Guidelines for Proper Wound Care and Management
Proper wound care requires a systematic approach focused on cleaning the wound, maintaining a moist environment, controlling exudate, and preventing infection to optimize healing outcomes and reduce morbidity and mortality.
Core Principles of Wound Care
Initial Assessment and Wound Cleansing
- Clean wounds regularly with water or saline 1
- Avoid using footbaths as they can cause skin maceration 2
- For minor acute wounds, thorough cleansing with potable tap water or normal saline is recommended 3
Wound Bed Preparation
- Debride necrotic tissue to promote healing 1, 2
- Perform sharp debridement to remove necrotic tissue, slough, and surrounding callus 2
- Consider enzymatic debridement for sloughy wounds when sharp debridement is not feasible 2
Maintaining Optimal Wound Environment
- Control exudate to maintain a moist wound environment 1
- Use sterile, inert protective dressings for most wounds 1
- Maintain moisture while avoiding tissue maceration 2
- Select dressings based on wound characteristics 2:
- Necrotic wounds: saline gauze or hydrogels
- Exudative wounds: alginates or foams
- Dry wounds: films or hydrocolloids
Dressing Selection and Application
Application Guidelines
- For minor wounds (adults and children ≥2 years): apply a small amount of topical antimicrobial product 1-3 times daily; may cover with sterile bandage 4
- For children under 2 years: consult a healthcare provider 4
Advanced Wound Therapies
- Consider negative pressure wound therapy (NPWT) for wounds that fail to show 50% reduction after 4 weeks of standard care 2
- Topical negative pressure therapy may hasten healing of post-operative wounds, though cost-effectiveness remains to be established 1
- Hyperbaric oxygen therapy may be considered for non-healing diabetic foot ulcers after revascularization 1
Special Considerations for Diabetic Foot Ulcers
Management Approach
- Treatment principles for diabetic foot ulcers include 1:
- Treating any associated infection
- Revascularization if appropriate
- Offloading to minimize trauma
- Wound bed management to promote healing
Pressure Offloading
- Implement pressure offloading for diabetic foot ulcers 1
- Total-contact casts show higher and faster rates of wound healing compared to half-shoes or removable cast walkers 1
- Consider pressure offloading even for non-diabetic foot ulcers to promote tissue growth and wound healing 1
Infection Management
Antibiotic Use
- Prompt management of foot infection with antibiotics and debridement is essential, particularly for diabetic patients 1
- Start appropriate antibiotics only if clinical signs of infection are present 2
- Do not treat clinically uninfected wounds with antimicrobial therapy 2
Infection Severity Assessment
- Tailor antibiotic selection based on infection severity 2:
- Mild (local inflammation ≤2 cm): Amoxicillin/clavulanate
- Moderate (cellulitis >2 cm or deeper extension): Amoxicillin/clavulanate or ceftriaxone
- Severe (systemic toxicity): Piperacillin/tazobactam
Follow-up and Monitoring
Reassessment Schedule
- Reassess wounds frequently to evaluate healing progress 2
- Follow up within 2-3 days for infected wounds 2
- Follow up within 7-10 days for initially uninfected wounds 2
- Monitor for signs of spreading infection or deterioration 2
Common Pitfalls to Avoid
- Overuse of antibiotics: Do not use antimicrobials for uninfected wounds 2
- Inadequate debridement: Failure to remove necrotic tissue impedes healing 2
- Inappropriate dressing selection: Using the wrong dressing type for wound characteristics can delay healing 2
- Neglecting underlying conditions: Failure to address factors like vascular insufficiency, diabetes control, or nutritional status will prevent healing 1, 2
- Inconsistent follow-up: Inadequate monitoring can lead to missed complications 2
By following these guidelines systematically, clinicians can optimize wound healing outcomes, reduce complications, and improve patient quality of life.