Orchestrating wound healing: assessing and preparing the wound bed.

PURPOSE To provide an overview of the steps needed to prepare the wound bed for healing. TARGET AUDIENCE This continuing-education activity is intended for physicians and nurses with an interest in learning about the process for preparing the wound bed for healing. LEARNING OBJECTIVES After reading the article and taking the test, the participant will be able to: 1. Describe the anatomy and physiology of the skin. 2. Describe the wound healing process, the local and systemic factors that may impair healing, and the parameters that assess the wound status. 3. Describe the steps in the process to prepare the wound bed for healing.

[1]  D. Armstrong,et al.  Seasonal variations in lower extremity amputation. , 1997, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[2]  C. McCollum,et al.  Expression of cyclooxygenase isoforms in normal human skin and chronic venous ulcers , 2001, The Journal of pathology.

[3]  J. Raffetto,et al.  The proliferative capacity of neonatal skin fibroblasts is reduced after exposure to venous ulcer wound fluid: A potential mechanism for senescence in venous ulcers. , 1999, Journal of vascular surgery.

[4]  D. Keast,et al.  Preparing the wound bed--debridement, bacterial balance, and moisture balance. , 2000, Ostomy/wound management.

[5]  D. Muir,et al.  Ratios of activated matrix metalloproteinase‐9 to tissue inhibitor of matrix metalloproteinase‐1 in wound fluids are inversely correlated with healing of pressure ulcers , 2002, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[6]  D. Steed,et al.  Wound healing trajectories as predictors of effectiveness of therapeutic agents. , 2000, Archives of surgery.

[7]  H. Brem,et al.  Healing of Venous Ulcers of Long Duration with a Bilayered Living Skin Substitute: Results from a General Surgery and Dermatology Department , 2001, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[8]  Koji Kito,et al.  Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel monograph. , 2001, Advances in skin & wound care.

[9]  D. Margolis,et al.  Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group. , 1998, Archives of dermatology.

[10]  J. Menzoian,et al.  Fibroblasts cultured from venous ulcers display cellular characteristics of senescence. , 1998, Journal of vascular surgery.

[11]  A. Boulton,et al.  The diabetic foot: a global view , 2000, Diabetes/metabolism research and reviews.

[12]  K. Burnand,et al.  Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers , 2002, The British journal of surgery.

[13]  T. Gilman,et al.  A multicentre study of percentage change in venous leg ulcer area as a prognostic index of healing at 24 weeks , 2003, The British journal of dermatology.

[14]  R. Kirsner,et al.  MATRIX METALLOPROTEINASES IN NORMAL AND IMPAIRED WOUND HEALING: A POTENTIAL ROLE OF NANOCRYSTALLINE SILVER , 2001 .

[15]  Rachel Smith,et al.  Mechanism of action of PROMOGRAN, a protease modulating matrix, for the treatment of diabetic foot ulcers , 2002, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[16]  J. V. Vande Berg,et al.  Fibroblast senescence in pressure ulcers , 1998, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[17]  T. Osler,et al.  Senescence and the healing rates of venous ulcers. , 2001, Journal of vascular surgery.

[18]  D. M. Cooper,et al.  Definitions and guidelines for assessment of wounds and evaluation of healing , 1994, Archives of dermatology.

[19]  D. Armstrong,et al.  Maggot debridement therapy: a primer. , 2002, Journal of the American Podiatric Medical Association.

[20]  I. K. Cohen,et al.  MMP-8 is the predominant collagenase in healing wounds and nonhealing ulcers. , 1999, The Journal of surgical research.

[21]  R. Kirsner,et al.  Chronic venous insufficiency and venous leg ulceration. , 2001, Journal of the American Academy of Dermatology.

[22]  R. Visse,et al.  This Review Is Part of a Thematic Series on Matrix Metalloproteinases, Which Includes the following Articles: Matrix Metalloproteinase Inhibition after Myocardial Infarction: a New Approach to Prevent Heart Failure? Matrix Metalloproteinases in Vascular Remodeling and Atherogenesis: the Good, the Ba , 2022 .

[23]  R. Kirsner,et al.  Debridement: Rationale and therapeutic options , 2002 .

[24]  G. Mulder,et al.  Cellular senescence and matrix metalloproteinase activity in chronic wounds. Relevance to debridement and new technologies. , 2002, Journal of the American Podiatric Medical Association.

[25]  S. Pollack.  The wound healing process. , 1984, Clinics in dermatology.

[26]  M. Robson.  Wound Infection: A Failure of Wound Healing Caused by an Imbalance of Bacteria , 1997 .

[27]  I. K. Cohen,et al.  Modified cotton gauze dressings that selectively absorb neutrophil elastase activity in solution , 2001, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[28]  • Epidermis,et al.  WOUND healing. , 1959, The Medical journal of Australia.

[29]  E. Dabelsteen,et al.  Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic venous leg ulcers is ulcer-age dependent. , 1999, The Journal of investigative dermatology.

[30]  K. Beckrich,et al.  Hospital-acquired pressure ulcers: a comparison of costs in medical vs. surgical patients. , 1999, Nursing economic$.

[31]  P. Bowler.  The 10(5) bacterial growth guideline: reassessing its clinical relevance in wound healing. , 2003, Ostomy/wound management.

[32]  R. Kirsner,et al.  The biology of skin grafts. Skin grafts as pharmacologic agents. , 1993, Archives of dermatology.

[33]  M. Stacey,et al.  Mitogenic activity and cytokine levels in non‐healing and healing chronic leg ulcers , 2001, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[34]  N. Light,et al.  The role of oxidised regenerated cellulose/collagen in chronic wound repair and its potential mechanism of action. , 2002, The international journal of biochemistry & cell biology.

[35]  D. Margolis,et al.  Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis. , 1999, Diabetes care.

[36]  V. Falanga.  Classifications for wound bed preparation and stimulation of chronic wounds , 2000, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[37]  D. Yager,et al.  The proteolytic environment of chronic wounds , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[38]  V. Falanga,et al.  Prognostic indicators in venous ulcers. , 2000, Journal of the American Academy of Dermatology.