Wound Bed Preparation

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By Ronald A. Sherman, MD

Challenges are nothing new for those of us who work in health care. Every day, we triumph over difficult situations. Yet, the current coronavirus outbreak has complicated even the simplest of procedures and has brought us additional challenges.

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Silver Nitrate Sticks

By the WoundSource Editors

Silver nitrate is a natural, inorganic chemical compound with antimicrobial properties that has been used in medical applications since the 13th century. It is used as a cauterizing agent and is available as a solution or an applicator stick. The applicator sticks, known as silver nitrate sticks or caustic pencils, contain silver nitrate and potassium nitrate. There are certain brands of silver nitrate sticks that can be bent or shaped to increase ease of access within a target area. The silver nitrate stick is activated by contact with moisture. When applied to wounds, silver nitrate sticks deliver free silver ions to the tissue that form an eschar as they bind to tissue and obstruct vessels.

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Achieving Closure

By the WoundSource Editors

Wound healing is a highly complex chain of events that allows the skin to repair and regenerate to provide protective functions, such as temperature modulation, and moisture regulation, as well as sensation reception and transmission.

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Patient Considerations

By the WoundSource Editors

Wound debridement is often necessary to address the underlying causes of chronic wounds, remove non-viable tissue, manage biofilm, and ultimately promote and expedite the healing process. There are multiple methods of debridement, including surgical/sharp, autolytic, mechanical, biological, enzymatic, ultrasonic, hydrosurgical, or synergistic (combination of debridement methods). Selecting the most appropriate methods of debridement is crucial in treating chronic and acute wounds successfully and optimizing the healing environment.

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Debridement

By the WoundSource Editors

Wound debridement is a crucial strategy for addressing some of the underlying causes of wound chronicity. The wound healing process can be impacted by chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiency, advanced age, and local factors such as pressure, infection, and edema. Debridement can expedite healing when used to remove necrotic tissue, other non-viable tissue, and foreign material. It can also be a tool to manage biofilm. Debridement exposes the viable underlying tissue, which promotes healing. There are several methods of debridement; determining the best option depends on the health care setting as well as the characteristics of the wound being treated.

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TIMERS

By the WoundSource Editors

Wound bed preparation is a well-established concept, and for many years the TIME framework – consisting of addressing Tissue Management, Inflammation and Infection, Moisture Balance, and Edge or Epithelial Advancement – was the standard tool used by clinicians to manage patients’ wounds throughout the wound care cycle.

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By the WoundSource Editors

Conservative sharp debridement: Conservative sharp debridement is done outside the operating room, and although it removes necrotic tissue and debris, it is not as aggressive a procedure as surgical sharp debridement.

Eschar: Eschar is dead tissue and is found only in full- thickness wounds. It may be tan, brown, or black.

Fibroblasts: Fibroblasts have several roles in wound healing, including breaking down fibrin clots, creating new extracellular matrix and collagen structures, and contracting the wound.

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By the WoundSource Editors

Advanced Treatment Modalities: Wound care interventions that are typically applied when standard of care treatments have failed to lead to significant wound closure progress. Treatments include collagen products, cellular and/or tissue-based products, negative pressure wound therapy, hyperbaric oxygen, and others.

Cellular and/or Tissue-Based Products: Cellular and/or tissue-based products (CTPs) actively promote healing by stimulating the patient’s own cells to regenerate healthy tissue.

Collagen: Collagen is the most abundant protein in the human body. In wound healing, collagen attracts fibroblasts and encourages the deposition of new collagen to the wound bed.

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Patient Education and Wound Cleansing

By Margaret Heale, RN, MSc, CWOCN

As patient-driven groupings model hits home care, patients or their caregivers will be expected to do more of the care. Subsequently, nursing staff are expected to provide more education, making "how to" information more crucial than ever.

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Wound Bed Assessment

By the WoundSource Editors

Wound treatment plans are frequently ineffective because of a widespread failure to identify wound etiology accurately. One study found that up to 30% of all wounds lack a differential diagnosis, and this poses a real barrier to administering effective treatments. Furthermore, recent advances in the understanding of wounds, including the use of growth factors and bioengineered tissue and the ability to grow cells in vitro, present new opportunities to provide more effective treatment. Wound bed preparation that incorporates the TIME framework (tissue management, Infection or inflammation, moisture imbalance, and edge of wound) into the A, B, C, D, E wound bed preparation care cycle can significantly increase the ability to perform the following accurately.

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