Wound Care for Stage 2 Pressure Ulcers
Apply hydrocolloid or foam dressings as the primary treatment for stage 2 pressure ulcers, as these dressings are superior to gauze for reducing wound size and promoting healing. 1, 2
Primary Dressing Selection
- Hydrocolloid dressings are associated with nearly three times more complete healing compared to saline gauze and should be your first-line choice for stage 2 pressure ulcers 1, 3
- Foam dressings are equally effective as hydrocolloid dressings and may be preferred when moderate to high exudate is present, as they are more absorbent and easier to remove 3
- Select dressings based on exudate control, comfort, and cost rather than antimicrobial properties, as antimicrobial dressings are not recommended as the sole intervention 1, 2
- Change hydrocolloid dressings based on clinical need rather than a fixed schedule—typically every 1-7 days depending on exudate levels, with most changes occurring every 1.5-3 days for moderate to heavily exuding wounds 4
- Extend dressing change intervals to 3-7 days once exudate decreases and healing progresses appropriately 4
Wound Bed Preparation
- Perform sharp debridement to remove necrotic debris, planktonic bacteria, and biofilm, as this is the critical first step in wound management 4
- Debride frequently with a scalpel to maintain a clean wound bed and allow accurate assessment of ulcer depth 2
- Do not perform aggressive debridement if the ulcer is ischemic without signs of infection, as this can worsen tissue damage 1, 2
Pressure Redistribution (Essential Component)
- Use alternative foam mattresses rather than standard hospital mattresses, which provides a 69% relative risk reduction in pressure ulcer incidence 1, 2
- Apply support surfaces in all settings including sleeping, seating, and transportation to prevent recurrent injury 4
- 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
Nutritional Support
- Provide protein or amino acid supplementation to reduce wound size, particularly in patients with nutritional deficiencies 4, 1, 2
- Ensure adequate caloric intake and correct nitrogen balance 1, 2
- Do not routinely supplement with vitamins or trace elements unless documented deficiency exists, as vitamin C supplementation alone has not shown benefit 4, 1, 2
Adjunctive Therapies to Consider
- Consider electrical stimulation as adjunctive therapy to accelerate wound healing for stage 2 ulcers, with moderate-quality evidence supporting its use 4, 1, 2
- Be aware that frail elderly patients may experience more adverse events (primarily skin irritation) with electrical stimulation 2
Infection Management
- Assess for infection using the NERDS criteria: Nonhealing, Exudate, Red friable tissue, Debris/discoloration, and Smell 4
- Apply topical antimicrobials (iodine preparations, medical-grade honey, or silver-containing dressings) only when infection is present 4
- Do not use povidone iodine routinely, as it may impair healing compared to non-antimicrobial dressings 4
- Obtain wound cultures only when infection is suspected, using quantitative tissue biopsy or semiquantitative swab with Levine technique 4
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
- Do not neglect vascular assessment when pedal pulses are absent or ulcers fail to improve 1, 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 culture wounds without clinical signs of infection, as this leads to inappropriate antibiotic use 4