Wound Bed Preparation in Wound Clinics

Unlike acute wounds, chronic wounds do not follow the normal pattern of repair. In such wounds, the process of healing will be disrupted at one or more points in the phases of hemostasis, inflammation, proliferation, and remodeling. Wound bed preparation aims at removing the barriers to healing and initiating the repair process with on-going debridement, reduction of bacterial burden, and effective exudate management.

To choose the right method of wound-bed preparation for a particular wound, clinicians should first assess the patient’s condition, wound history, physical wound characteristics, and availability of resources. Wound beds need to be assessed for presence of granulation tissue, fibrin slough (yellow), eschar (black), tendon and other underlying structure. Documentation of these assessments can be done using wound specific EMR. It facilitates clinicians as well as the administration staff to access the patient’s data online in real-time. With a separate interface for physician and nurse, the EMR can further enhance the communication. Unlike in general EMR, wound-specific templates in wound EMR help professionals to enter and access specific wound details without searching through many templates.

Preparing the Wound Bed – TIME Principles

TIME principle that was developed in 2002 by a group of wound care experts can assist clinicians in implementing the concept of wound bed preparation. TIME refers to four main components of wound bed preparation such as – Tissue management, Control of infection and inflammation, Moisture imbalance and Advancement of the epithelial edge of the wound.

  • Tissue management – With necrotic or sloughy tissue, it is difficult to accurately assess the depth of a wound that is covered or filled. Accurate description of this tissue is an important feature of wound assessment. With non-viable or deficient tissue, wound healing will be delayed. In a chronic wound, debridement is often required more than once as the healing process can stop or slow down allowing further devitalized tissue to develop.
  • Control of infection and inflammation – Infection in a wound causes pain and discomfort for the patient, and can be life threatening. Signs of infection in chronic wounds include delayed healing, increased exudates and bright red discoloration of granulation tissue. The existence of bacteria in the wound bed is often divided into categories such as contamination, colonization, local infection, and spreading infection.
  • Moisture imbalance – Excessive amounts of exudate have an adverse effect on wound healing. Wound bed gets saturated and moisture leaks may cause maceration and excoriation, leading to an increased risk of infection. Nurses should make sure to record the type, amount and viscosity of the exudates. Dressings should be selected based on the exudate’s characteristics. Occlusive dressing products can promote a moist environment at the wound interface.
  • Epithelial advancement – Epidermal margin fails to migrate due to various reasons including dressing trauma, infection, desiccation and inadequate tissue oxygenation. The presence of well vascularised granulation tissue and viable epidermal cells in the wound bed is crucial for the smooth epithelialisation process to take place. Wound contraction and migration of epidermal cells and keratinocytes indicates the wound bed is adequately prepared

Appropriate knowledge about wound bed preparation is necessary to allow for appropriate and timely healing of chronic wounds.