The importance of wound bed preparation

Wound bed preparation a core component to effective wound care treatment.

It is well documented that chronic wounds constitute a major problem in society, as they lead to social isolation of the patient, prolonged inability to work and considerable effects on quality of life.

There is also the cost to the community of the considerable healthcare resources dedicated to the management and treatment of chronic wounds.

What is wound bed preparation?
The term "Wound Bed Preparation" was first described by Falanga et al in 2000 and can be defined as the global wound management plan to accelerate endogenous healing and enhance the effectiveness of advanced wound care products. The ultimate objective is to ensure formation of healthy granulation tissue resulting in complete wound closure through a systematic approach to removing the barriers to healing.

Wound bed preparation in practice
Wound bed preparation (WBP) should not be seen as an isolated local therapy as it treats the patient holistically, it considers factors that may inhibit wound healing and aims to maintain a high quality of life for the patient.

A widely accepted approach to WBP is the TIME concept being Tissue, Inflammation/Infection, Moisture and Edge advancement

The importance of wound bed preparation
TIME provides the clinician a framework and process to guide the evaluation, review and treatment of the wound bed prior to dressing with the aim to provide the optimal environment for healing to occur.

In this approach, evaluation of the wound is an important first step every time a clinician treats a wound. Let us look into a bit more detail about wound evaluation.

Precise evaluation of the wound
There are core factors to consider in order to perform effective wound evaluation, prior to dressing.

As evaluation is performed, the choice of therapy therefore is more easily decided. Factors to consider are:
* Recognition of local and systemic risk factors that can inhibit wound healing
* Debridement (surgical, mechanical, enzymatic, autolytic, biosurgical) of Avital
tissue (necrotic tissue, fibrin coating)
* Monitoring of moisture content/balance in the wound bed (exudate management)
* Other considerations; the presence of infection, the peri-wound tissue, the need to apply graduated compression and the fragility of the skin.

And finally, WBP would not be complete if it did not include reference to wound bed cleansing.

The role of wound cleansing
One of the most important principles of proper wound bed preparation is certainly wound cleaning, as a clean wound can heal more rapidly. Avital tissue such as necrosis and fibrin coating, detritus and a high bacterial load can considerably affect wound healing, resulting in stagnation of the wound healing process.

It must be remembered that the treatment of a chronic wound can take several months and therefore highly effective, gentle and patient-friendly wound cleansing is of great significance.

Particular attention should therefore be given to the choice of wound cleansing agent, which will assist this process.

This first appeared in Braun Australia's Wound Bed Innovations newsletter.

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