Rapid Dressing & Protocol Matcher
Select patient's wound bed condition, exudate volume, and infection risk to determine the optimal evidence-based dressing regimen immediately.
Rapid Wound Bed Assessment & Management
Core tissue identification, clinical objectives, and contraindications
Granulation Tissue
ProliferativeAppearance: Beefy red, shiny, moist, cobblestone uneven granular surface rich in microcapillaries.
- Maintain optimal moist healing environment
- Protect fragile neo-capillaries from shear & trauma
- Manage excessive exudate without desiccating bed
High exudate: Calcium alginate, Hydrofibre, Foam.
Overgranulation
HyperplasiaAppearance: Raised above surrounding periwound skin level, spongy, hyperemic, bleeds readily on contact.
- Suppress hypertrophic tissue to skin rim level
- Clear obstacle to permit horizontal epithelial migration
- Check for retained foreign material / undissolved sutures
- Hydrophilic foam with firm localized pressure
- Mesalt (27% hypertonic saline dressing)
- Daily Povidone Iodine 10% paint + dry gauze pressure
- Silver nitrate chemical cautery (if prescribed)
Sloughy Tissue
DevitalizedAppearance: Yellow, cream, or grey-white stringy fibrin, leukocytes, and cellular debris.
- Debride slough (autolytic, mechanical, or enzymatic)
- Eliminate media for bacterial colonization
- Protect periwound skin from moisture maceration
Mechanical/Chemical: Hypertonic saline (Mesalt).
Enzymatic: Collagenase debridement ointment.
Necrotic (Eschar)
AvascularAppearance: Dry, thick, leathery, dark brown or black devitalized tissue.
- Cross-hatch eschar with scalpel to facilitate hydration
- Apply amorphous Hydrogel + secondary film/foam
- Prepare for Conservative Sharp Wound Debridement (CSWD)
Infected / Bioburden
BioburdenHallmarks: Erythema >2cm, warmth, induration, malodor, purulence, delayed healing, friable bleeding bed.
- Obtain wound swab using Levine Technique before antibiotics
- Select broad-spectrum antimicrobial dressing (Silver, Cadexomer Iodine, Honey)
- Ensure adequate drainage; daily dressing changes
Epithelializing Wound
MaturationAppearance: Pale pinkish, translucent, delicate new epidermal layer advancing from wound margins.
- Maintain delicate moisture balance without macerating
- Prevent shearing trauma to migrating cell sheets
- Provide atraumatic dressing removal
Bedside Wound Cleansing Solutions Guide
Indications, toxicity profiles, and specific application protocols
| Solution | Type / Mechanism | Best Indications | Limitations & Toxicities | Clinical Bedside Tip |
|---|---|---|---|---|
| Normal Saline (0.9% NaCl) | Isotonic physiological fluid | Clean granulating beds, routine irrigation, post-swab rinse | No antimicrobial or antiseptic activity | Safe baseline for all viable tissues without cellular cytotoxicity. |
| Chlorhexidine 2% Aqueous | Broad-spectrum bisbiguanide antiseptic | General skin and superficial wound antisepsis | Inactive against acid-fast bacilli, fungi, viruses; inactivated by blood/pus | Low tissue toxicity compared to older antiseptics. Ensure aqueous base is used on open beds. |
| Cetrimide (0.015% Chloro + 0.15% Cetrimide) | Quaternary ammonium surfactant + detergent | Cleansing heavily contaminated, dirty, grit-laden trauma wounds | Toxic to fibroblasts! Prone to contamination by Pseudomonas aeruginosa | Use only for initial dirty grit/debris removal; never for routine granulating beds. |
| Povidone Iodine 10% | Halogen releasing free iodine | Grossly contaminated wounds, preoperative antisepsis, overgranulation paint | Cytotoxic to fibroblasts; systemic iodine absorption risk (acidosis, renal strain) | Contraindicated: Pregnancy, lactation, thyroid disease, large extensive surface areas. |
| PHMB + Surfactant (e.g. Prontosan) | Polyhexanide + betaine surfactant | Stubborn biofilms, heavily coated slough, colonized chronic ulcers | Cost considerations; rare hypersensitivity | Protocol: Apply soaked gauze in situ and leave for 10 minutes before dressing. |
| Hypochlorite-based (e.g. Granudacyn) | Hypochlorous acid (HOCl) + Sodium hypochlorite | Biofilm-laden cavities, acute infected wounds, malodorous ulcers | Cost; partially inhibited by heavy organic exudate | Rapid antimicrobial activity against Gram+ & Gram- without damaging healthy granulation cells. |
Wound Dressing Product Directory
Mechanism, wear time, advantages, contraindications, and commercial examples
Calcium Alginates
Mod to Heavy ExudateSeaweed-derived polysaccharides; absorbs 17–20× weight, exchanging sodium/calcium to form a cohesive hydrophilic soft gel.
Hydrofibre / Gelling Fibre
Heavy ExudatePure sodium carboxymethylcellulose (CMC); vertical fluid locking keeps exudate inside fibres, preventing periwound maceration.
Hydrophilic Foams
Light to Mod ExudateHydrophilic polyurethane foam with breathable backing; manages moderate exudate, provides thermal insulation, and cushions bony areas.
Hydrocolloids
Light to Mod / AutolyticAdhesive wafer containing gelatin, pectin, and sodium CMC. Swells with exudate into a moist gel facilitating rapid autolytic debridement.
Hydrogels
Dry to Low ExudateContains 90% water in polymer matrix. Donates moisture to soften hard eschar and rehydrate necrotic slough.
Hypertonic Saline (Mesalt)
Slough & HypergranulationNonwoven gauze impregnated with 27% NaCl. Creates osmotic pressure gradient drawing edema, bacteria, and debris.
Cadexomer / Povidone Iodine
Infected & SloughSlowly releases free iodine (0.9–1.0%) on contact with exudate. Cadexomer beads absorb slough while providing broad-spectrum bactericidal action.
Medical Honey
Infected & OdorStandardized medical honey. Provides high osmolarity and acidic pH (3.2–4.5), inhibiting pathogen growth while promoting autolysis.
Silver-Containing (Ag)
AntimicrobialReleases silver ions ($Ag^+$) or nanocrystalline silver. Disrupts bacterial cell membranes, DNA replication, and respiratory enzymes.
Superabsorbent Polyacrylate (SAP)
Rinsing & AbsorptionHydrophilic superabsorbent pad pre-activated with Ringer's solution. Delivers continuous interactive rinsing while sequestering exudate.
Odour-Absorbing (Activated Charcoal)
Odor ManagementActivated carbon fabric with micropores that adsorb volatile odor molecules and trap bacteria via electrostatic attraction.
Low-Adherent & Tulle Gras
Contact LayerPerforated polyester/plastic film or paraffin-impregnated open-weave gauze to prevent adherence of secondary absorbent pads.
Ankle-Brachial Index (ABI) Calculator
Patient supine 15–20 min prior to Doppler assessment. Probe at 45° angle.
Take whichever is higher between DP and PT artery signals.
Toe-Brachial Pressure Index (TBPI)
Hallux PPG sensor + mini-cuff. Critical for diabetic and renal patients where ankle vessels calcify.
Semmes-Weinstein Monofilament (SWME) Bedside Rules
- Use standardized 5.07 monofilament (delivers 10g force).
- Press perpendicular until filament buckles smoothly; hold 1–2 seconds.
- Patient eyes closed, responds "Yes" on feeling touch.
- NEVER test on calluses, ulcer margins, scars, or necrotic eschar!
Leg Ulcer Compression Decision Pathway
Graduated pressure selection based on Doppler ultrasound signals & vascular indices
Venous Leg Ulcer
Arterial flow preserved. Edema hampers healing by creating tissue hypertension and cellular barrier.
Safe for Full Gradient Compression (40 mmHg at ankle).
Start at reduced compression (17–23 mmHg); titrate up to 40 mmHg if tolerated.
Mixed Arterial / Venous Ulcer
Concurrent venous hypertension and significant peripheral arterial disease.
Severe Arterial Insufficiency
Severe limb-threatening ischemia. Ulcer healing impossible without surgical revascularization.
Wound Cavity Packing Safety
Conservative Sharp Debridement (CSWD)
- Densely adherent necrotic tissue without clear interface with viable margin
- Patients on anticoagulants (warfarin, NOACs) or bleeding disorders
- Non-infected dry eschar on heels, toes, fingers
- Wounds on face, hands, or overlying the Achilles tendon
- Adjacent to arterial branches, vascular bypass grafts, or dialysis fistulae
- Fungating/malignant wounds; neonates and pediatric patients
- Patient reports sharp or excessive pain
- Exposure of gleaming white tendon, fascia, or periosteum
- Pulsatile or active arterial hemorrhage
Wound Swab Procedure (Levine Technique)
Collect before starting antibiotics. Do NOT swab superficial pus or dead slough.
Continuous Diffusion of Oxygen (CDO) & NPWT
- Delivers 98% humidified pure oxygen continuously at 3–13 mL/hr directly to tissue.
- Crucial Early Expectation: In first 14 days, wound may temporarily appear larger and exudate may increase due to stimulated autolysis!
- STRICT RULE: Never use petroleum- or oil-based ointments in the bed—they block oxygen diffusion.
- Ideal treatment duration is ≥ 25 days.
- Contraindicated if untreated osteomyelitis, exposed blood vessels/organs, or dry eschar.
- Never interrupt therapy for > 2 hours to prevent bacterial pooling and foam adhering.
- Turn off suction and soak foam thoroughly before peeling.