scholarly journals Wound bed preparation from a clinical perspective

2012 ◽  
Vol 45 (02) ◽  
pp. 193-202 ◽  
Author(s):  
A. S. Halim ◽  
T. L. Khoo ◽  
A. Z. Mat Saad
Keyword(s):  
Time Management ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Wound Care ◽  
Scientific Basis ◽  
Tissue Necrosis ◽  
Wound Assessment ◽  
Moisture Balance ◽  
Wound Bed Preparation ◽  
Dressing Materials

ABSTRACTWound 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.

Wound Bed Preparation 2012

2013 ◽  
Vol 17 (4_suppl) ◽  
pp. S12-S22 ◽  
Author(s):  
R. Gary Sibbald ◽  
Laurie Goodman ◽  
Persaud Reneeka
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Scientific Evidence ◽  
Holistic Approach ◽  
Evidence Base ◽  
Opinion Leaders ◽  
Patient Centered ◽  
Clinical Criteria ◽  
Moisture Balance ◽  
Wound Bed Preparation

Background: 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. Objective: To present a holistic, evidence-informed approach to chronic wound care management. Methods: This article reviews the scientific evidence base, and forms an expert consensus of key opinion leaders to the Wound Bed Preparation model. Results and Conclusion: This article provides clinicians with evidence-informed wound caring approaches translating the evidence base into practice.

Experience of negative pressure wound therapy over sternal wound healing: A retrospective review

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 9-18
Author(s):  
Wai Sze Ho ◽  
Wai Kuen Lee ◽  
Ka Kay Chan ◽  
Choi Ching Fong
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Assessment Tool ◽  
Wound Care ◽  
Wound Therapy ◽  
Treatment Pathways ◽  
Wound Assessment ◽  
One Year

Objectives The aim of this study was to retrospectively review the effectiveness of negative pressure wound therapy (NPWT) in sternal wound healing with the use of the validated Bates-Jensen Wound Assessment Tool (BWAT), and explore the role of NPWT over sternal wounds and future treatment pathways. Methods Data was gathered from patients' medical records and the institution's database clinical management system. Seventeen subjects, who had undergone cardiothoracic surgeries and subsequently consulted the wound care team in one year were reviewed. Fourteen of them were included in the analysis. Healing improvement of each sternal wound under continuous NPWT and continuous conventional dressings was studied. In total, 23 continuous NPWT and 13 conventional dressing episodes were analysed with the BWAT. Results Among conventional dressing episodes, sternal wound improvement was 2.5–3% over 10 days to 3.5 weeks, whereas 4–5% sternal healing was achieved in 5 days to 2 weeks with sternal wire presence. Better healing at 11% in 1 week by conventional dressing was attained after sternal wire removal. In NPWT episodes, 8–29%, 13–24%, and 15–46% of healing was observed in 2 weeks, 3.5 to 5 weeks and 6 to 7 weeks, respectively. Only 39% wound healing was acquired at the 13th week of NPWT in one subject. With sternal wire present, 6%–29% wound healing progress was achieved by NPWT in 1–4 weeks, and 16–23% wound improvement in 2 to 4.5 weeks by NWPT after further surgical debridement. After sternal wire removal, 6–34% sternal wound healing occurred by continuous NPWT for 1–2 weeks, and maximum healing at 46% after 2.5 weeks of NPWT were observed. Conclusions Better wound healing was achieved in the NPWT group in comparison to conventional dressings alone. However, suboptimal sternal wound healing by NPWT alone was observed. Removal of sternal wire may improve the effectiveness of NPWT. Successful tertiary closure after NPWT among subjects supports the important bridging role of NPWT in sternal wound healing. Factors causing stagnant sternal wound healing by NPWT alone are discussed.

Chronic wounds: the challenges of appropriate management

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S26-S32 ◽  
Author(s):  
Leanne Atkin
Keyword(s):  
Wound Healing ◽  
Health Services ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Management ◽  
Product Selection ◽  
Wound Assessment ◽  
Moisture Balance ◽  
Selection For ◽  
Chronic Wound Management

The immense burden imposed by chronic wounds—those persisting over 6 weeks despite active intervention—on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

Use of a bacterial fluorescence imaging device: wound measurement, bacterial detection and targeted debridement

2019 ◽  
Vol 28 (12) ◽  
pp. 824-834 ◽  
Author(s):  
Rose Raizman ◽  
Danielle Dunham ◽  
Liis Lindvere-Teene ◽  
Laura M Jones ◽  
Kim Tapang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Fluorescence Imaging ◽  
Wound Care ◽  
Standard Of Care ◽  
Imaging Device ◽  
Wound Assessment ◽  
Coefficients Of Variation ◽  
Heavy Loads ◽  
Evidenced Based ◽  
Wound Bed Preparation

Objective: Diagnostics which provide objective information to facilitate evidence-based treatment decisions could improve the chance of wound healing. Accurate wound measurements, objective bacterial assessment, and the regular, consistent tracking of these parameters are important aspects of wound care. This study aimed to assess the accuracy, clinical incorporation and documentation capabilities of a handheld bacterial fluorescence imaging device (MolecuLight i:X). Method: Benchtop wound models with known dimensions and clinical wound images were repeatedly measured by trained clinicians to quantify accuracy and intra/inter-user coefficients of variation (COV) of the imaging device measurement software. In a clinical trial of 50 wounds, wound dimensions were digitally measured and fluorescence images were acquired to assess for the presence of bacteria at moderate-to-heavy loads. Finally, fluorescence imaging was implemented into the routine assessment of 22 routine diabetic foot ulcers (DFU) to determine appropriate debridement level and location based on bacterial fluorescence signals. Results: Wound measurement accuracy was >95% (COV <3%). In the clinical trial of 50 wounds, 72% of study wounds demonstrated positive bacterial fluorescence signals. Levine sampling of wounds was found to under-report bacterial loads relative to fluorescence-guided curettage samples. Furthermore, fluorescence documentation of bacterial presence and location(s) resulted in more aggressive, fluorescence-targeted debridement in 17/20 DFUs after standard of care debridement failed to eliminate bacterial fluorescence in 100% of DFU debridements. Conclusion: The bacterial fluorescence imaging device can be readily implemented for objective, evidenced-based wound assessment and documentation at the bedside. Bedside localisation of regions with moderate-to-heavy bacterial loads facilitated improved sampling, debridement targeting and improved wound bed preparation.

scholarly journals Instillation-TIME (iTIME) as a rationale amendment for TIME conception. Is there enough evidence for the efficiency of negative pressure wound therapy with instillation (iNPWT) to announce a breakthrough idea for wound treatment?

2019 ◽  
Vol 6 (2) ◽  
pp. 7-8
Author(s):  
Adam Bobkiewicz ◽  
Adam Studniarek ◽  
Łukasz Krokowicz ◽  
Michał Drews ◽  
Tomasz Banasiewicz
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Care Management ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wound ◽  
Wound Care ◽  
Wound Treatment ◽  
Wound Therapy ◽  
Number Of Patients ◽  
Moisture Balance

An increased number of patients developing difficult-to-heal wounds results in billions spending for chronic wound care management. Introduction of TIME conception has been a breakthrough idea for wound healing based on phase-adapted wound therapy that interacts and influence each other and included: T – tissue management, I - infection control, M - moisture balance, E - edge of the wound. Negative pressure wound therapy (NPWT) revolutionized the management of wound healing. Moreover, recently NPWT with instillation (iNPWT) has gained the popularity of optimizing wound healing. In the context of acceleration of wound healing, iNPWT meets the criteria of the TIME conception. All individual components of TIME strategy are found in iNPWT providing “all in one” conception. Such management is easy to apply, monitor and it is well- tolerated by patients. Based on the current studies, iNPWT is found to be an important alternative for other methods of wound healing. It is believed that iNPWT will evolve and gain popularity as an innovative treatment for TIME conception.

The Evidence for Antimicrobial and Hard to Infect Regenerative Matrices

2021 ◽  
Author(s):  
Keval Ray ◽  
◽  
Nazanin Khajoueinejad ◽  
So Park ◽  
Mabel Chan ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Basic Science ◽  
Antimicrobial Agents ◽  
Chronic Wounds ◽  
Wound Care ◽  
Antimicrobial Properties ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Full Understanding ◽  
Wound Bed Preparation

Preparation of the wound bed is a key step in the use of cell- and tissue-based therapy (CTP). In particular, good pre-application debridement is an essential component of CTP. However, there are many situations in which the wound bed is not adequately debrided, including trauma, burn, and in cases of chronic wounds with significant biofilm. In the setting of inadequate wound bed preparation, the use of a CTP that has either added or intrinsic antimicrobial properties is attractive. Some CTPs include added antimicrobial agents such as PHMB or silver, while others have intrinsic antimicrobial components, such as Omega 3 fatty acids. In addition, some wound-covering dressings are completely synthetic, and therefore simply do not become infected. A full understanding of the basic science and clinical data supporting the use of these therapies is important for the advanced wound care practitioner.

TIMERS: undertaking wound assessment in the community

2019 ◽  
Vol 24 (Sup12) ◽  
pp. S22-S25
Author(s):  
Melanie Lumbers
Keyword(s):  
Chronic Wounds ◽  
Assessment Tool ◽  
Wound Care ◽  
Tissue Infection ◽  
Assessment Tools ◽  
Health Needs ◽  
Community Settings ◽  
Wound Edge ◽  
Wound Assessment

Community nurses regularly treat patients with chronic wounds (those persisting over 6 weeks); with the complexity of both the patients' health needs and the wound itself, this often becomes a highly time-consuming task for the nurse. Wound assessment tools are designed to support all qualified nurses, regardless of whether the nurse possesses specialist wound care knowledge or not, in delivering safe and appropriate wound care. The wound assessment tool, using the acronym TIME, has been recently amended to now be known as TIMERS (Tissue, Infection/Inflammation, Moisture, Wound edge, Repair/Regeneration, Social). This article will examine what the newly amended wound assessment tool TIMERS represents, in addition to looking at the practical issues around its implementation in community settings.

scholarly journals Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management

2020 ◽  
Vol 7 (1) ◽  
pp. 97
Author(s):  
Tashi G. Khonglah ◽  
Bhaskar Borgohain ◽  
Wanlamkupar Khongwir ◽  
Kashif A. Ahmed
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Wound Care ◽  
Size Difference ◽  
Magic Bullet ◽  
Care Hospital ◽  
Wound Therapy ◽  
Major Health Problem ◽  
Split Skin Grafting

<p><strong>Background:</strong> Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.</p><p><strong>Methods:</strong> This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).</p><p><strong>Results:</strong> The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).</p><p><strong>Conclusions:</strong> NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.</p>

scholarly journals Timer switch to convert suction apparatus for negative pressure wound therapy application

2014 ◽  
Vol 47 (03) ◽  
pp. 412-417
Author(s):  
Surath Amarnath ◽  
Mettu Rami Reddy ◽  
Chayam Hanumantha Rao ◽  
Harsha Vardan Surath
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Healing Rate ◽  
Chronic Wounds ◽  
Open Fractures ◽  
Wound Therapy ◽  
Electronic Timer ◽  
The Cost ◽  
Dressing Materials ◽  
Wound Healing Rate

ABSTRACT Background: Negative pressure wound therapy (NPWT) is an established modality in the treatment of chronic wounds, open fractures, and post-operative wound problems. This method has not been widely used due to the high cost of equipment and consumables. This study demonstrates an indigenously developed apparatus which gives comparable results at a fraction of the cost. Readily available materials are used for the air-tight dressing. Materials and Methods: Equipment consists of suction apparatus with adjustable pressure valve set to a pressure 125-150 mmHg. An electronic timer switch with a sequential working time of 5 min and a standby time of 3 min provides the required intermittent negative pressure. Readily available materials such as polyvinyl alcohol sponge, suction drains and steridrapes were used to provide an air tight wound cover. Results: A total of 90 cases underwent 262 NPWT applications from 2009 to 2014. This series, comprised of 30 open fractures, 21 post-operative and 39 chronic wounds. The wound healing rate in our study was comparable to other published studies using NPWT. Conclusion: The addition of electronic timer switch will convert a suction apparatus into NPWT machine, and the results are equally effective compared to more expensive counter parts. The use of indigenous dressing materials reduces the cost significantly.

scholarly journals APLIKASI PERAWATAN LUKA DENGAN MENGGUNAKAN ENZYMATIK THERAPY: ALOE VERA DALAM MANAJEMEN LUKA DIABETES

2018 ◽  
Vol 11 (2) ◽  
pp. 121-129
Author(s):  
Ferawati Ferawati
Keyword(s):  
Time Management ◽  
Assessment Tool ◽  
Wound Care ◽  
Aloe Vera ◽  
Wound Management ◽  
Enzymatic Reactions ◽  
Diabetic Wound ◽  
Wound Assessment ◽  
Diabetic Wounds ◽  
Evidence Based Nursing

Introduction:Diabetes mellitus is a metabolic disease group will facilitate the occurrence of diabetic foot wounds. To prevent the complications of diabetic wound that lasts longer and prevents the worse then takes care of wounds in diabetics. Latest wound care techniques are already using a bandage. The principle of modern wound treatment products is to maintain and keep the environment humid permanent cuts to facilitate the process of wound healing, maintaining the loss of fluid networks and cell death. Objective: this study aimed to find out how the application methods of wound care using the enzymatik therapy: aloe vera in diabetic wound management. Methods: the study was qualitative research with approach case studies, a number of participants 1 person: patients with diabetic wounds, treated for 9 days using the method of modern wound care therapy: enzymatic reactions with the use of aloe vera. Participants selected by the method of purposive sampling. Data collection using observation and interviews, data analysis using the method of explanation building. Results: the results of the research there are 4 themes, namely the study of the wound, the kind of wrap used, how to wound care, influence on the wound. The study of the wound using Bates-Jensen Wound Assessment Tool, a type of bandage used are enzymatic reactions therapy: aloe vera and ointments wound, how to wound care using approaches TIME management, and reduced effect on wound care the size of the cuts, epitelisasi, granulation wounds and the amount of fluid that appears. Conclusion: the method of Application wound care therapy: enzymatic reactions using aloe vera on wounds of diabetes affect the dwindling size of cuts, epitelisasi and granulation wound. Health care personnel are advised to use enzymatik therapy: aloe vera in the treatment of diabetic wounds as diabetic wound management integrated with attention to the principles of wound care using the latest evidence based nursing

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