Technology and product reviews Tissue debridement


Page Points


1. Observing a healthy sheet of epithelial cells migrating from the edge of a chronic wound is probably the most sensitive indicator of


when the three other components of TIME have been properly addressed


2. Epithelial cells cannot proliferate and migrate over a layer of fibrinous slough that has not been properly debrided


3. Moisture levels must be optimal or maceration will develop in sheets of non-keratinised epithelial cells and disrupt their migration


Superficial pseudomonas infection Biofilms


Epithelial Edge Surgical


Infection/Inflammation


Moisture balance Figure 1: Wound Bed Preparation and TIME.


understand the use of compression in exuding leg ulcers with a venous component[21,22]


.


Additionally, he or she would be more likely to accurately assess and describe exudate levels.


References


6. Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound


management.Wound Repair Regen 2003; 11(1 Suppl): S1–28.


7. Steed DL, Donohoe D, Webster


MW, Lindsley L. Effect of extensive debridement and treatment on


the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg 1996; 183(1): 61–64.


8. Cardinal M, Eisenbud DE, Armstrong DG, et al. Serial surgical


debridement: a retrospective study on clinical outcomes in chronic lower extremity wounds.Wound Repair Regen 2009; 17(3): 306–11.


Edge of the Wound/Epithelial Cell Migration — E Observing a healthy sheet of epithelial cells migrating from the edge of a chronic wound is probably the most sensitive indicator of when the three other components of TIME have been properly addressed. Epithelial cells cannot proliferate and migrate


over a layer of fibrinous slough that has not been properly debrided[23]


. Inflammation must


be reduced so that protease levels can drop to low levels and not destroy the critical growth factors and extracellular matrix proteins that epithelial cells require to proliferate and migrate. Moisture levels must be optimal or


maceration will develop in sheets of non- keratinised epithelial cells and disrupt their migration. In addition, fibroblasts and epithelial cells in wounds that have remained chronic for many months or even years frequently display a 'senescent phenotype', which is evidenced by the cells' decreased proliferation and


27 Wounds International Vol 3 | Issue 1 | ©Wounds International 2012


migration in response to growth factors, even when placed in ideal conditions in a laboratory culture dish[24]


. The 'E' in the TIME framework is not always


well understood by clinicians. This may be because the cellular environment cannot be assessed by clinical observation alone, and clinicians may have a poor understanding of the role of MMPs and the impact of cell senescence. However, an educational programme utilising the TIME framework has been shown to improve knowledge and practice in this area, ensuring patients who fail to heal in an expected time frame are referred to specialist services and have access to advanced therapies[22]


.


Regular wound evaluation and measurement is an essential element of implementing the 'E' element of the TIME framework so that non- healing wounds can be identified and treated in a timely manner.


WOUND BED PREPARATION AND TIME IN ACUTE WOUNDS Although wound bed preparation and TIME was initially developed to target chronic wounds, it

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