I had a pt the other day whose dressing orders bugged me and I want to see if anyone has some insight. I was desperate to get the wound care team to consult on him, but most of when I had him was over the Christmas holidays and it seems they were on vacation. Anyhow, the guy was a repeated pressure ulcer pt who came in with a necrotic (presumed) stage IV covering his entire buttocks areas. They debrided it in OR and ordered wtd dressings tid w/ dakens. The wound though post-OR was very odd, it had a few pockets of tissue or small tunnels but was otherwise a smooth, shiny pink surface with some small areas of yellow. It looked like a stage II ulcer except that so much of the area had been eaten away, assumedly from past hx, that it was totally hard.
I received him from a nurse yesterday and upon removing the wtd dressing, there were little bleeding spots all over the wound bed and as I say, the tissue looked almost uniformly pink. Given that, isn't wtd dressing far to harsh? I was under the impression it was used for debridement (and even that was in question r/t to efficacy, risk profile, etc). I really think that some sort of foam or allevyn or something to keep the wound moist would have been ideal, but I do not think at my facility that's a decision we can make w/o MD orders. In any case, the pt was a plastic surgery pt, shouldn't they have a better idea than most about appropriate wound dressings? I did not feel comfortable applying wtd over thin pink tissue like that, anyone have more experience in this domain and care to shed some light?