Treatment of Stage 2 Pressure Ulcers

For stage 2 pressure ulcers, hydrocolloid or foam dressings are recommended as the primary treatment to reduce wound size and promote healing. 1

Primary Treatment Approach

Use hydrocolloid or foam dressings as the first-line treatment for stage 2 pressure ulcers, as these have been shown to be more effective than gauze dressings for reducing wound size 1
Clean the wound regularly with water or saline to remove debris and create an optimal healing environment before applying dressings 2
Moderate-quality evidence shows that hydrocolloid dressings result in complete wound healing similar to that of foam dressings (hydrocellular or polyurethane) 1, 3
Ensure complete pressure offloading from the affected area to minimize trauma to the ulcer site and promote healing 2

Provide protein or amino acid supplementation to reduce wound size, particularly in patients with nutritional deficiencies 1, 2
Be aware that nutritional supplementation may not benefit all patients with pressure ulcers, only those with pre-existing nutritional deficiencies 1
Vitamin C supplementation alone has not shown benefit compared to placebo and is not recommended as a standalone treatment 1

Consider electrical stimulation as an adjunctive therapy to accelerate wound healing (moderate-quality evidence supports its use for stage 2 to 4 ulcers) 1, 2
Be cautious when using electrical stimulation in frail elderly patients who may be more susceptible to adverse events 4
Regularly assess the wound for signs of healing or deterioration to determine if the treatment plan needs adjustment 2

Hydrocolloid dressings are easier to apply but may be more difficult to remove than foam dressings 3
Foam dressings may be preferable for wounds with moderate to heavy exudate 2, 5
When changing dressings, minimize trauma to the wound bed to prevent delayed healing 2
Change dressings as needed based on exudate levels and manufacturer recommendations 3

If the pressure ulcer is not showing signs of healing within 6 weeks despite optimal management, reevaluate the treatment approach 2
Monitor for signs of infection such as increasing pain, erythema, warmth, or purulent drainage 2
For infected pressure ulcers, consider appropriate antimicrobial therapy in addition to standard wound care 2

Advanced support surfaces like alternating-air and low-air-loss beds have limited evidence for effectiveness and add unnecessary costs; they should not be used routinely 1, 2
Do not rely solely on intermediate outcomes like reduction in wound size, as the relationship between reduction in wound size and eventual complete healing is not well-defined 1
A Cochrane review found limited evidence to suggest that any specific dressing type is superior to others when used under compression, highlighting the importance of addressing the underlying pressure issue 6
Surgical intervention is rarely indicated for stage 2 pressure ulcers and should be reserved for deeper (stage 3 and 4) ulcers 7