Plan of Care and Wound Management
Organize the plan with TIME
Tissue management means removing nonviable tissue by the safest effective method: sharp or surgical, enzymatic, autolytic, mechanical, or biologic debridement. Infection and inflammation control addresses bioburden. Moisture balance drives dressing selection. Edge advancement means addressing rolled edges, epibole, callus, or a stalled margin. Underpinning all of it are pressure redistribution, offloading, vascular optimization, nutrition, pain control, and treating the underlying cause.
Match the dressing to the goal
Transparent films protect intact or nearly healed skin. Hydrocolloids suit low-exudate partial-thickness wounds. Hydrogels donate moisture to dry beds. Foams absorb moderate exudate and cushion. Alginates and hydrofibers absorb heavily and fill cavities. Silver and other antimicrobials are for critical colonization or infection, used for a defined period. Avoid wet-to-dry gauze as a routine method, since it is nonselective and damaging to new tissue.
Cause-directed therapy
Compression is the cornerstone for venous leg ulcers once arterial perfusion is confirmed adequate; multilayer or short-stretch systems are typical. Plantar neuropathic ulcers need true offloading, such as a total contact cast or irremovable walker, not just a shoe insert. Pressure injuries need repositioning schedules and an appropriate support surface.
Traps and a rule of thumb
Do not apply high compression without vascular assessment, and do not use occlusive dressings on heavily exudating or infected wounds. A dry, intact eschar on a well-perfused heel without infection may be left undisturbed rather than debrided. Rule of thumb: choose the dressing by exudate level first, then by tissue type and cavity depth.