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CC BY-NC-ND 4.0 · Indian J Plast Surg 2012; 45(02): 193-202
DOI: 10.4103/0970-0358.101277
Review Article
Association of Plastic Surgeons of India

Wound bed preparation from a clinical perspective

A. S. Halim
Department of Reconstructive Sciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
,
T. L. Khoo
Department of Reconstructive Sciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
,
A. Z. Mat Saad
Department of Reconstructive Sciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
› Author Affiliations
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Publication History

Publication Date:
27 November 2019 (online)

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ABSTRACT

Wound bed preparation has been performed for over two decades, and the concept is well accepted. The ′TIME′ acronym, consisting of tissue debridement, i nfection 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.

KEY WORDS

Chronic wound - negative pressure therapy - ulcer - wound - wound bed
 
  • 1 Falanga V. Wound bed preparation: Science applied to practice. In: Wound Bed Preparation in Practice. EWMA Position Document. London: Medical Education Partnership Ltd; 2004. p. 2-5.
  • 2 Panuncialman J, Falanga V. The science of wound bed preparation. Surg Clin North Am 2009;89:611-26.
  • 3 Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 2000;8:347;52.
  • 4 Dowsett C. The role of the nurse in wound bed preparation. Nurs Stand 2002;16:69-72.
  • 5 Knox KR, Datiashvili RO, Granick MS. Surgical wound bed preparation of chronic and acute wounds. Clin Plast Surg 2007;34:633-41.
  • 6 Sibbald RG, Williamson D, Orsted HL, Campbell K, Keast D, Krasner D, et al. Preparing the wound bed--debridement, bacterial balance, and moisture balance. Ostomy Wound Manage 2000;46:14-22.
  • 7 Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: Focus on infection and inflammation. Ostomy Wound Manage 2003;49:23-51.
  • 8 Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, et al. Wound bed preparation: A systematic approach to wound management. Wound Repair Regen 2003;11(Suppl 1):S1-28.
  • 9 Sibbald RG, Orsted HL, Coutts PM, Keast DH. Best practice recommendations for preparing the wound bed: Update 2006. Adv Skin Wound Care 2007;20:390-405.
  • 10 Sibbald RG, Goodman L, Woo KY, Krasner DL, Smart H, Tariq G, et al. Special considerations in wound bed preparation 2011: An update(c). Adv Skin Wound Care 2011;24:415-36.
  • 11 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986;78:285-92.
  • 12 Mustoe TA, O′Shaughnessy K, Kloeters O. Chronic wound pathogenesis and current treatment strategies: A unifying hypothesis. J Plast Reconstr Surg 2006;117:35-41.
  • 13 Fletcher J. Differences between acute and chronic wounds and the role of wound bed preparation. Nurs Stand 2008;22:62-8.
  • 14 Ligresti C, Bo F. Wound bed preparation of difficult wounds: An evolution of the principles of TIME. Int Wound J 2007;4:21-9.
  • 15 Panuncialman J, Falanga V. The science of wound bed preparation. Clin Plast Surg 2007;34:621-32.
  • 16 Granick MS, Tenenhaus M, Knox KR, Ulm JP. Comparison of wound irrigation and tangential hydrodissection in bacterial clearance of contaminated wounds: Results of a randomized, controlled clinical study. Ostomy Wound Manage 2007;53:64-6.
  • 17 Granick M, Boykin J, Gamelli R, Schultz G, Tenenhaus M. Toward a common language: surgical wound bed preparation and debridement. Wound Repair Regen 2006;14(Suppl 1):S1- 10.
  • 18 Gravante G, Delogu D, Esposito G, Montone A. Versajet hydrosurgery versus classic escharectomy for burn debridment: A prospective randomized trial. J Burn Care Res 2007;28:720-4.
  • 19 Patton MA. Eusol: The continuing controversy. BMJ 1992;304:1636
  • 20 Falabella AF. Debridement and wound bed preparation. Dermatol Ther 2006;19:317-25.
  • 21 Gardner SE, Frantz RA, Doebbeling BN. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair Regen 2001;9:178-86.
  • 22 Trengove NJ, Stacey MC, McGechie DF, Mata S. Qualitative bacteriology and leg ulcer healing. J Wound Care 1996;5:277- 80.
  • 23 Attinger CE, Janis JE, Steinberg J, Schwartz J, Al-Attar A, Couch K. Clinical approach to wounds: Debridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg 2006;117:72 S-109.
  • 24 Mat Saad AZ, Khoo TL, Dorai AA, Halim AS. The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction. Indian J Plast Surg 2009;42:94-9.
  • 25 Mat Saad AZ, Halim AS, Khoo TL. The use of glycerol-preserved skin allograft in conjunction with reconstructive and flap surgery: Seven years of experience. J Reconstr Microsurg 2011;27:103- 8.
  • 26 Borgquist O, Gustafsson L, Ingemansson R, Malmsjo M. Micro- and macromechanical effects on the wound bed of negative pressure wound therapy using gauze and foam. Ann Plast Surg 2010;64:789-93.
  • 27 Hasan A, Murata H, Falabella A, Ochoa S, Zhou L, Badiava E, et al. Dermal fibroblasts from venous ulcers are unresponsive to action of transforming growth factor-beta I. J Dermatol Sci 1997;16:59-66.
  • 28 Agren MS, Steenfos HH, Dabelsteen S, Hansen JB, Dabelsteen E. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic leg ulcers is ulcer-dependent. J Invest Dermatol 1999;112:463-9.
  • 29 Cook H, Davies KJ, Harding KG, Thomas DW. Defective extracellular matrix reorganization by chronic wound fibroblasts is associated with alterations in TIMP-1, TIMP-2 and MMP-2 activity. J Invest Dermatol 2000;115:225-33.
  • 30 Falanga V, Grinnell F, Gilchrist B, Maddox YT, Moshell A. Workshop on the pathogenesis of chronic wounds. J Invest Dermatol 1994;102:125-7.
  • 31 Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005;366:1736-43.
  • 32 Stanley AC, Park HY, Phillips TJ, Russakovsky V, Menzoian JO. Reduced growth of dermal fibroblasts from chronic venous ulcers can be stimulated with growth factors. J Vasc Surg 1997;26:994- 9.
  • 33 Henderson EA. The potential effect of fibroblast senescence on wound healing and the chronic wound environment. J Wound Care 2006;15:315-8.
  • 34 Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol 2007;25:19-25.
  • 35 Simonsen L, Holstein P, Larsen K, Bullow J. Glucose metabolism in chronic diabetic foot ulcers measured in vivo usingmicrodialysis. Clin Physiol 1998;18:355-9.
  • 36 Stolle LB, Riegels-Nielsen P. The metabolism if the diabetic foot. In vivo investigation with microdialysis. Acta Orthop Scand 2004;75:106-8.
  • 37 Khanna S, Biswas S, Shang Y, Collard E, Azad A, Kauh C, et al. Macrophage Dysfunction Impairs Resolution of Inflammation in the Wounds of Diabetic Mice. PLoS ONE 2010;5:e9539.
  • 38 Liu ZJ, Velazquez OC. Hyperoxia, Endothelial progenitor cell mobilization, and diabetic wound healing. Antioxid Redox Signal 2008;10:1869-82.
  • 39 Brem H, Stojadinovic O, Diegelmann RF, Entero H, Lee B, Pastar I. Molecular markers in patients with chronic wounds to guide surgical debridement. Mol Med 2007;13:30-9.
  • 40 Jude EB, Blakytny R, Bulmer J, Boulton AJ, Ferguson MW. Transforming growth factor-beta 1, 2, 3 and receptor type I and II in diabetic foot ulcers. Diabet Med 2002;19:440-7.
  • 41 Blakytny R, Jude EB, Martin Gibson J, Boulton AJ, Ferguson MW. Lack of insulin-like growth factor-1 (IGF-1) in the basal keratinocyte layer of diabetic skin and diabetic foot ulcers. J Pathol 2000;190:589-94.
  • 42 Herrick SE, Sloan P, McGurk M, Freak L, McCollum CN, Ferguson MW. Sequential changes in histologic pattern and extracellular matrix deposition during the healing of chronic venous ulcers. Am J Pathol 1992;141:1085-95.
  • 43 Fivenson D, Scherschun L. Clinical and economic impact of Apligraf for the treatment of non-healing venous leg ulcers. Int J Dermatol 2003;42:960-5.
  • 44 Da Costa RM, Ribeiro Jesus FM, Aniceto C, Mendes M. Randomised, double-blind, placebo-controlled, dose-ranging study of granulocytemacrophage colony stimulating factor in patients with chronic venous leg ulcers. Wound Repair Regen 1999;7:17-25.
  • 45 Robson MC, Phillips TJ, Falanga V, Odenheimer DJ, Parish LC, Jensen JL, et al. Randomised trial of topically applied Repifermin (recombinant human keratinocyte growth factor-2) to accelerate wound healing in venous ulcers. Wound Repair Regen 2001;9:347-52.
  • 46 Colletta V, Dioguardi D, Di Lonardo A, Maggio G, Torasso F. A trial to assess the efficacy and tolerability of Hyalofill-F in non-healing venous leg ulcers. J Wound Care 2003;12:357-60.
  • 47 Vin F, Teot L, Meaume S. The healing properties of Promogran in venous leg ulcers. J Wound Care 2002;11:335-41.
  • 48 Sibbald RG, Torrance G, Hux M, Attard C, Milkovich N. Cost-effectiveness of becaplermin for non-healing neuropathic diabetic foot ulcers. Ostomy Wound Manage 2003;49:76-84.
  • 49 Edmonds M, Foster A. Hyalofill: A new product for chronic wound management. Diabetic Foot 2000;3:9-30.
  • 50 Vevas A, Sheehan P, Pham HT. A randomised controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcer. Arch Surg 2002;137:822-7.
  • 51 Felts AG, Grainger DW, Slunt JB. Locally delivered antibodies combined with systemic antibiotics confer synergistic protection against antibiotic-resistant burn wound infection. J Trauma 2000;49:873-8.