Wound Bed Preparation Flashcards
TIME principles
Tissue Management
Inflammation/Infection Control
Moisture Balance
Epithelial (Edge) Advancement
Tissue management
Remove necrotic tissue - Autolytic - Enzymes - Biosurgical (maggots) - Mechanical (lavage, wet to dry) - Conservative sharp (0 bleeding) - Surgical Remove inferior tissue - Hypergranulation - Hypertrophic
Moisture balance
Provide moist wound therapy
Absorb excess drainage
Fill dead space
Epithelial (Edge) advancement
Keep edges open
Address epiboli & undermining
Remove callous
Factors that prolong inflammation
Local ischemia
Necrotic tissue
Heavy bacterial load
Not addressing cause of wound
Factors affecting immune competence
> age (declining Tcell function)
Co-existing disease
Medications (antimicrobials, immunosuppression)
Nutritional deficit
Breaks in body defense (wounds, indwelling cath)
Psychosocial
Biofilms
Present in 60% of chronic wounds
Not affected by antimicrobials
Removed via debridement
Not detected by cultures
Planktonic bacteria
Free floating bacteria
Occurs in contamination & colonization
Osteomyelitis
Suspected if bone exposed or wound over boney prominence
MRI needed for diagnosis
Contamination
All chronic wounds are contaminated w. non-replicating microorganisms
Colonization
Occurs w/i 3-4 weeks
No treatment needed
Does not impair wound healing
Critical colonization
Bio-burden
Antimicrobials needed
Indicators of critical colonization
> exudate
Friable tissue
pain
No improvement in healing
Critical colonization: NERDS
Non-healing wound Exudative wound Red & bleeding wound Debris or necrotic tissue Smell
3+ = critical colonization
Deep tissue infection: STONEES
Size is bigger Temp increase OS (probes to bone) New area of breakdown Erythema/edema Exudate Smell
3+ = systemic treatment needed, wound culture
Topicals cytotoxic to healthy cells
-Short-term use only Acetic acid Chlorhexidine Povidone-iodine Sodium hypochlorite Hydrogen peroxide
Importance of moist wound healing
Prevents desiccation
> cell migration
> angiogenesis
> autolysis
Category 1A skin tear
Linear
Full thickness
Category 1B skin tear
Flap type
Partial thickness
Replace flap & apply steri-strip
Category 2A skin tear
Scant tissue loss (75% dermis is covered
Category 2B skin tear
Moderate to large tissue loss
Loss of >25% epidermis
>25 of dermis exposed
Can’t be approximated
Category 3 skin tear
Partial-thickness wound
Epidemis is absent or non-viable
