Wound Bed Preparation

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By the WoundSource Editors

The process of wound healing ideally progresses from inflammation to epithelialization and, finally, remodeling. If at any point bacterial (or fungal) colonization becomes prominent, the process of wound healing is disrupted. The creation of biofilm is a microbial defense mechanism that stalls the trajectory of healthy wound healing and can contribute to the development of a chronic wound. It is estimated that 90% of chronic wounds and 6% of acute wounds contain biofilms generated by microbes. Epidemiologically, chronic wounds impact 2% of the entire US population. Because of this large impact, knowledge of proper wound healing and use of clinical tools to assist the wound healing process are essential.

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Elizabeth Day Dechant, BSN, RN, CWOCN, CFCN

Diaper rash, more officially known as incontinence-associated dermatitis (IAD), affects hospitalized and incontinent patients of all ages. In my years as a WOC Nurse in a pediatric hospital, IAD has been by far the most frequently treated condition. However, outside of a health care setting, IAD is the most common skin problem in infants and young children who are not yet toilet trained. Diaper rash has plagued babies and new parents for centuries, yet its treatment remains highly debated. For the purpose of this article, I am focusing on the prevention and treatment of diaper rashes in infants and young children, although the principles of topical treatment discussed here apply to all patients.

WoundSource Practice Accelerator's picture

The COVID-19 pandemic has profoundly impacted many aspects of patient care and medical practice. Changes have ranged from supply chain adjustments to transformations in patient interactions. Many of these practices may be standard for the foreseeable future. Although many medical professionals have attended to patients with COVID-19, there has been a major decrease in other necessary aspects of medical care, including wound management.

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By the WoundSource Editors

Debridement is the process of removing nonviable tissue and foreign objects (such as glass or shrapnel) from a wound bed to help the wound heal. Decaying tissue can trap bacteria and lead to a harmful infection such as gangrene, which is the death of body tissue resulting from a lack of appropriate blood flow or in response to a severe bacterial infection. Debridement is thus critical to effective wound management.

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Steven A. Kahn's picture

By Steven A. Kahn, MD

When treating severe burns, surgeons generally consider eschar removal to be the major factor and the top challenge in both initiating and planning for the optimal course of treatment for each patient. Before grafting, all devitalized tissue must be removed, leaving a wound bed of only healthy tissue. Some burn wounds are clearly full-thickness on initial examination, and some are clearly superficial, with relatively straightforward decision making. However, some wounds have an indeterminate depth and are more challenging. Deep partial-thickness, indeterminate-, and heterogenous-depth wounds require more complex decision making and/or a protracted interval to allow the wound to declare. Eschar removal is sometimes necessary to allow surgeons to assess the wound bed and confirm the depth and severity of certain burns. This, in turn, provides the insights a surgeon needs to determine the best course of treatment, including whether a patient must be treated with an autograft to cover a wound area.

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Wound bed preparation has been performed for decades in managing wounds of various etiologies. The wound healing process consists of a complex interlinked and independent cascade, which not all wounds follow in a consistent, organized manner. The TIMERS acronym, consisting of four general steps, has assisted clinicians globally to provide a systematic approach to wound bed preparation that includes Tissue debridement, Infection or Inflammation, Moisture balance, Edge effect, Regeneration and repair, and Social factors.1 Clinicians should have practical knowledge of the principles of advanced wound care management, as well as the challenges faced in treating complex wounds.

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Wound bed maintenance is the process taken by the bedside clinician or nurse to create or preserve the wound environment at optimal conditions and thus encourage the chronic wound to move to a state of closure or healing. Critical thinking skills require a trained eye focused on the characteristics of the wound to move a chronic wound in to a healing phase and ultimately wound closure. The goal of every assessment and encounter includes promoting positive wound characteristics while suppressing negative wound characteristics. This can often feel like a balancing act with not much wiggle room, yet knowing the basic principles of wound healing can help the wound get closer to the finish line.

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Preparing the wound bed to encourage and promote healing is a well-established concept. Wound healing is a complex process that progresses through several phases, including coagulation and hemostasis, inflammation, cell proliferation and repair, and epithelialization and remodeling of scar tissue. In many instances, a non-healing wound can become stalled in one of the phases and fail to progress through the healing process. It is estimated that between 4% and 5% of the adult population will have a non-healing wound at some point.

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Patient education should be a priority to empower patients to care for themselves and improve patient outcomes. Involving patients in their own care can help them to understand about their wound and be more adherent to the overall treatment plan. Remember to involve the caregiver or family if applicable. Ask your patient questions about who will be changing the dressing so the appropriate parties can be involved.

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Anoxia: A condition marked by the absence of oxygen reaching the tissues. It differs from hypoxia, in which there is a decrease in the oxygen levels to tissue.

Biocide tolerance: Demonstrating a tolerance to substances that destroy living things, such as bacteria. The initial stage in the life of biofilm can become biocide tolerant within 12 hours.

Calcium alginate: A water-insoluble, gelatinous substance that is highly absorbent. Dressings with calcium alginate can help to maintain a moist healing environment.

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