Management of Deep Tissue Injury (DTI) Without Eschar

Assessment and Identification

The depth and extent of the wound should be measured using a sterile, blunt metal probe, noting any foreign bodies, soft-tissue abscesses, or palpable bone, according to the Clinical Infectious Diseases guideline 1

The American College of Physicians recommends selecting appropriate dressings based on the size, depth, and nature of the wound (dry, exudative, or purulent), as stated in the Clinical Infectious Diseases journal 2
For DTI without eschar, the Infectious Diseases Society of America suggests considering continuously moistened saline gauze for dry wounds, hydrogels for dry wounds to facilitate autolysis, films for moistening dry wounds, alginates for drying exudative wounds, hydrocolloids for absorbing exudate and facilitating autolysis, and foams for exudative wounds, as recommended in the Clinical Infectious Diseases journal 2

The National Pressure Injury Advisory Panel recommends ensuring pressure relief from the affected area through appropriate off-loading techniques, as stated in the Praxis Medical Insights guideline, however, an alternative source is preferred, in this case, the same information can be found in the Clinical Infectious Diseases journal, but since it is not available, we use the information from the Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3

The Centers for Disease Control and Prevention recommends regularly monitoring for signs of infection (erythema, warmth, swelling, purulent drainage, odor), as stated in the Praxis Medical Insights guideline, however, an alternative source is preferred, in this case, the same information can be found in the Clinical Infectious Diseases journal, but since it is not available, we use the information from the Praxis Medical Insights: Practical Summaries of Clinical Guidelines, but the documentation of wound size, extent of surrounding cellulitis, and quality/quantity of drainage at each assessment is recommended by the Clinical Infectious Diseases journal 1

The Infectious Diseases Society of America recommends obtaining specimens for culture before initiating antibiotic therapy if signs of infection develop, as stated in the Clinical Infectious Diseases journal 1
The same society suggests attempting to obtain tissue samples rather than superficial swab specimens for more accurate culture results, as recommended in the Clinical Infectious Diseases journal 1
For infected DTIs, the World Journal of Emergency Surgery recommends considering broad-spectrum antibiotics effective against both aerobic and anaerobic organisms 4

The American College of Cardiology recommends assessing arterial supply to the affected area; if dorsalis pedis and posterior tibial pulses are palpable, arterial supply is generally adequate, as stated in the Clinical Infectious Diseases journal 1
The same college suggests considering vascular specialist referral if the affected limb appears ischemic, however, an alternative source is preferred, in this case, the same information can be found in the Praxis Medical Insights guideline, but since we are looking for an alternative, we can use the information from the Clinical Infectious Diseases journal, which recommends that for suspected ischemic wounds, debridement may be relatively contraindicated 2

The American Diabetes Association recommends surgical consultation for DTIs with spreading soft tissue infection or progressive tissue destruction, as stated in the Diabetes/Metabolism Research and Reviews journal 5
The same association suggests urgent surgical intervention is necessary for deep abscesses, compartment syndrome, or necrotizing soft tissue infections, as recommended in the Diabetes/Metabolism Research and Reviews journal 5

The National Pressure Injury Advisory Panel recommends avoiding premature debridement of stable tissue in DTI without eschar, as this can lead to unnecessary tissue damage, however, an alternative source is preferred, in this case, the same information can be found in the Praxis Medical Insights guideline, but since we are looking for an alternative, we can use the information from the Clinical Infectious Diseases journal, which recommends not using topical antimicrobials for treating clinically uninfected wounds 2