Periwound Management

Wound bed preparation is the systematic approach clinicians use to identify and remove barriers to the healing process of the wound. The approach aims to create an optimal wound healing environment by focusing on all critical components, including debridement, bacterial balance, and exudate management, as well as taking into account the patient's overall health status and how this may impinge on the wound healing process.

Wound bed preparation is a vital element of wound care. It ensures that the wound has the best environment for closure by addressing the needs of the wound and removing barriers. Wound bed preparation is usually achieved by following a systematic approach such as the TIMERS mnemonic, which consists of tissue, infection/inflammation, moisture management, edge of wound/epibole, repair/regeneration, and social factors. These steps do not necessarily need to occur in order, and some or all of them may need to be repeated as the wound changes and progresses toward closure.

Wound bed preparation is the concept that provides clinicians with a framework for treating hard-to-heal wounds by assessing the patient as a whole and not focusing only on the characteristics of the wound. Moisture management is essential for a wound to heal correctly, so clinicians must regularly assess the wound because excess moisture or exudate can be an indicator of ongoing inflammation or other complicating factors.

Wound bed preparation is vital to treating biofilm. Resistant to antibiotic treatment, biofilm not only stalls the healing process of chronic wounds but also puts patients at greater risk for amputation. Clinicians should follow the process of successful wound healing described in the TIMERS framework (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement, Repair/regeneration, and Social factors) to guide wound care. Proper wound bed preparation recognizes that biofilm prevention and treatment in chronic wounds incorporate aggressive wound debridement to suppress biofilm regrowth, disrupt the bacterial burden, and promote a healthy wound bed environment

by Cathy L. Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

The periwound is generally defined as the area from the wound edge to 4 cm beyond circumferentially. Breakdown of the periwound can adversely affect wound healing even if the wound itself is doing well. After the initial assessment of the wound bed and edges, one should direct their assessment to the periwound. Generally speaking, there are three major conditions (other than intact) in which you may find the periwound: damaged from trauma, too moist, or in an inflammatory state.

by the WoundSource Editors

Epidermis: the outer layer of the skin, which is the protective layer against the outside elements.

Epithelialization: the growth of the epidermis over a wound during the remodeling stage.

Granulation: condition occurring in a full-thickness wound where the growth of small vessels and connective tissue forms “scaffolding” as the wound rebuilds.