Wound Care Surgeons Can Rely on TIME for Chronic Wound Care

Wound care surgeons have a good deal of monitoring to do to decide treatment options for chronic wounds. They rely on their own observations plus the observations and documentation of nurses and other professionals in the care team. A wound care EMR facilitates this for eventually better outcomes.

TIME Principles for Wound Care

The World Healing Society has introduced the TIME set of principles which help doctors and nurses to make sure they do not miss out on the important tasks while dealing with wound healing which is impaired.  These guidelines are certainly a massive help for wound care surgeons.  Here’s a brief look into TIME:

  • T – Identifying tissue deficits specifically
  • I – Checking for inflammation in and around the wound site
  • M – Checking for the maceration or desiccation level of moisture balance
  • E – Analyzing the wound edge, whether it is non-advancing, heaped up, and hyperkeratotic, and also describing the level of re-epithelialization


The first step in chronic wound management is removing local wound healing impediments such as necrotic material, devascularized tissue and too much bacterial burden. Thorough debridement is essential to remove the accumulated impediments from the wound site while preserving vital tissue. This converts the chronic state of the wound to a condition resembling acute wound.


Uncontrolled inflammatory mechanisms that sustain themselves are considered to be one of the major factors inhibiting healing of chronic wounds. This burden must be brought down to sub-infection levels to ensure that these systemic and local inflammatory mediators can be controlled. Concentrations of bacteria that exceed 105 or 106 units for every gram of tissue or the presence of ß-hemolytic streptococci are known to interfere with wound healing. Semi-quantitative swab techniques and quantitative tissue biopsies can give objective evidence of the bacterial burden and help deal with the pathogen.

Systemic antibiotics are the right treatment for systemic infection, local cellulites and acute foot infections. However, these should be discontinued once the bacteria levels have been balanced. Continued antibiotic use could inhibit the healing process through the development of microorganisms resistant to them. Osteomyelitis may require surgical intervention in addition to antibiotics.


The wound must be cleansed with nontoxic and non-irritating solutions for minimizing cytotoxicity and further trauma. Maintaining a moist but not macerated environment is considered the best topical condition for open wounds.  Dressings must ideally combine debridement, antimicrobial activity and moisture control.

Wound Edge

Regular monitoring of the wound should result in progress in healing, usually demonstrated by the ulcer reducing in size. If that doesn’t happen, it could be time to carry out other investigations for ruling out conditions such as pyoderma grangraenosum, squamous cell carcinoma or systemic autoimmune diseases possibly related to the use of some drug.

Surgical procedures may be needed, and these could include procedures treating the underlying condition preventing the wound from healing, or procedures dealing with definitive wound closure. Bacterial load, vascular status, hemodynamic factors, and nutritional status of the patient are factors playing major roles in deciding when to resort to surgical repair.

Why the Wound EMR is a Great Tool

Through all these stages, the wound EMR is of great assistance to wound care surgeons thanks to its comprehensive documentation capabilities, and effortless access to that documentation by various members of the care team. The wound care software can generate customized reports containing the aforementioned documentation as well as history, orders, prescriptions and referrals, eliminating the need for paperwork.

The interface for nurses enables nurses to enter observations and patient data dealing with the condition of the wound during various stages of the treatment, with photographs. The physician module enables physicians to make the required amendments in the record. The modules can be connected for note comparison by any member of the care team.

There is no doubt that the use of the wound care EMR complements the application of TIME principles for chronic wound care.