Ultimate Guide to Wound Care Staging and Wound Dressing Selection

Wound healing is a complex and continuously evolving process. Based on  Wound Care and the internationally recognized TIME framework, wounds can be classified by tissue color into four stages: black, yellow, red, and pink.

01 Wound Classification and Nursing Objectives

• Black Stage (Necrosis Stage)
  Description: The wound surface is covered with dark brown or black dry eschar, accompanied by dead tissue and absence of viable tissue growth.
  Nursing aim: Remove necrotic tissue through debridement and prevent infection.
  Rationale: Wound Care highlights that during this stage, necrosis should be cleared primarily through autolytic or enzymatic debridement to reduce infection risk.
  Suggested dressings: Hydrocolloid, Hydrogel, Chitosan dressings.

• Yellow Stage (Inflammatory/Exudative Stage)
  Description: Characterized by slough, yellowish-white necrotic tissue, increased wound exudate, and potential infection.
  Nursing aim: Manage infection, absorb excess exudate, and encourage granulation tissue formation.
  Evidence: Research indicates that moist dressings help maintain an optimal moist environment and promote necrotic tissue breakdown (Chinese Journal of Nursing, 2020).
  Suggested dressings: Silicone foam, Hydrocolloid, Hydrogel, Alginate, Chitosan dressings.

• Red Stage (Granulation Phase)
  Description: The wound bed contains bright red granulation tissue with good vascularization and reduced exudate.
  Nursing aim: Protect granulation tissue, support epithelial migration, and avoid secondary wounds.
  Rationale: Wound Care advises using low-adhesion dressings at this stage to minimize harm to new tissue when changing dressings.
  Suggested dressings: Silicone foam, Hydrocolloid, Hydrogel, Alginate, Chitosan dressings.

• Pink Stage (Epithelialization Phase)
  Description: The wound surface is covered by newly formed pink epithelial cells, nearing complete healing.
  Nursing aim: Safeguard epithelial cells, maintain moist wound environment, and support full wound closure.
  Support: Studies have shown that occlusive dressings reduce scar formation (Chinese Journal of Reparative and Reconstructive Surgery, 2019).
  Suggested dressings: Hydrocolloid, Hydrogel, Chitosan dressings.

02 Selection Guidelines for Moist Functional Dressings

According to wound stage, combined with Wound Care and clinical research findings, the following dressings are recommended.

Important tips: Dressing change frequency should be adjusted depending on the amount of wound exudate to prevent excessive dryness or oversaturation. Proper selection of moist dressings plays an essential role in wound management. It is advisable to tailor wound care plans dynamically according to the wound’s evolving stage and under professional medical supervision.

03 References

• Wound Care (People's Medical Publishing House): Provides a thorough explanation of the TIME framework and stage-specific wound care.
• Zhang Li et al., Application of moist healing theory in chronic wound care, Chinese Journal of Nursing, 2020.
• Wang Qiang, Mechanism of new dressings in wound repair, Chinese Journal of Reparative and Reconstructive Surgery, 2019.