Wounds International Vol 3 Issue 1

Technology and product reviews Page Points

1. Although wound bed preparation and TIME was initially developed to target chronic wounds, it has also been used by clinicians caring for acute wounds

2. Many burn surgeons have been practising key principles of wound bed preparation and TIME since the 1970s

3. The concept of wound bed preparation and the TIME framework has gained international recognition as a framework that can provide a structured approach to wound management

has also been used by clinicians caring for acute wounds. Indeed, many burn surgeons have been practising key principles of wound bed preparation and TIME since the 1970s, when early excision (debridement) of full thickness and partial thickness burns was reported to reduce infection rates and improve survival better than conservative management using topical antimicrobials plus excision in the second or third week[25, 26]

. However, it is reassuring that

similar approaches and objectives are being used to optimise the molecular and cellular status needed for the healing of both large acute burn wounds and chronic wounds.

References

9. Phillips PL, Wolcott RD, Fletcher J, Schultz GS. Biofilms Made Easy. Available at: http://www. woundsinternational.com/made-easys/biofilms-made-easy (accessed 14 February, 2012)

10. Kirshen C, Woo K, Ayello EA, Sibbald RG. Debridement: a vital component of wound bed preparation. Adv Skin Wound Care 2006; 19(9): 506–17.

11. Trengove NJ, Stacey MC, Macauley S, et al. Analysis of the acute and chronic wound

environments: the role of proteases and their inhibitors.Wound Repair Regen 1999; 7(6): 442–52.

12. Black RA, Rauch CT, Kozlosky CJ, et al. A metalloproteinase disintegrin that releases tumour-necrosis factor- alpha from cells. Nature 1997; 385(6618): 729–33.

13. Gibson D, Cullen B, Legerstee R, Harding KG, Schultz G. MMPs Made Easy. Wounds International 2010;1(1):1-6.

14. Ladwig GP, Robson MC, Liu R, Kuhn MA, Muir DF, Schultz GS. Ratios of activated matrix metalloproteinase-9 to tissue inhibitor of matrix metalloproteinase-1 in wound fluids are

inversely correlated with healing of pressure ulcers. Wound Repair Regen 2002; 10(1): 26–37. 15. Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy Wound Manage 200; 49(11): 23–51.

16. Cullen B, Watt PW, Lundqvist C, et al. The role of oxidised regenerated cellulose/collagen in

chronic wound repair and its potential mechanism of action. Int J Biochem Cell Biol 2002; 34(12): 1544–56.

17. James GA, Swogger E, Wolcott R, et al. Biofilms in chronic wounds. Wound Repair Regen 2008; 16(1): 37–44.

18. Phillips PL, Yang Q, Sampson E, Schultz G. Effects of antimicrobial agents on an in vitro biofilm model of skin wounds. Adv Wound Care 2010; 1: 299–304.

19. Wolcott RD, Rumbaugh KP, James G, et al. Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care 2010; 19(8): 320–28.

20. Dowsett C, Ayello E. TIME principles of chronic wound bed preparation and treatment. Br J Nurs 2004; 13(15 Suppl): S16–23.

21. Dowsett C. The role of the nurse in wound bed preparation.Nurs Stand 2002; 16(44): 69–76.

22. Dowsett C. Use of TIME to improve community nurses' wound care knowledge and practice. Wounds 2009; 5(5): 14–21.

23. Kubo M, Van de Water L, Plantefaber LC, et al. Fibrinogen and fibrin are anti-adhesive for

keratinocytes: a mechanism for fibrin eschar slough during wound repair. J Invest Dermatol 2001; 117(6): 1369-81.

24. Agren MS, Steenfos HH, Dabelsteen S, Hansen JB, Dabelsteen E. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic venous leg ulcers is ulcer-age dependent. J Invest Dermatol 1999; 112(4): 463–69.

25. Schultz G, Mozingo D, Romanelli M, Claxton K. Wound healing and TIME; new concepts and scientific applications. Wound Repair Regen 2005; 13(4 Suppl): S1–11.

26. Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma 1970; 10: 1103–08.

RECENT IMPACT ON WOUND CARE PRACTICE The concept of wound bed preparation and the TIME framework has gained international recognition as a framework that can provide a structured approach to wound management. The concept focuses the clinician on optimising conditions at the wound bed so as to encourage normal endogenous healing[3,6]

. The concept

has become an established framework for the assessment and management of wounds and is commonly used as a tool for wound care education and training[22]

. It offers the potential

to improve the lives of people with intractable wounds and to empower clinicians to effectively manage complex wounds. Even though the principles of wound

bed preparation and TIME have evolved to incorporate new concepts revealed by basic and clinical research, the core principles have remained viable because they are based on biological processes that are fundamental and essential for wound healing. The next 10 years will see more exciting advancements in the translation of basic research into clinical treatments, however, TIME is flexible and will adapt and incorporate important new factors that influence healing of acute and chronic wounds [Fig 1].

AUTHOR DETAILS Gregory Schultz, PhD, is a Research Foundation Professor/Director Institute for Wound Research, Department Obstetrics and Gynecology, University of Florida, USA Caroline Dowsett, PhD, RN is a Nurse Consultant Tissue Viability, Community Health Newham Directorate, East London NHS Foundation Trust/Tissue Viability Service, East Ham Care Centre, London

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

Page 1 | Page 2 | Page 3 | Page 4 | Page 5 | Page 6 | Page 7 | Page 8 | Page 9 | Page 10 | Page 11 | Page 12 | Page 13 | Page 14 | Page 15 | Page 16 | Page 17 | Page 18 | Page 19 | Page 20 | Page 21 | Page 22 | Page 23 | Page 24 | Page 25 | Page 26 | Page 27 | Page 28 | Page 29 | Page 30 | Page 31 | Page 32 | Page 33