Selection of dressings and topical medications in pressure ulcer treatment

The core goal of pressure ulcer treatment is to create a local environment conducive to wound healing. This environment needs to be moderately moist, infection controlled, exudate managed, and surrounding skin protected. Faced with a wide variety of dressings and medications on the market, patients and caregivers are often confused. How to choose the right dressing based on the different stages and specific circumstances of the pressure ulcer requires some basic scientific understanding.

How to assess pressure ulcer wounds to select products ?

First, determine the stage of the pressure ulcer: is it stage I (redness), stage II (blisters or superficial ulceration), stage III (full-thickness skin loss), or stage IV (deep into the bone)? Simultaneously, observe the wound size, depth, amount of exudate, presence of necrotic tissue or necrotic tissue, signs of infection, and the condition of the surrounding skin. Exudate volume is a key indicator for dressing selection; excessive exudate will saturate the skin, while insufficient exudate may cause the dressing to stick to the wound. Signs of infection, such as increased redness and swelling, purulent discharge, and odor, indicate the need for products containing antibacterial ingredients. Remember, no single product is suitable for all wounds; assessment is the first step.

What are some common modern functional dressings ?

Modern dressings have far surpassed traditional gauze, actively managing the wound environment through physical or chemical means. Hydrocolloid dressings are suitable for stage II pressure ulcers with minimal exudate; they absorb exudate to form a gel, maintaining a moist environment while isolating bacteria. Foam dressings have moderate to strong absorbency and are suitable for stage II to III wounds with moderate to large exudates, providing good cushioning and warmth. Alginate dressings, made from seaweed extracts, are highly absorbent and suitable for cavity wounds with significant exudate, forming a gel and providing mild hemostasis. Hydrogel dressings primarily provide moisture to the wound and are suitable for dry wounds with a small amount of necrotic tissue or necrotic tissue, promoting autolytic debridement. Transparent film dressings are often used for stage I pressure ulcers or as an outer layer for securing other dressings, allowing for wound observation.

When and how should topical antibacterial medications be used ?

When a wound shows signs of local infection but has not yet caused systemic symptoms, topical antibacterial agents can be considered. Silver ion dressings are currently widely used; silver ions have broad-spectrum antibacterial properties and are suitable for chronic wounds at risk of infection or with existing colonization. Medical honey dressings, utilizing their high osmotic pressure and natural antibacterial components, can also effectively fight infection and promote debridement. Iodine preparations, such as cardemerol, are also effective in killing bacteria and are less likely to induce resistance. It is important to note that these products are mainly used to control bacterial load and cannot replace systemic antibiotics for treating deep or systemic infections. Furthermore, once the infection is under control, switching to non-antibacterial dressings should be considered to avoid potential long-term effects on cell viability.

How to treat black or yellow wounds with necrotic tissue ?

When pressure ulcers are covered with black eschar or yellow necrotic tissue, the wound cannot heal. Debridement is then necessary. Autolytic debridement is a gentle method, using hydrogel or hydrocolloid dressings to keep the wound moist and utilizing the wound's own enzymes to liquefy necrotic tissue. It is suitable for non-infected wounds and when the patient's condition is too poor for surgery. Enzymatic debridement uses exogenous collagenases and other ointments to selectively break down necrotic tissue, and is more efficient than autolytic debridement. For large amounts of hard eschar, especially when accompanied by infection, surgical debridement with sharp instruments may be necessary; this is the fastest and most effective method. After debridement, the wound enters the red granulation stage, and the aforementioned dressings are selected based on the amount of exudate.

How to properly use and change dressings ?

Proper handling maximizes dressing effectiveness and prevents damage. Clean hands before changing dressings. When removing old dressings, if they are stuck together, gently peel them off after moistening with saline solution. Rinse the wound with sterile saline solution; avoid using irritating disinfectants such as alcohol or hydrogen peroxide to rinse the inside of the wound. Gently pat the surrounding skin dry to keep the wound moist. Cut the dressing to the size of the wound, extending at least two centimeters beyond the wound edge. When securing the dressing, avoid excessive stretching of the tape, which can cause tension. The frequency of dressing changes depends on the amount of exudate; foam or alginate dressings are typically changed when 70% saturated with exudate, while hydrocolloid dressings can be changed when they turn milky white and bulge. Record each observed change in the wound; this is crucial for tracking progress.

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Editor: kiki Jia