Wound Care Fundamentals: Tissue Types, Wound-Bed Preparation, and Dressing Selection

Why wound care still gets undertaught

Wound care is one of the highest-frequency, lowest-glamour nursing skills. It is also one of the most consequential — a single mis-staged pressure injury can derail an admission, a single inappropriate dressing can stall healing for weeks.

The principles are simple. Applying them consistently is not.

Identify the tissue you are looking at

Before you choose a dressing, name the tissue:

• Epithelial — pink, new skin migrating from edges; protect it
• Granulation — beefy red, bumpy, healthy; keep moist
• Slough — yellow or tan, stringy, devitalized; needs removal
• Eschar — black, leathery, dead; usually needs removal unless dry stable heel
• Hypergranulation — granulation gone overgrown; needs gentle suppression

Photograph and measure on admission and at consistent intervals. Memory is not a wound-care strategy.

Pressure injury staging in one paragraph

Stage 1: intact, non-blanchable erythema. Stage 2: partial-thickness skin loss exposing dermis. Stage 3: full-thickness loss exposing fat. Stage 4: exposing bone, tendon, or muscle. Unstageable: obscured by slough or eschar. Deep tissue injury: persistent non-blanchable deep red, maroon, or purple discoloration.

Mucosal injuries are not staged with this system.

The TIME framework for wound-bed preparation

TIME is the practical bedside model:

• T — Tissue management (debride devitalized tissue when appropriate)
• I — Infection or inflammation control (treat bioburden, recognize biofilm)
• M — Moisture balance (not too wet, not too dry)
• E — Edge advancement (rolled or undermined edges block closure)

A wound that is not progressing despite a good dressing usually has one of these four problems.

Matching dressings to the wound

A simplified decision tree:

• Dry wound → hydrogel
• Light to moderate exudate → foam
• Heavy exudate → alginate or super-absorbent
• Necrotic, suitable for autolysis → hydrocolloid
• Infected, needs antimicrobial → silver-impregnated foam or alginate
• Cavity wound → ribbon alginate or NPWT
• Fragile peri-wound skin → silicone-bordered dressings

No dressing fixes the wrong indication. A foam on a dry wound desiccates it; an alginate on a dry wound is painful and useless.

Pain is a vital sign in wound care

Dressing changes are the most-feared moment of an admission for many patients. Pre-medicate adequately. Use atraumatic dressings where possible. Soak adhered dressings before peeling. Ask about pain before, during, and after the change — not as a formality.

When to escalate

Refer to wound care or vascular when:

• Wound has not measurably reduced in 2-4 weeks of appropriate care
• Signs of infection beyond the wound margin (cellulitis, fever, increased pain)
• Suspected arterial insufficiency (cold limb, absent pulses, dependent rubor)
• Suspected osteomyelitis (probe-to-bone, sinus tracts)
• Atypical appearance (purple borders, undermining out of proportion)

Further reading

For deeper coverage, our Surgery and Dermatology eBook collections include illustrated wound-staging atlases and advanced dressing-selection guides.