Hi Jami,

Thank you for your question.

When treating a wound with tendon exposure, there are several important considerations to ensure optimal healing and reduce the risk of complications. Here are some key points to keep in mind:

Treat the cause and comorbidities: 

• Addressing the Underlying Cause: Treating the underlying condition that caused the wound is essential for successful healing. For example, diabetic ulcers with tendon exposure are typically classified as Wagner Grade 2 since they penetrate to the tendon. If the wound is infected or involves deeper tissue, it may be a Wagner Grade 3 ulcer, which could benefit from hyperbaric oxygen therapy to enhance healing. An x-ray or MRI can be beneficial to assess underlying osteomyelitis and deep abscesses.
• Vascular Status: Assessing the vascular status of the wound is important. Tendons in wounds with compromised blood flow are more vulnerable to drying out, infection, and poor healing. Ensuring good circulation around the tendon may require additional interventions.
• Minimizing Movement: The tendon should be protected from excessive movement, which could cause further injury. This can be achieved by immobilizing the area or using dressings that provide support and reduce friction or shear.

Local wound care (TIME concept): 

• Debridement (Tissue): Debridement of necrotic tissue in the wound bed is necessary to promote healing, but the tendon itself should not be debrided. Preserving the tendon is key to preventing further complications.
• Infection Control Management and Assessment: Infection control is crucial to prevent complications and promote healing. Regular assessment for signs of infection, such as increased redness, swelling, warmth, or purulent discharge, should be conducted. Depending on the severity, appropriate antimicrobial therapy may be required (antimicrobial dressings, topicals, and/or antibiotics per assessment/culture).
• Moisture Management: Tendons exposed to air can dry out quickly, which can impair healing. It's important to keep the tendon covered and in a moist environment to prevent desiccation. Using appropriate dressings that maintain moisture without making the area too wet or too dry is essential for supporting healing.
• Dressings: Choosing the right dressing depends on the level of wound drainage. A contact layer placed directly over the tendon as a base layer provides protection from sticking or pulling. Silicone-coated foam dressings are particularly useful for wounds with medium to heavy exudate. Hydrogel dressings may be considered for ulcers with low exudate or to maintain a granulating, moist wound bed. These dressings protect the tendon and manage moisture effectively, which will promote healing. Select an antimicrobial dressing if signs of infection are present.

Here are some additional resources:

• Assessment:  How To Assess A Patient With Chronic Wounds
• Wound bed preparation framework: Wound Management
• Selecting a Dressing: Prep and Dress Tool
• Previous Curbside Consult  https://woundreference.com/app/post?id=1237

Hope that helps!

Kim