Wound Bed Preparation

Question 1

TIME principles

Answer 1

Tissue Management
Inflammation/Infection Control
Moisture Balance
Epithelial (Edge) Advancement

Question 2

Tissue management

Answer 2

Remove necrotic tissue
- Autolytic 
- Enzymes
- Biosurgical (maggots)
- Mechanical (lavage, wet to dry)
- Conservative sharp (0 bleeding)
- Surgical
Remove inferior tissue
- Hypergranulation
- Hypertrophic

Question 3

Moisture balance

Answer 3

Provide moist wound therapy
Absorb excess drainage
Fill dead space

Question 4

Epithelial (Edge) advancement

Answer 4

Keep edges open
Address epiboli & undermining
Remove callous

Question 5

Factors that prolong inflammation

Answer 5

Local ischemia
Necrotic tissue
Heavy bacterial load
Not addressing cause of wound

Question 6

Factors affecting immune competence

Answer 6

> age (declining Tcell function)
Co-existing disease
Medications (antimicrobials, immunosuppression)
Nutritional deficit
Breaks in body defense (wounds, indwelling cath)
Psychosocial

Question 7

Biofilms

Answer 7

Present in 60% of chronic wounds
Not affected by antimicrobials
Removed via debridement
Not detected by cultures

Question 8

Planktonic bacteria

Answer 8

Free floating bacteria

Occurs in contamination & colonization

Question 9

Osteomyelitis

Answer 9

Suspected if bone exposed or wound over boney prominence

MRI needed for diagnosis

Question 10

Contamination

Answer 10

All chronic wounds are contaminated w. non-replicating microorganisms

Question 11

Colonization

Answer 11

Occurs w/i 3-4 weeks
No treatment needed
Does not impair wound healing

Question 12

Critical colonization

Answer 12

Bio-burden

Antimicrobials needed

Question 13

Indicators of critical colonization

Answer 13

> exudate
Friable tissue
pain
No improvement in healing

Question 14

Critical colonization: NERDS

Answer 14

Non-healing wound
Exudative wound
Red & bleeding wound
Debris or necrotic tissue
Smell

3+ = critical colonization

Question 15

Deep tissue infection: STONEES

Answer 15

Size is bigger
Temp increase
OS (probes to bone)
New area of breakdown
Erythema/edema
Exudate
Smell

3+ = systemic treatment needed, wound culture

Question 16

Topicals cytotoxic to healthy cells

Answer 16

-Short-term use only
Acetic acid
Chlorhexidine
Povidone-iodine
Sodium hypochlorite
Hydrogen peroxide

Question 17

Importance of moist wound healing

Answer 17

Prevents desiccation
> cell migration
> angiogenesis
> autolysis

Question 18

Category 1A skin tear

Answer 18

Linear

Full thickness

Question 19

Category 1B skin tear

Answer 19

Flap type
Partial thickness
Replace flap & apply steri-strip

Question 20

Category 2A skin tear

Answer 20

Scant tissue loss (75% dermis is covered

Question 21

Category 2B skin tear

Answer 21

Moderate to large tissue loss
Loss of >25% epidermis
>25 of dermis exposed
Can’t be approximated

Question 22

Category 3 skin tear

Answer 22

Partial-thickness wound

Epidemis is absent or non-viable