Wound Management and Intervention
Moist wound healing and the TIME framework
Modern management rests on a moist, clean, bacteria-balanced wound bed. TIME organizes it: Tissue non-viable (debride), Infection/inflammation (control), Moisture imbalance (manage exudate), Edge (advance or manage non-advancing edges). Debridement options include sharp/surgical, autolytic (hydrogels, films, hydrocolloids), enzymatic, mechanical, and larval therapy. Choose based on urgency, perfusion, pain, and setting; sharp debridement of an ischemic limb is unsafe. Wet-to-dry dressings are non-selective and painful and should not be used to maintain a clean granulating bed.
Match the dressing to the exudate
Rule of thumb: "if it's wet, dry it; if it's dry, wet it." Low-exudate shallow wounds suit films, hydrocolloids, and hydrogels; moderate exudate suits foams and alginates; heavy exudate or cavity wounds suit hydrofiber, alginate rope, or negative pressure wound therapy (typically −80 to −125 mmHg). Protect periwound skin with barrier products and manage incontinence-associated dermatitis separately from pressure injury.
Treat infection thoughtfully
Cleanse with saline or potable water at safe pressure; avoid routine cytotoxic antiseptics (hydrogen peroxide, sodium hypochlorite) in healing tissue. Suspect biofilm when healing stalls: sharp debridement plus a time-limited topical antimicrobial (silver, cadexomer iodine, PHMB), not indefinite use. Tissue biopsy is the preferred culture method; a Levine-technique swab is second best; never culture purulence in isolation from the clinical picture.
Offload and compress
Venous leg ulcers need sustained compression (often 30–40 mmHg at the ankle) once perfusion is confirmed. Plantar neuropathic diabetic foot ulcers need pressure redistribution, with total contact casting as the gold standard. Pressure injuries need repositioning plus an appropriate support surface.
Trap
Questions offering compression for a mixed ulcer with ABI 0.6, or a "routine" antiseptic soak, are testing safety awareness.