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T E C H N O L O G Y U P D A T E : Wound bed preparation revisited


Authors:


Gregory Schultz Caroline Dowsett


The concepts of wound bed preparation and TIME were created in 2003 to help clinicians identify the key barriers to healing in individual patient’s wounds and to design treatment strategies to correct them. Studies showed that educating wound care providers on the principles of wound bed preparation and implementing TIME-based treatments as the standard for wound care significantly improved the knowledge levels of wound care providers and resulted in improved healing. Since 2003, the science of wound bed preparation has advanced in several important areas and new technologies have been developed, which are improving the effectiveness of TIME-based treatments.


Useful links


EWMA Position Document: Wound bed preparation in practice


Biofilms Made Easy MMPS Made Easy


INTRODUCTION Normal healing of skin wounds proceeds through four sequential phases (haemostasis, inflammation, repair, and remodelling) and results in a scar that repairs the damaged tissue structures adequately enough to enable the skin to maintain its major functions[1]


. Unfortunately, some acute wounds fail to References 1. Holloway S, Harding K,


Stechmiller J, Schultz G. Acute and chronic wound healing. In:


Baranoski S, Ayello E, (eds). Wound Care Essentials: Practice Principles.


3rd ed. Lippincott Williams & Wilkins; Springhouse, PA, 2011: 83–100.


2. Tarnuzzer RW, Schultz GS.


Biochemical analysis of acute and chronic wound environments.


Wound Repair Regen 1996; 4(3): 321–25.


3. Falanga V. Classifications for wound bed preparation and


stimulation of chronic wounds. Wound Repair Regen 2000; 8(5): 347–52.


progress through all four phases of healing and become stalled at some point in the sequence, resulting in acute wounds becoming chronic. Most wound care providers are eventually confronted by a wound that fails to heal despite their best efforts to identify the factors impairing healing and design a treatment regimen that creates an optimal healing environment for that patient’s wound.


WOUND BED PREPARATION In the 1990s, the knowledge base around the molecular and cellular regulation of normal wound healing was rapidly expanding[2]


. In


addition, major discoveries were being made about abnormal parameters of molecular, cellular, and microbial environments of chronic wounds[2] In 2003 a group of 10 physicians, nurses,


.


and basic scientists met to generate a simple framework of key clinical assessments and treatment options that would identify and remove/correct the barriers to healing in


25 Wounds International Vol 3 | Issue 1 | ©Wounds International 2012 most chronic wounds[3-6] . The result was the


integrated concept of wound bed preparation and the acronym TIME, which provided a structured approach to wound management[6] This rapidly expanding scientific data base


.


was used to generate a simple framework of key clinical assessments and treatment options that would identify and remove/correct the barriers to healing in most chronic wounds [3-5]


.


. The result was


the integrated concept of wound bed preparation and the acronym TIME, which provided a structured approach to wound management[6]


ORIGINAL SCIENCE OF WOUND BED PREPARATION AND NEW ADVANCES T — tissue Debridement or removal of devitalised or non- functional tissue (fibrous scar or callous), which was not optimal repair tissue was generally recognised as beneficial for healing. However, frequent debridement was not


fully recognised as a major factor in enhancing healing of chronic wounds until a retrospective analysis of patients in a randomised controlled trial of growth factor therapy (platelet-derived growth factor [PDGF]) showed an enormous improvement in healing for diabetic foot ulcers that had received both standard care and growth factor therapy[7]


.


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