What is the best wound filler for a stage 3 (three-stage) sacral region pressure injury?

Best Wound Fillers for Stage 3 Sacral Pressure Injuries

Hydrocolloid or foam dressings are the recommended wound fillers for stage 3 sacral pressure injuries to reduce wound size and promote healing. 1, 2

Primary Dressing Selection

First-Line Options

• Hydrocolloid dressings are superior to gauze dressings for reducing wound size and should be considered a primary option 1, 2
• Foam dressings are equivalent to hydrocolloid dressings for complete wound healing and are also recommended as first-line treatment 1
• Triangle-shaped hydrocolloid border dressings may be more effective than oval-shaped ones for sacral wounds, showing greater reduction in ulcer width 3

For Moderate to Heavy Exudate

• Alginate or hydrofiber dressings should be considered when exudate levels are moderate to high 2
• Amorphous hydrocolloid (hydrogel) has been shown to significantly reduce wound volume compared to saline dressings (26% vs 64% of initial volume) 4

Adjunctive Therapies

Recommended Adjuncts

• Electrical stimulation should be added to standard treatment to accelerate healing rate of stage 2-4 ulcers (moderate-quality evidence) 1, 2
• Collagen matrix dressings can be considered to reduce protease activity and promote dermal fibroblast proliferation 1, 2
• For non-healing wounds, negative pressure wound therapy should be evaluated as an option 2

Antimicrobial Considerations

• Apply antimicrobial dressings containing silver, iodine, or medical-grade honey to control biofilm and prevent infection 1, 2
• Target wound pH between 4-6 using stabilized hypochlorous acid solutions to create an optimal healing environment 1

Wound Bed Preparation

Debridement

• Sharp debridement should be performed to remove all necrotic tissue and slough 1, 2
• Enzymatic debridement agents should be considered if sharp debridement is contraindicated 2
• Hydrogel-treated wounds require less frequent debridement compared to saline-treated wounds (7% vs 21% of weekly dressings) 4

Cleansing

• Clean wound with normal saline or water at each dressing change 2
• Implement strict hand hygiene and aseptic technique when cleaning wounds 1, 2

Supportive Measures

Pressure Relief

• Complete offloading of the sacral area using an air-fluidized bed or specialized pressure-redistribution surface is essential 1, 2
• Implement a strict turning schedule every 2-4 hours 2

Nutritional Support

• Provide protein supplementation (1.25-1.5 g/kg/day) to support wound healing 1
• Consider micronutrient supplementation (B6, B12, folate, zinc, arginine, glutamate) if deficiencies are present 1

Monitoring and Reassessment

• Document wound measurements and characteristics weekly 2
• Change dressings as needed based on exudate levels, typically every 1-3 days 2
• Reassess treatment plan if no improvement is seen within 2-4 weeks 2

Common Pitfalls to Avoid

• Do not use gauze dressings as they are inferior to hydrocolloid dressings for reducing ulcer size 1, 2
• Avoid focusing solely on intermediate outcomes like reduction in wound size without considering complete healing 1
• Do not mistake exudates, debris, and slough for biofilm 2
• Be aware that sacral pressure injuries have lower recurrence rates after surgery compared to ischial pressure injuries 1

Special Considerations

• For wounds with no healing potential, follow the S-P-E-C-I-A-L approach: Stabilize wound, Prevent new wounds, Eliminate odor, Control pain, Infection prevention, Advanced absorbent dressings, and Lessen dressing changes 1, 2
• Monitor for signs of infection using NERDS/STONES assessment tools (NERDS: Nonhealing, Exudate, Red friable tissue, Debris and Smell; STONES: Size increasing, Temperature elevation, Os, New breakdown, Erythema/Edema, Exudate and Smell) 1, 2