A client is admitted with a stage four pressure ulcer that has a black, hardened surface. Which dressing is appropriate?

• A. Dry gauze
• B. Hydrogel dressing
• C. Transparent film
• D. Wet to moist dressing

Answer: (D)

A stage IV pressure ulcer with a black, hardened surface has necrotic tissue (eschar) that needs to be removed to allow healing. The dressing choice that best supports this is one that provides moisture to soften the necrotic tissue while allowing removal of dead tissue when the dressing is changed. A wet-to-moist dressing accomplishes this by keeping the wound bed moist and using the gauze as a vehicle to mechanically lift away necrotic tissue and slough as it is removed. This promotes debridement and improves conditions for healing.

Dry gauze won’t soften or help remove necrotic tissue and can keep the wound dry, hindering debridement. A hydrogel dressing hydrates and can aid autolytic debridement, but it does not actively remove necrotic tissue during dressing changes. A transparent film is occlusive and not ideal for a heavily necrotic, exudative wound; it won’t promote debridement and can trap moisture, risking maceration.