Concept Of Wound Bed Preparation Research Articles

Local wound management: A review of modern techniques and products.

Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.

Benefits of maggot debridement therapy on leg ulcers: a literature review.

Maggot debridement therapy (MDT) is an effective method for debriding wounds such as leg ulcers, supporting the concept of wound bed preparation ( Dumville et al, 2009 ; Soares et al, 2009 ; Mudge et al, 2014 ). New evidence is emerging to suggest that maggots might contribute to wound healing in other ways. For example, the reduction of biofilms and disinfection of wounds ( Van Der Plas et al, 2008 ; Brown et al, 2012 ; Pritchard and Brown, 2015 ) plus regulation of protease levels ( Chambers et al, 2003 ; Van Der Plas et al, 2009a ; Van Der Plas et al, 2009b ). This review will discuss research exploring new benefits of maggots in the management of individuals with chronic leg ulcers.

Wound cleansing: a key player in the implementation of the TIME paradigm.

The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells.

褥瘡に対するチーム医療と形成外科治療

A refractory pressure ulcer should be treated not only by surgery but also with team medical care in order to avoid recurrence after the initial treatment. At our hospital, plastic surgeons are responsible for organizing the team care. As part of the team care strategy, physical therapists (PTs) and occupational therapists (OTs) provide education to improve the mobility of spinal-cord-injury patients, e.g., improving muscle strength of the upper extremities for adequate transfer and ability to perform wheelchair push ups. For elderly patients, nurses assess the risk of pressure ulcer development using the Braden's scale and set up a nutrition support team. Additionally, if patients have difficulty swallowing, a speech therapist treats the dysphagia. And PTs and OTs treat their impaired activities of daily living. Finally, medical social workers arrange home-health-care services when the patient returns to their home. The management of chronic wounds has progressed from merely assessing the status of the wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation, TIME, has simultaneously evolved to provide a systematic approach to removing the barriers to natural healing and enhancing the effectiveness of advanced therapies. Wound bed preparation and the TIME framework are most likely to be successful when used alongside the wound bed preparation care cycle.

Wound Bed Preparation 2012

The concept of wound bed preparation is a holistic approach to wound diagnosis and treatment of the cause, patient-centered concerns and optimizing the components of local wound care (débridement, infection and persistent infection, moisture balance) before edge effect for healable but stalled chronic wounds. This article has introduced the concepts of healable, nonhealable and maintenance wounds. Additionally, clinical criteria (mnemonic NERDS and STONEES) are provided on the use of topical agents for critical colonization or systemic antimicrobials for deep and surrounding infection. To present a holistic, evidence-informed approach to chronic wound care management. This article reviews the scientific evidence base, and forms an expert consensus of key opinion leaders to the Wound Bed Preparation model. This article provides clinicians with evidence-informed wound caring approaches translating the evidence base into practice.

Wound bed preparation: The impact of debridement and wound cleansing

Wound healing is a complex series of events that are interlinked and dependent on one another. Acute wounds usually follow a well-defined process. In the past this model of healing has been applied also to chronic wounds, but it is well known that chronic wound healing is different from acute wound healing. Wound bed preparation as a concept allows the clinician to focus systematically on all of the critical components of a non-healing wound to identify the cause of the problem, and implement a care programme in order to achieve wound healing. To assist with implementing the concept of wound bed preparation, the TIME acronym was developed in 2002 by a group of wound care experts. It is important to understand wound bed preparation and TIME within the context of total patient care. Debridement is an integrated part of wound management, achieving certain goals and, thus, creating a healthy wound bed, margins and peri-wound skin with the objective to promote and accelerate healing. Debridement is defined as the removal of foreign material and necrotic tissue from a wound and it can also help to stimulate wound healing. However, not all methods of debridement are the same. Each method has advantages and disadvantages that must be clearly understood. Wound cleansing loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Failure to use the correct method for a given wound may lead to further delays in wound healing, increase patient suffering, and unnecessarily increase the cost of care. Aim of this review is to give an overview of current standards and definitions concerning wound bed preparation and debridement.

Stem Cells in Tissue Repair and Regeneration

The field of tissue repair and wound healing has blossomed in the past 30 years. We have gone from recombinant growth factors, to living tissue engineering constructs, to stem cells. The task now is to pursue true regeneration, thus achieving complete restoration of structure and function.

Wound bed preparation from a clinical perspective

Wound bed preparation has been performed for over two decades, and the concept is well accepted. The ‘TIME’ acronym, consisting of tissue debridement, infection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.

Special Considerations in Wound Bed Preparation 2011

This article builds and expands upon the concept of wound bed preparation introduced by Sibbald et al in 2000 as a holistic approach to wound diagnosis and treatment of the cause and patient-centered concerns such as pain management, optimizing the components of local wound care: Debridement, Infection and persistent Inflammation, along with Moisture balance before Edge effect for healable but stalled chronic wounds.

Using the TIME framework in wound bed preparation

This article discusses the concept of wound bed preparation and the associated TIME framework, as a systematic approach to wound assessment. Successful outcomes for patients with wounds relies on identification and treatment of the underlying cause of the wound and management of issues at the wound bed that impact on healing. This systematic approach can improve wound assessment and assist with treatment choices for patients, so as to optimize wound care for patients.

Reviewing the evidence for wound bed preparation

This paper explores the nature of evidence and how it has evolved in recent years, and sets out a process for assembling and assessing the evidence to support wound bed preparation as an effective method of managing chronic wounds

Using wound area measurement to predict and monitor response to treatment of chronic wounds

A wound measurement system has been launched that incorporates wound tracing and digital planimetry. It is hoped its speed and accuracy will enable more clinicians to use wound area measurements to predict treatment outcomes.

Proteases and pH in chronic wounds

Research into the chronic wound environment has led to an improved understanding of the molecular and cellular processes occurring at the wound bed, culminating in the concept of wound bed preparation. This paper discusses the role of proteases and pH in wound healing, and proposes that pH may influence healing outcomes.

Open Wound Integrated Regenerative Therapy with Topical bFGF Trafermin for Deep Soft Tissue Defects with Bone Exposure

Aim: Recently advocated concept of wound bed preparation (WBP) has systematically concreted the critical components of wound care, including debridement, bacterial balance, and management of exudate. We succeed in experiences by topical pharmaceutical therapy combined with WBP. We aimed to demonstrate availability of the wound management.Methods: Since 1999, 18 exteriorized‐bone patients with deep soft tissue defects were treated with this treatment. Our procedure was composed of four steps; 1) Resection or debridement, 2) Wound cleansing (soaking foot and hand in the hot bath with antibacterial carbonated agent), 3) Topical medication: basic fibroblast growth factor (Trafermin; KAKEN, Tokyo) and bucladecine sodium (Actocin ointment; Daiichi Pharmaceu. Co. Ltd, Tokyo), and 4) Dressing.Results: The average time for whole coverage of the exposed‐bone area with healthy granulation was 23 ± 13( median;19, range; 7–47) days after surgical treatment (the 1st step). The average time for complete epithelization was 72 ± 42 (55, 26–150) days in the patients who had not undergone skin graft. For minor amputations of diabetic feet the healing time until complete epithelization was 65 ± 46 (44, 26–150) days on an average.Conclusions: We concluded that the integrated approach mobilizing commercial available products for wound healing under optimally prepared environment offers advantage of facilitating the efficacy of exogenous therapeutic measures on condition that endogenous regeneration has been accelerated.

TIME principles of chronic wound bed preparation and treatment.

Managing chronic wounds has progressed from merely assessing the wound to understanding the underlying cellular abnormalities and associated clinical problems. The concept of wound bed preparation offers a systematic approach to removing barriers to healing such as tissue (non-viable), infection/inflammation, moisture (imbalance) and edge (non-advancing or undermining). The principles of wound bed preparation as outlined in the tissue, infection, moisture, edge (TIME) table are explained in this article, with examples and recommended treatment interventions. The TIME table is recommended for use at the bedside when assessing patients with wounds.

Wound bed preparation and a brief history of TIME

Management of chronic wounds has progressed from merely assessing the status of a wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation has simultaneously evolved to provide a systematic approach to removing these barriers to natural healing and enhancing the effects of advanced therapies. This brief review of wound bed preparation traces the development of these concepts and explains how to apply systematic wound management using the TIME acronym - tissue (non viable or deficient), infection/inflammation, moisture (imbalance) and edge (non advancing or undermined).

The role of wound-bed preparation in managing chronic pressure ulcers.

The relatively modern concept of wound-bed preparation draws together elements of current practice, including various methods of 'maintenance debridement' and the use of antibiotics and antiseptic agents, to speed up healing of chronic wounds.