---
title: Wound Care and Healing Protocol
description: A comprehensive clinical reference on the assessment and management of acute and chronic wounds.
keywords: [wound care, wound healing, dressings, debridement, infection]
category: clinical
---

## Wound Assessment

Proper wound assessment is the foundation of effective wound management. This includes evaluation of wound characteristics such as size, depth, tissue type, exudate, and signs of infection. Measurement of wound dimensions, including length, width, and depth, should be documented using a consistent method, such as the longest length and perpendicular width in centimeters.

The wound bed should be inspected for the presence and percentage of the following tissue types: healthy granulation tissue (beefy red, bleeding with gentle pressure), slough (yellow or white avascular tissue), and necrotic tissue (black, brown, or tan hard eschar). The amount of exudate should be quantified as scant, moderate, or heavy, and the characteristics (serous, sanguineous, purulent) noted.

Assessment for clinical signs of infection, including erythema, edema, increased temperature, purulent discharge, and delayed healing, is crucial. The clinician should also evaluate for systemic signs of infection, such as fever, leukocytosis, and elevated inflammatory markers. In cases of suspected infection, wound culture and sensitivity testing should be obtained prior to initiation of antibiotic therapy.

## Wound Bed Preparation

Optimal wound bed preparation is essential to promote wound healing. This may involve debridement to remove devitalized tissue, control of wound exudate, and management of bacterial burden.

Debridement techniques may include sharp debridement with scissors or scalpel, autolytic debridement using moisture-retentive dressings, enzymatic debridement with topical agents (e.g., collagenase, papain-urea), or mechanical debridement with wet-to-dry dressings or hydrotherapy. The choice of debridement method should be based on the wound characteristics, the patient's comorbidities, and the clinician's expertise.

Wound exudate management is crucial to maintain a moist wound environment conducive to healing. Dressings should be selected based on the amount and characteristics of exudate, with more absorbent dressings (e.g., foam, alginates) used for heavily exudating wounds and semi-occlusive or occlusive dressings (e.g., hydrocolloids, hydrogels) for low-exuding wounds.

Topical antimicrobial agents, such as silver, polyhexamethylene biguanide (PHMB), or cadexomer iodine, may be used to manage bacterial burden in wounds with clinical signs of infection or critically colonized wounds. Systemic antibiotic therapy should be reserved for wounds with evidence of spreading infection or systemic signs of infection.

## Wound Healing Optimization

Optimizing the patient's overall health is essential to promote wound healing. This includes addressing any underlying medical conditions, such as diabetes, peripheral arterial disease, or malnutrition, that may impair wound healing.

For patients with diabetes, tight glycemic control (target HbA1c <7%) has been shown to improve wound healing outcomes. Referral to a podiatrist or vascular specialist may be warranted for patients with diabetic foot ulcers or lower extremity ischemia.

Nutritional assessment and supplementation, if indicated, can also support wound healing. Recommended daily intake of protein, calories, and micronutrients (e.g., vitamin C, zinc) should be met, with enteral or parenteral nutrition provided for patients with poor oral intake.

Adjunctive therapies, such as negative-pressure wound therapy (NPWT), hyperbaric oxygen therapy, or bioengineered skin substitutes, may be considered for complex or chronic wounds that are not responding to standard wound care.

## Wound Dressings and Products

The selection of appropriate wound dressings and products is crucial to facilitate wound healing. Dressings should be chosen based on the wound characteristics, the stage of healing, and the desired effects, such as moisture management, autolytic debridement, or antimicrobial properties.

Common wound dressing categories include:
- Hydrocolloids: Occlusive dressings that absorb exudate and promote a moist wound environment.
- Alginates: Highly absorbent dressings that can manage moderate to heavy exudate.
- Foams: Absorbent dressings that can manage moderate to heavy exudate and provide cushioning.
- Hydrogels: Dressings that provide a moist wound environment and facilitate autolytic debridement.
- Antimicrobial dressings: Dressings impregnated with silver, PHMB, or other antimicrobial agents to manage wound infection.

Topical wound care products, such as enzymatic debriders, wound cleansers, and skin protectants, may also be used as part of a comprehensive wound management plan.

## Monitoring and Follow-up

Ongoing monitoring and follow-up are essential to evaluate the effectiveness of the wound care plan and make necessary adjustments. This includes regular assessment of wound characteristics, such as size, depth, tissue type, and signs of infection, as well as the patient's overall health status and response to treatment.

Specific monitoring parameters may include:
- Wound dimensions (length, width, depth)
- Percentage of wound bed covered by granulation, slough, or necrotic tissue
- Characteristics and amount of wound exudate
- Presence of clinical signs of infection (erythema, edema, increased temperature, purulent discharge)
- Systemic signs of infection (fever, leukocytosis, elevated inflammatory markers)
- Patient-reported pain, odor, and quality of life

Frequency of follow-up visits and wound assessments should be tailored to the individual patient and the wound characteristics, with more frequent monitoring for complex or high-risk wounds.

## Conclusion

Effective wound care and healing requires a comprehensive, evidence-based approach that addresses wound assessment, bed preparation, optimization of the patient's overall health, selection of appropriate dressings and products, and ongoing monitoring and follow-up. By implementing this protocol, clinicians can improve wound healing outcomes and enhance the quality of life for patients with acute and chronic wounds.