Wound Bed Preparation

by the WoundSource Editors

Successful utilization of the TIME model for wound bed preparation requires a working knowledge of chronic wound tissue types. In addition, building on this foundational knowledge is the development of accurate wound assessment skills. These components combined will assist the clinician in implementing the appropriate interventions for each wound.

by the WoundSource Editors

Before embarking on the journey of wound bed preparation, the goals for wound care should be carefully considered. A realistic look at the goals and expectations from the perspective of the patient as well as the wound care team is the first step in developing and implementing the appropriate plan of care.

Is the wound healable? This requires that the individual's body can support the phases of wound healing in an expected time frame. Treatment should be aggressive to prevent any delay in the healing process that would stall wound healing or lead the wound to become chronic. Is maintenance the goal? If so, then efforts should focus on keeping the wound from deteriorating by providing comprehensive wound care. Is hospice or palliative care the goal? If the wound is not expected to heal and the individual's body cannot support the phases of wound healing within an expected time frame, then comfort measures are more important than a cure. All parties should be on the same page with goals and objectives so they are working in tandem toward the best outcome for the individual patient.

by the WoundSource Editors

For wound healing to occur, a complex, well-defined cascade of events must take place in the body’s natural host processes. When this cascade of events is disturbed, a wound can fall into a state of non-healing or chronicity. In clinical practice, chronic wounds such as pressure ulcers, vascular ulcers, and neuropathic wounds behave differently and may be extremely slow to heal. A chronic wound, by definition, is a wound that has failed to progress through the “normal” healing process or is not responsive to management in a timely manner.

by the WoundSource Editors

Bioburden in chronic wounds can be a principal contributor to inflammation, clinical wound infection, and further delayed wound healing. Clinically diagnosing infection in chronic wounds can be problematic because most individuals susceptible to developing chronic wounds are subject to physiological states that often blunt typical infectious responses in various ways. These responses include pain, erythema, febrile state, leukocytosis, edema and increased wound exudate, wound odor, etc.

by the WoundSource Editors

Bacterial load/burden: Presence of bacterial pathogens in an open wound contributing to wound chronicity and persistence of inflammatory cycle. There are several points along the spectrum of bacterial presence in chronic wounds: contamination, colonization, critical colonization, infection, and sepsis.

by the WoundSource Editors

Effective wound management and the prevention of infection for patients with wounds are not only key to wound improvement, but also to avoiding a slide into a state of chronicity. Unfortunately, many wounds that start out simple turn into chronic wounds because of the complications associated with comorbid conditions and secondary infection. Approximately 6.7 million patients in the United States are affected by chronic wounds, and the pervasiveness of these wounds and their connection to other chronic illnesses are underappreciated. That said, estimates for treatment costs are in excess of $50 billion annually.¹

An important factor in wound healing is adequate blood flow; thus patients with critical limb ischemia (CLI) and complex wounds are poor healers. Primary treatment for CLI is revascularization. Wound healing can be prolonged as a consequence of cyclical protease production by necrotic tissue during the inflammatory phase of healing. Debridement of necrotic tissue is therefore necessary to reduce inflammation and progress the healing cycle, as well as to promote epithelialization and reduce risk of infection. Conventional debridement therapy can be difficult in patients with CLI because of limitations in visualizing wound margins and time effectiveness. Maggot debridement therapy (MDT) is a traditional debridement therapy using live, sterilized fly larvae. This study investigated MDT in patients with CLI after midfoot amputation following revascularization by endovascular therapy. The outcomes of wound bed preparation were compared with the outcomes in patients receiving conventional therapy.

by the WoundSource Editors

One of the greatest challenges when dealing with biofilms in chronic wounds is identifying their existence in the first place. The extracellular polymeric substance or EPS coating on biofilms essentially is an invisible cloak that protects and hides biofilms from both the body's immune system and antimicrobial therapies. This biofilm property keeps the wound from advancing through the phases of wound healing and thus remaining in the inflammatory phase, thereby allowing further proliferation of biofilms.

by Martin D. Vera, LVN, CWS

Wound bed preparation has become the gold standard model for proper wound assessment. It allows us clinicians to identify and breakdown local barriers to wound healing. Throughout our health care careers, we have seen it over and over again: the collective emphasis on standards of care, evidence-based practice, and cost-effectiveness in order to achieve positive outcomes for our patients.The wound bed preparation model supports all of these aspects of care delivery.

Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.