What to do

1. Off-load pressure immediately
   • Change position regularly, commonly at least every 2 hours if in bed, tailored to comfort and clinical needs.
   • Use pillows, positioning devices, or a pressure-redistributing mattress.
   • For a heel sore, float the heel completely off the bed surface.
   • Avoid rubbing, dragging, and sitting directly on the wound.
2. Clean gently
   • Rinse with normal saline or clean water at dressing changes.
   • Pat surrounding skin dry.
   • Do not use hydrogen peroxide, alcohol, or routine iodine in the wound because these can damage healing tissue.
3. Use an appropriate protective dressing
   • A clinician usually selects a silicone foam dressing or hydrocolloid dressing, depending on drainage, location, skin fragility, and incontinence.
   • The dressing should protect from friction and absorb drainage while keeping the wound moist, not soggy. Hydrocolloid or foam dressings may reduce wound size. The Washington Manual of Medical Therapeutics, p. 19.
4. Control moisture and friction
   • Manage urine or stool incontinence promptly.
   • Use a skin barrier product on the surrounding skin if it is exposed to moisture.
   • Keep sheets smooth and avoid donut-shaped cushions, which can concentrate pressure.
5. Support healing
   • Ensure enough calories, protein, fluids, and treatment of nutritional deficiencies if present.
   • Treat pain, particularly before cleaning or changing the dressing.
   • Review causes such as immobility, poor nutrition, diabetes, poor circulation, or reduced sensation.

Usually not needed

• Antibiotics are not routinely needed unless there is clinical infection.
• Sharp debridement is usually not needed for a true stage 2 wound because it should not contain slough or eschar. If yellow/black tissue is present, it may be deeper than stage 2 and needs reassessment.

Get urgent clinical review if

• Redness spreads, warmth/swelling increases, pus or foul odor develops
• Fever, confusion, or feeling generally unwell
• The wound becomes deeper, black/yellow, very painful, or does not start improving within 1 to 2 weeks
• The person has diabetes, poor circulation, paralysis, is immunocompromised, or the sore is near the sacrum with stool contamination