What are the key principles of wound assessment and management in primary care?

Key principles of wound assessment and management in primary care involve a comprehensive, patient-centred approach that integrates clinical evaluation, appropriate wound cleansing, debridement, dressing selection, infection control, and ongoing monitoring.

Assessment should begin with a detailed evaluation of the wound’s characteristics including size, depth, location, presence of necrotic tissue, exudate amount, and condition of surrounding skin, as well as patient factors such as comorbidities, nutritional status, and pain levels ¹,⁴,⁶,⁷. Using standardised classification systems where applicable (e.g., SINBAD for diabetic foot ulcers) supports consistent documentation and guides management ⁶.

Wound cleansing in primary care typically involves gentle washing with tap water or saline at body temperature, avoiding scrubbing to prevent tissue damage and pain; sterile techniques are reserved for immunocompromised patients or wounds with bony involvement ¹,⁴. The choice between tap water and saline should consider patient preference and availability, as evidence shows little difference in healing outcomes ¹.

Debridement is a critical step to remove necrotic, devitalised, or infected tissue to promote healing and can be achieved via autolytic, sharp, mechanical, enzymatic, or biosurgical methods depending on wound type, patient tolerance, and available expertise ¹,⁴,⁶,⁷. In primary care, debridement should be performed by trained professionals, with referral to specialist services when necessary ⁶.

Dressing selection aims to maintain a moist wound environment conducive to healing while managing exudate and protecting surrounding skin. Low-adherence, absorbent dressings are preferred for wounds with minimal exudate, while alginate or foam dressings suit moderate to heavy exudate ¹,²,⁵. Dressings should be chosen considering wound type, infection risk, patient comfort, and cost-effectiveness ¹,⁶.

Infection prevention and management require careful clinical assessment; systemic antibiotics are reserved for wounds with clinical signs of infection such as spreading cellulitis or systemic sepsis, not based solely on positive wound cultures ¹,³,⁷. Swabbing should be done before starting antibiotics to guide therapy if needed ². Topical antiseptics and prophylactic antibiotics are generally not recommended due to potential tissue damage and resistance concerns ¹,³,⁵,⁷.

Additional principles include assessing and addressing patient education, pain management, nutritional support, and pressure offloading where relevant (e.g., diabetic foot ulcers, pressure ulcers) to optimise healing outcomes ⁶,⁷. Regular review and documentation of wound progress, complications, and patient concerns are essential, with involvement of specialist wound care professionals as appropriate ⁴,⁶.

Holistic wound assessment also considers psychological and quality of life impacts, especially in palliative care settings, where the focus may shift from healing to symptom control and maintaining quality of life ⁴[(Chaplin, 2004)][(Cornforth, 2013)][(Woo et al., 2015)].