Wound bed preparation

Wound bed preparation (WBP) is a systematic approach to wound management by identifying and removing barriers to healing. The concept was originally developed in plastic surgery. During the year 2000, the concept was applied to systematizing the treatment of chronic wounds. The 2000 proposals recommended that wound management address the identifiable impediments to healing in order to achieve more successful outcomes. Three publications appeared that year that focused on the concept of managing the healing processes of a wound exudate, bioburden and devitalized tissue. Initially, emphasis was placed on debridement, moisture balance and bacterial balance as the three guiding principles of good wound care, while at the same time recognizing that the provision of care includes a vast array of patient, clinical and environmental variables. Since the year 2000, the wound bed preparation concept has continued to improve. For example, the TIME acronym (Tissue management, Inflammation and infection control, Moisture balance, Epithelial (edge) advancement) has supported the transition of basic science to the bedside in order to exploit appropriate wound healing interventions and has not deviated from the important tenets of debridement, moisture balance, and bacterial balance. The TIME framework is not a continuum and as such is applicable to a wide range of wounds. The WBP model can be effectively applied only when a high level of precision is utilized in the assessment of the patient and their wound. The corollary of this is that intervention demands an equally high level of precision and this should be preceded by a comprehensive wound assessment. Wound assessment is a vital first step in the precision management process. The purpose of wound assessment is: To identify: the origin of the wound, the effects of the wound on the individual, the effects of the individual on the wound. To determine: if healing is taking place, the most appropriate management of the wound. To gather data: to permit a comparison of wounds and their management.