Treatment of Stage 2 Pressure Ulcers
Apply hydrocolloid or foam dressings to the wound, ensure pressure redistribution with alternative foam mattresses, and provide protein supplementation if nutritionally deficient. 1
Primary Wound Management
Use hydrocolloid or foam dressings as first-line therapy, as these are superior to gauze dressings for reducing wound size and promoting healing. 1, 2
- Select dressings based on exudate control, comfort, and cost rather than antimicrobial properties. 1, 2
- Antimicrobial dressings should not be used as the sole intervention to accelerate healing. 1, 2
- Stage 2 ulcers typically heal in approximately 23 days with appropriate treatment, though ulcers smaller than 3.1 cm heal about 12 days faster than larger ones. 3
Pressure Redistribution (Critical Component)
Replace standard hospital mattresses with alternative foam mattresses immediately, which provides a 69% relative risk reduction in pressure ulcer incidence. 1, 2
- Avoid expensive advanced support surfaces like alternating-air and low-air-loss beds, as evidence for superiority is limited and they add unnecessary costs. 1, 2
- Air-fluidized beds are superior to standard hospital beds for reducing pressure ulcer size, though evidence on complete wound healing remains limited. 2
Nutritional Support
Provide protein or amino acid supplementation to reduce wound size, particularly in patients with nutritional deficiencies. 1, 2
- Ensure adequate caloric intake and correct nitrogen balance. 1, 2
- Vitamin C supplementation alone has not shown benefit compared to placebo. 1, 2
- Higher hemoglobin levels and oral nutrition are associated with improved healing outcomes. 4
Adjunctive Therapies
Consider electrical stimulation as adjunctive therapy if the wound fails to show 50% or more reduction in size after 4 weeks of standard management. 1, 2, 5
- Use high-voltage pulsed current (HVPC) with the active electrode placed directly over the wound. 5
- Apply electrical stimulation alongside standard wound care principles including appropriate dressings, pressure relief, and nutritional support. 5
- Be aware that frail elderly patients experience higher rates of adverse events, particularly skin irritation. 2, 5
Infection Surveillance
Evaluate for infection requiring antibiotic therapy if the ulcer shows signs of deep tissue involvement, cellulitis, or drainage. 2
- Direct antibiotic therapy against Gram-positive and Gram-negative organisms as well as anaerobes when infection is present. 2
Critical Pitfalls to Avoid
Do not continue standard therapy beyond 4 weeks without considering advanced wound therapy if the ulcer shows inadequate improvement (less than 50% reduction in size). 1, 2, 5
- Do not neglect vascular assessment when pedal pulses are absent or ulcers fail to improve—check ankle-brachial index, toe pressure, or TcPO2. 2
- Assess footwear meticulously if the ulcer is on the foot, as ill-fitting shoes are the most frequent cause of ulceration. 2
- Do not use electrical stimulation as monotherapy; it must be adjunctive to proper wound care. 5