Wound bed preparation always extend from the existing use of hoslistic approach to evaluation and the removal of all barriers that will prevent proper wound healing. There are four components of wound bed preparation that form a framework for a comprehensive wound healing approach. This is based on international WBP(World Business partners)advisory Board.TIME which stands:
T =Tissue management- removal of necrotic burden in a chronic wound. Necrotic burden will include:
A. Nonvascularized tissues.
I= Inflammation and infection control.Wound that did not heal has a high rate of bacterial burden.Bioburden is the number of microorganism on a contaminated object. The connection between a high bacterial burden in the wound bed and the failure of chronic wound to close .Decreasing this bacterial burden is a vital elements of wound bed preparation.
M= Moisture balance- Keeping the wound bed moist accelerates re-epithelization.Chronic wound exudate interfere with repair process.
E= Epithelial Edge Advancement effective healing requires the re- establishment of an intact Epithelial and restoration of skin function.
Debridement. It is the removal of dead devitalized contaminated or foreign materials from the wound.
Categories of debridement are Selective and nonsective.
Selective is the removal of only the nonviable tissues.
Nonselective is the removal of viable and nonviable tissues.
SELECTIVE DEBRIDEMENT ARE:
1. Enzymatic debridement which is application of collagenase ointment. Selective not harmful to healthy tissue, fast healing.
2.Biosurgical/ Biological debridement. Use of medicinal maggots to remove nonviable tissues. Also known as ( MDT) Maggots debridement therapy. Maggots will be left in the wound for 1 to 3 days.
3.Myiasis treatment:The larvae will be surgically removed by a medical professional.
4.Tetanus immunization is very important. Tetanus= Chronic wound and skin lesions.Patient must be updated for Tetanus immunization and primary immunization. Read about the importance of tetanus. Check out CDC on immunization.