Treatment of Stage 2 Sacral Pressure Ulcers
Apply hydrocolloid or foam dressings as the primary wound management strategy for stage 2 sacral pressure ulcers, as these dressings are superior to gauze for reducing wound size and promoting healing. 1, 2
Primary Wound Management
- Use hydrocolloid or foam dressings rather than gauze dressings, as the American College of Physicians found hydrocolloid dressings superior to gauze for reducing wound size in stage 2 pressure ulcers 1, 2, 3
- Select dressings based on exudate control, patient comfort, and cost-effectiveness rather than antimicrobial properties, as antimicrobial dressings are not recommended as the sole intervention 4, 2
- Change dressings based on exudate saturation and product wear time; incontinence will reduce the interval between dressing changes 3
- Keep the wound bed continuously moist while keeping surrounding intact skin dry 5
Pressure Redistribution (Critical Foundation)
- Replace standard hospital mattresses with alternative foam mattresses, which provides a 69% relative risk reduction in pressure ulcer incidence 4, 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 without proven benefit over foam mattresses 4, 2
- Ensure complete pressure relief from the sacral area through repositioning protocols 6
Nutritional Support
- Provide protein or amino acid supplementation to reduce wound size, particularly in patients with nutritional deficiencies, as this improves wound healing rates when combined with standard therapies 1, 4, 2
- Ensure adequate caloric intake and correct nitrogen balance 4, 2
- Do not rely on vitamin C supplementation alone, as it has not shown benefit compared to placebo 4, 2
Wound Cleansing
- Irrigate with saline to remove loose debris and exudate without damaging viable tissue 5
- Avoid aggressive cleansing that could damage the partial-thickness wound bed characteristic of stage 2 ulcers 5
Adjunctive Therapy
- Consider electrical stimulation as adjunctive therapy to accelerate wound healing, as moderate-quality evidence shows it accelerates healing rate when added to standard treatment for stage 2-4 ulcers 1, 4, 2
- Be aware that frail elderly patients experience more adverse events (primarily skin irritation) with electrical stimulation than younger patients 1, 4
Infection Surveillance
- Evaluate for signs of infection requiring antibiotic therapy, including deep tissue involvement, cellulitis, or purulent drainage 4, 2
- Direct antibiotic therapy against Gram-positive and Gram-negative organisms as well as anaerobes when infection is present 4
Critical Pitfalls to Avoid
- Do not continue standard therapy beyond 4 weeks without reassessing if the ulcer shows less than 50% reduction in size—consider advanced wound therapy at this point 4, 2, 6
- Do not use gauze dressings as the primary treatment, as they are inferior to hydrocolloid and foam dressings 1, 3
- Do not neglect pressure redistribution—dressings alone will not heal a stage 2 sacral ulcer if pressure is not adequately relieved 4, 2
- Do not perform aggressive debridement on stage 2 ulcers, as these are partial-thickness wounds that typically do not require sharp debridement unless necrotic tissue is present 5