Stop Using Betadine-Soaked Gauze for Deep Sacral Pressure Ulcers
You should discontinue packing this deep sacral pressure ulcer with Betadine-soaked gauze and switch to hydrocolloid or foam dressings, which have superior evidence for promoting healing. Betadine (povidone-iodine) is not recommended as a primary treatment strategy for pressure ulcer healing, and plain gauze dressings are inferior to modern moisture-retentive dressings 1.
Why Betadine-Soaked Gauze Is Not Recommended
Evidence Against Antiseptics for Healing
Antiseptics like povidone-iodine have not been shown to improve pressure ulcer healing and may actually result in fewer ulcers healing compared to non-antimicrobial alternatives 2.
A Cochrane systematic review found that povidone-iodine was associated with lower healing rates compared to protease-modulating dressings (RR 0.78,95% CI 0.62 to 0.98) and hydrogel (RR 0.64,95% CI 0.43 to 0.97) 2.
The evidence quality for antiseptics ranges from moderate to very low, with no clear benefit demonstrated for wound healing 2.
Gauze Dressings Are Inferior
Hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence) 1, 3.
The American College of Physicians guidelines specifically recommend hydrocolloid or foam dressings over gauze 1.
What You Should Do Instead
Primary Wound Care Strategy
Apply hydrocolloid or foam dressings as the primary dressing after appropriate wound cleansing and debridement 1, 4.
Hydrocolloid and foam dressings are equivalent in effectiveness (moderate-quality evidence), so choose based on the exudate level: foam dressings are more absorbent for moderate to high exudate 5.
Essential Concurrent Interventions
Ensure surgical debridement of necrotic tissue if present, as this is necessary for infected pressure ulcers 1.
Provide protein supplementation at 1.2-1.5 g/kg/day to support wound healing—this is a formal recommendation from the American College of Physicians (weak recommendation, low-quality evidence) 1, 4.
Implement pressure redistribution with air-loss mattress or dynamic support surfaces and repositioning every 2-4 hours 4.
Special Considerations for Sacral Location
Manage fecal and urinary incontinence aggressively, as moisture increases maceration risk and can contaminate dressings in the sacral area 6.
Sacral pressure ulcers have lower recurrence rates after surgery compared to ischial ulcers if the wound progresses to requiring surgical intervention 1, 3.
When Antimicrobials Might Be Appropriate
Systemic Antibiotics Only for Infection
Reserve antibiotic therapy for patients with severe pressure ulcer infections, including those with spreading cellulitis or systemic signs of infection 1.
Because pressure ulcer infections are typically polymicrobial (S. aureus, Enterococcus, Proteus, E. coli, Pseudomonas, and anaerobes including Bacteroides and Clostridium), therapeutic regimens should cover Gram-positive, Gram-negative, and anaerobic organisms 1.
Do not obtain wound cultures unless infection is clinically suspected 4.
Common Pitfalls to Avoid
Do not use dextranomer paste—it is inferior to other wound dressings for reducing ulcer area 1, 3.
Avoid detergent-containing povidone-iodine preparations (skin cleansers/surgical scrubs) as the detergent component can cause tissue damage and delay healing; if used, immediately rinse with saline 7.
Do not rely on antiseptics as a healing strategy—the evidence shows they do not improve outcomes and may worsen them 2.
Additional Adjunctive Therapies to Consider
Electrical stimulation may accelerate wound healing as adjunctive therapy (moderate-quality evidence), though it doesn't clearly improve complete healing rates 1, 3.
The most common adverse effect of electrical stimulation is skin irritation, and frail elderly patients are more susceptible to adverse events 1, 3.