What is the best course of action for a patient with a healing wound on the right heel?

Management of Healing Right Heel Wound

Continue the current standard wound care approach with regular dressing changes, sharp debridement as clinically indicated, and basic moisture-balanced dressings—this patient's wound is demonstrating appropriate healing without infection and requires no additional interventions beyond standard care. 1

Current Wound Status Assessment

The wound demonstrates positive healing indicators:

• Decreased size and improved appearance 1
• No signs or symptoms of infection 1
• Patient tolerating treatment well with maintained quality of life 1
• Adequate nutritional intake (65% meal consumption) supporting healing 1

Standard Wound Care Protocol

Sharp Debridement

• Perform sharp debridement to remove any slough, necrotic tissue, and surrounding callus as clinically needed 1
• The frequency should be determined by clinical assessment at each dressing change—there is no fixed schedule 1
• For heel wounds specifically, adherent eschar may be left in place if dry and no underlying infection is suspected 1

Dressing Selection

• Select dressings based on exudate control, comfort, and cost 1
• For this healing wound, use basic dressings that absorb exudate and maintain a moist wound healing environment 1
• Do not use topical antimicrobial or antiseptic dressings as they do not improve healing outcomes and are strongly contraindicated for non-infected wounds 1
• Avoid honey, collagen, alginate, or herbal remedy dressings as they provide no benefit 1

Monitoring Schedule

Continue the planned Friday dressing change schedule with assessment for:

• Progressive wound size reduction 1
• Maintenance of healthy granulation tissue 1
• Absence of infection signs (increased erythema, purulence, warmth, odor) 1
• Patient comfort and functional status 1

When to Consider Advanced Therapies

Only consider adjunctive therapies if the wound fails to show adequate healing progress after optimized standard care for at least 2 weeks 1:

• Sucrose-octasulfate impregnated dressing for non-infected neuro-ischemic ulcers that plateau 1
• Autologous leucocyte, platelet, and fibrin patch for difficult-to-heal wounds where resources exist 1
• Placental-derived products when standard care has failed 1

Critical Pitfalls to Avoid

• Do not add topical antimicrobials or antiseptics to this non-infected healing wound—strong evidence shows they impair rather than enhance healing 1
• Do not use growth factors, platelet gels, bioengineered skin products, or cellular substitutes as routine adjuncts 1
• Do not employ physical therapy modalities (ultrasound, electrical stimulation, shockwaves) as they lack efficacy 1
• Avoid negative pressure wound therapy for non-surgical wounds 1

Vascular Assessment Consideration

If healing plateaus or deteriorates, assess vascular status:

• Heel wounds are particularly vulnerable to ischemia 1
• Consider vascular evaluation if wound fails to progress despite optimal care 1
• Ankle-brachial index <0.5 or ankle pressure <50 mmHg warrants urgent vascular surgery consultation 2