What are the steps for effective wound care?

Effective Wound Care: A Systematic Approach

Clean the wound with water or saline, perform sharp debridement to remove all necrotic tissue and debris, apply a simple moisture-retentive dressing, and ensure the wound is protected from pressure and contamination.

Initial Wound Assessment and Cleaning

• Clean wounds with clean water or normal saline—this removes surface debris and contaminants without damaging healthy tissue 1
• Warm the cleaning solution before use to reduce procedural pain 1
• Cleaning should remove excess debris, exudates, foreign material, and necrotic tissue to create an optimal healing environment 2

Debridement: The Critical First Step

Sharp debridement is the preferred method and should be performed immediately for most wounds.

• Use sharp debridement with scalpel, scissors, or tissue nippers as the primary method—this is more definitive and controllable than other approaches 1, 3
• Remove all slough, necrotic tissue, and surrounding callus (particularly important in diabetic foot ulcers) 1, 3
• Debride before obtaining wound cultures if infection is suspected 3
• Continue into healthy-looking tissue until viable tissue is reached—do not let concerns about the residual defect limit adequate debridement 1, 4
• Contraindication: Exercise caution with sharp debridement in severely ischemic wounds 1
• Repeat debridement as clinically needed, typically weekly or more frequently if significant necrotic tissue accumulates 3

Dressing Selection and Application

Select simple, cost-effective dressings that maintain a moist wound environment.

• Choose dressings based on exudate control, comfort, and cost—not antimicrobial properties 1, 5
• Apply a sterile, inert dressing that controls excessive exudate while maintaining a warm, moist environment 1
• Do NOT use antimicrobial dressings or topical antibiotics—they do not improve wound healing or prevent secondary infection 1, 3, 5
• For surgical wounds, simple gauze performs as well as advanced dressings (silver, hydrogels, alginates, foam) 5
• Keep postoperative dressings undisturbed for minimum 48 hours unless leakage occurs 5

Pressure Off-Loading (Critical for Lower Extremity Wounds)

• Implement strict off-loading immediately for foot wounds—this is non-negotiable for healing 1, 3
• Use total contact casting or irremovable walkers for plantar wounds without infection 3
• Protect the wound from all pressure and trauma during daily activities 1, 3

Infection Management

• Assess for clinical signs of infection at each dressing change: increased exudate, odor, pain, surrounding erythema, warmth 1, 3
• If infection is present with abscess, gas, or necrotizing fasciitis, perform prompt surgical debridement 1
• Obtain tissue specimens from debrided wound base via curettage or biopsy—never swab undebrided ulcers 3
• Do NOT use antibiotics for uninfected wounds—they do not promote healing and contribute to resistance 3
• For infected wounds, initiate appropriate systemic antibiotics based on culture results 1

Adjunctive Therapies (Only After Standard Care Fails)

• Do NOT select growth factors, bioengineered skin products, or physical modalities (electricity, ultrasound, shockwaves) in preference to standard care 1
• Consider negative pressure wound therapy (NPWT) for post-operative wounds or after complete necrosis removal in necrotizing infections 1
• Hyperbaric oxygen therapy may be considered for non-healing diabetic foot ulcers after revascularization, though evidence remains moderate 1

Vascular Assessment (Essential for Lower Extremity Wounds)

• Obtain urgent vascular evaluation to rule out arterial insufficiency 3
• Check ankle-brachial index (ABI), toe pressures, and transcutaneous oxygen pressure (TcPO₂) 3
• If severe ischemia exists (ABI <0.5, ankle pressure <50 mmHg), perform revascularization within 1-2 days before aggressive wound therapy 1, 3

Monitoring and Re-evaluation

• Inspect wounds daily to identify new problems early 1
• Measure wound area weekly—expect 10-15% reduction per week with proper healing 6
• If wound shows <50% reduction in area after 2 weeks of optimal standard care, consider adjunctive therapies 3, 6

Common Pitfalls to Avoid

• Never delay debridement of necrotic tissue while awaiting revascularization—remove infected necrotic material immediately 1
• Avoid topical antimicrobials and antibiotics in uninfected wounds—they provide no benefit and may cause harm 1, 3
• Do not use advanced dressings on primarily closed surgical wounds—they do not reduce infection rates 5
• Do not shave hair around scalp wounds—this increases risk of long-term damage 1