infection/inflammation control: Monitor the gray/blue tissue but continue with hydrogel
• Moisture balance: Hydrogel provides optimal moisture for this wound type
• Edge advancement: The decreasing wound size indicates positive edge advancement

Monitoring the Gray/Blue Tissue

The gray/blue discoloration warrants monitoring but doesn't necessarily require changing the treatment approach because:

• The wound is decreasing in size (positive sign)
• Granulation tissue is healthy (beefy red)
• Capillary refill is adequate (<3 seconds)
• The discoloration is localized to new epithelial tissue

This discoloration may represent:

• Normal epithelialization process
• Residual effects from previous silver application (silver can cause tissue discoloration)
• Early signs of tissue changes that should be monitored but not necessarily treated differently at this time

Dressing Protocol

Based on current guidelines, the optimal dressing protocol is:

1. Continue serial debridement of eschar as needed
2. Apply hydrogel to maintain moist wound environment
3. Cover with adaptic (non-adherent layer)
4. Secure with gauze
5. Change dressing 1-2 times weekly based on exudate amount 1

When to Consider Treatment Modification

Modify treatment if:

• Wound size increases
• Signs of infection develop (increased pain, purulence, expanding erythema)
• Gray/blue tissue becomes necrotic or shows signs of deterioration
• Wound healing stalls for 2+ weeks

Conclusion

The current treatment with hydrogel (without silver) is appropriate and aligned with wound care guidelines. The presence of healthy granulation tissue and decreasing wound size are positive indicators that the current approach is effective. Continue to monitor the gray/blue tissue, but maintain the current treatment regimen as the wound is showing signs of healing.