Wound Bed Preparation

PURPOSE: To enhance the learner's knowledge and competence in wound bed preparation. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: Assess wounds to classify them and determine prognosis. Apply evolving evidence regarding effective wound bed preparation and recommend patient-specific therapy. This article builds and expands upon the concept of wound bed preparation introduced by Sibbald et al 2000 as a holistic approach to wound diagnosis and treatment of the cause and patient-centered concerns such as pain management, optimizing the components of local wound care: Debridement, Infection and persistent Inflammation, along with Moisture balance before Edge effect for healable but stalled chronic wounds.

[1]  B H Perry,et al.  Efficacy and safety of becaplermin (recombinant human platelet‐derived growth factor‐BB) in patients with nonhealing, lower extremity diabetic ulcers: a combined analysis of four randomized studies , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[2]  R. Griffiths,et al.  Water for wound cleansing. , 2008, Cochrane Database of Systematic Reviews.

[3]  M. Samitz Cutaneous disorders of the lower extremities , 1981 .

[4]  H. Vermeulen,et al.  Topical silver for treating infected wounds. , 2007, The Cochrane database of systematic reviews.

[5]  J. Kincey,et al.  Psychological status of diabetic people with or without lower limb disability. , 1996, Diabetes research and clinical practice.

[6]  P. Kranke,et al.  Systematic review of hyperbaric oxygen in the management of chronic wounds , 2005, The British journal of surgery.

[7]  M. Hanlon Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses , 2001 .

[8]  K. Woo,et al.  A cross-sectional validation study of using NERDS and STONEES to assess bacterial burden. , 2009, Ostomy/wound management.

[9]  D. Langemo,et al.  Skin Fails Too: Acute, Chronic, and End-Stage Skin Failure , 2006, Advances in skin & wound care.

[10]  E. Ayello,et al.  Increased Bacterial Burden and Infection: The Story of NERDS and STONES , 2006, Advances in skin & wound care.

[11]  S. Satya‐Murti Evidence-based Medicine: How to Practice and Teach EBM , 1997 .

[12]  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.

[13]  R. Salcido,et al.  Smoking-the Bane of Wound Healing: Biomedical Interventions and Social Influences , 2008, Advances in skin & wound care.

[14]  J Larsson,et al.  Long-Term Costs for Foot Ulcers in Diabetic Patients in a Multidisciplinary Setting , 1995, Foot & ankle international.

[15]  G. Sibbald,et al.  Assessment and management of persistent (chronic) and total wound pain , 2008, International wound journal.

[16]  L. Téot,et al.  The healing properties of Promogran in venous leg ulcers. , 2002, Journal of wound care.

[17]  A. Beaudet,et al.  Central Role of Fibroblast α3 Nicotinic Acetylcholine Receptor in Mediating Cutaneous Effects of Nicotine , 2003, Laboratory Investigation.

[18]  M. Brennan,et al.  Kennedy Terminal Ulcers: A Palliative Care Unit's Experience over a 12 Month Period , 2009 .

[19]  D. Miller,et al.  Health-related quality of life , 2002, Multiple sclerosis.

[20]  A. Lippman Adherence to medication. , 2005, The New England journal of medicine.

[21]  Pamela M. Sabine,et al.  A Practical Manual of Diabetic Foot Care, second edition, M.E. Edmonds, A.V.M. Foster, L.J. Sanders (2008). Elsevier. Price: £75.00, ISBN: 978-1-4051-6147-3 , 2009 .

[22]  H. Mayrovitz Compression-induced pulsatile blood flow changes in human legs. , 1998, Clinical physiology.

[23]  I. Bristow Non‐ulcerative skin pathologies of the diabetic foot , 2008, Diabetes/metabolism research and reviews.

[24]  D. Armstrong,et al.  Pain in diabetic foot ulcers. , 2003, Ostomy/wound management.

[25]  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.

[26]  G. Sibbald,et al.  Best Practice Recommendations for Preparing the Wound Bed: Update 2006 , 2007, Advances in skin & wound care.

[27]  E. Stolk,et al.  Diabetic foot ulcers and amputations: estimates of health utility for use in cost-effectiveness analyses of new treatments. , 2004, Diabetes & metabolism.

[28]  黄亚明 eMedicine , 2009 .

[29]  J P Doweiko,et al.  Role of albumin in human physiology and pathophysiology. , 1991, JPEN. Journal of parenteral and enteral nutrition.

[30]  D. Basketter,et al.  Patch tests versus use tests in skin irritation risk assessment , 1998, Contact dermatitis.

[31]  J. Lacy Albumin overview: use as a nutritional marker and as a therapeutic intervention. , 1991, Critical care nurse.

[32]  M. Hayter,et al.  The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysis. , 2009, Journal of clinical nursing.

[33]  Lynn Stockley,et al.  Specific , 1988 .

[34]  J. Varni,et al.  Health-Related Quality of Life , 2007 .

[35]  S. O’Meara,et al.  Antibiotics and antiseptics for venous leg ulcers. , 2010, The Cochrane database of systematic reviews.

[36]  W. Marston,et al.  The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. , 2003, Diabetes care.

[37]  K. Tobias OXYGEN AND WOUND HEALING , 2012 .

[38]  N. Stotts,et al.  Co-factors in impaired wound healing. , 1996, Ostomy/wound management.

[39]  A. Boulton,et al.  Evidence-Based Protocol for Diabetic Foot Ulcers , 2006, Plastic and reconstructive surgery.

[40]  J. Schols,et al.  Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. , 2010, Nutrition.

[41]  M. Sabolinski,et al.  A bilayered living skin construct (APLIGRAF®) accelerates complete closure of hard‐to‐heal venous ulcers , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[42]  Marcia E. Spear Wound cleansing: solutions and techniques. , 2011 .

[43]  B. Doebbeling,et al.  The validity of the clinical signs and symptoms used to identify localized chronic wound infection , 2001, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[44]  D. Sackett Evidence-based medicine: how to practice and teach EBM: 2nd ed , 2000 .

[45]  P. Silverstein Smoking and wound healing. , 1992, The American journal of medicine.

[46]  D. Armstrong,et al.  Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial , 2005, The Lancet.

[47]  B. Bates-Jensen,et al.  Wound care: a collaborative practice manual for physical therapists and nurses Carrie Sussman Barbara Bates-Jensen Aspen £58 256pp 0-8342-0748-6 0834207486. , 1999, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[48]  R. Sibbald,et al.  The diabetic neuropathic ulcer: an overview. , 1999, Ostomy/wound management.

[49]  D. Margolis,et al.  The accuracy of venous leg ulcer prognostic models in a wound care system , 2004, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[50]  J. Ninikoski Oxygen and wound healing. , 1977, Clinics in plastic surgery.

[51]  G. Caughman,et al.  Nicotine modulation of in vitro human gingival fibroblast beta1 integrin expression. , 2002, Journal of periodontology.

[52]  Wolf-Dieter Schmidt,et al.  Some Effects of a Topical Collagen-Based Matrix on the Microcirculation and Wound Healing in Patients With Chronic Venous Leg Ulcers: Preliminary Observations , 2005, The international journal of lower extremity wounds.

[53]  D. Krasner,et al.  Chronic Wound Care: A Clinical Source Book for Healthcare Professionals , 1990 .

[54]  Vincent Falanga,et al.  Wound healing and its impairment in the diabetic foot , 2005, The Lancet.

[55]  P. Cauwenberge,et al.  The microbiology of acute and chronic sinusits and otitis media: a review , 2006, European Archives of Oto-Rhino-Laryngology.

[56]  Christopher E. Attinger,et al.  Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization , 2006, Plastic and reconstructive surgery.

[57]  K. Woo,et al.  Reduction of Bacterial Burden and Pain in Chronic Wounds Using a New Polyhexamethylene Biguanide Antimicrobial Foam Dressing-Clinical Trial Results , 2011, Advances in skin & wound care.

[58]  P. Bowler,et al.  Clinical experience with wound biofilm and management: a case series. , 2009, Ostomy/wound management.

[59]  R. Rayner,et al.  Effects of Cigarette Smoking on Cutaneous Wound Healing , 2006 .

[60]  D. Keast,et al.  MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment. , 2004, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[61]  G. Xakellis,et al.  Cost and Cost Effectiveness of Venous and Pressure Ulcer Protocols of Care , 2001 .

[62]  N. Cullum,et al.  Therapeutic ultrasound for pressure ulcers. , 2006, The Cochrane database of systematic reviews.

[63]  J. Hanft,et al.  Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast-derived dermis. , 2002, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[64]  S. Enoch,et al.  Cellular, molecular and biochemical differences in the pathophysiology of healing between acute wounds, chronic wounds and wounds in the aged , 2004 .

[65]  R. Frykberg,et al.  Randomized Clinical Trial Comparing OASIS Wound Matrix to Regranex Gel for Diabetic Ulcers , 2005, Advances in skin & wound care.

[66]  J. Doweiko,et al.  Reviews: Role of Albumin in Human Physiology and Pathophysiology , 1991 .

[67]  G. Mosti,et al.  Compression therapy in the treatment of leg ulcers , 2009 .

[68]  P. Friden,et al.  Antimicrobial activity of silver nitrate against periodontal pathogens. , 2001, Journal of periodontal research.

[69]  E. Nothnagel,et al.  Effects of "second-hand" smoke on structure and function of fibroblasts, cells that are critical for tissue repair and remodeling , 2004, BMC Cell Biology.

[70]  Sibbald Rg,et al.  The diabetic neuropathic ulcer: an overview. , 1999 .

[71]  Richard Donnelly,et al.  ABC OF ARTERIAL AND VENOUS DISEASE , 2000 .

[72]  G. Schultz,et al.  Preparing the wound bed 2003: focus on infection and inflammation. , 2003, Ostomy/wound management.

[73]  N. Cullum,et al.  Therapeutic ultrasound for venous leg ulcers. , 2010, The Cochrane database of systematic reviews.

[74]  J. M. Arévalo,et al.  Skin coverage with Biobrane biomaterial for the treatment of patients with toxic epidermal necrolysis. , 1999, The Journal of burn care & rehabilitation.

[75]  E. Tredget,et al.  Anti-inflammatory activity of nanocrystalline silver in a porcine contact dermatitis model. , 2008, Nanomedicine : nanotechnology, biology, and medicine.

[76]  T. Dinh,et al.  The Efficacy of Apligraf in the Treatment of Diabetic Foot Ulcers , 2006, Plastic and reconstructive surgery.

[77]  R. Demling,et al.  The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver. , 2002, Burns : journal of the International Society for Burn Injuries.

[78]  T. Wild,et al.  Basics in nutrition and wound healing. , 2010, Nutrition.

[79]  M. Akai,et al.  Electrical stimulation as an adjunct to spinal fusion: A meta‐analysis of controlled clinical trials , 2002, Bioelectromagnetics.

[80]  G. Leese,et al.  Blood flow changes in diabetic foot ulcers treated with dermal replacement therapy. , 2002, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[81]  C. Harris,et al.  Malnutrition in the institutionalized elderly: the effects on wound healing. , 2004, Ostomy/wound management.

[82]  A. Rodgers,et al.  Randomized clinical trial of honey‐impregnated dressings for venous leg ulcers , 2007, The British journal of surgery.

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

[84]  G. Rodeheaver,et al.  Wound Cleansing, Wound Irrigation, Wound Disinfection , 2010 .

[85]  Richard Donnelly,et al.  Ulcerated lower limb , 2000, BMJ : British Medical Journal.

[86]  W. Marston Risk factors associated with healing chronic diabetic foot ulcers: the importance of hyperglycemia. , 2006, Ostomy/wound management.

[87]  K L Kennedy,et al.  The prevalence of pressure ulcers in an intermediate care facility. , 1989, Decubitus.

[88]  D. Steed Clinical Evaluation of Recombinant Human Platelet-Derived Growth Factor for the Treatment of Lower Extremity Ulcers , 2006, Plastic and reconstructive surgery.

[89]  Anke Persoon,et al.  Leg ulcers: a review of their impact on daily life. , 2004, Journal of clinical nursing.

[90]  D. Bild,et al.  Reduction of Lower Extremity Clinical Abnormalities in Patients with Non-Insulin-Dependent Diabetes Mellitus , 1993, Annals of Internal Medicine.

[91]  J. Giurini,et al.  Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. , 2003, Plastic and reconstructive surgery.

[92]  K. Harding,et al.  Wound chronicity and fibroblast senescence – implications for treatment , 2005, International wound journal.

[93]  David G Armstrong,et al.  Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. , 2001, Diabetes care.

[94]  A. Nicolaides,et al.  Effect of Intermittent Pneumatic Compression of Foot and Calf on Walking Distance, Hemodynamics, and Quality of Life in Patients With Arterial Claudication: A Prospective Randomized Controlled Study With 1-Year Follow-up , 2005, Annals of surgery.

[95]  B. Stanton,et al.  A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. , 1994, Journal of the American Academy of Dermatology.

[96]  T F Blaschke,et al.  Nicotine impairs endothelium‐dependent dilatation in human veins in vivo , 2000, Clinical pharmacology and therapeutics.

[97]  A. Heslop Establishing therapeutic relationships. , 1985, Nursing mirror.

[98]  C. Attinger,et al.  Serial surgical debridement: A retrospective study on clinical outcomes in chronic lower extremity wounds , 2009, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[99]  G. Schultz,et al.  Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors , 1999, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[100]  Julie W. Anderson,et al.  The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes , 2009, Advances in skin & wound care.

[101]  Marco Romanelli,et al.  Wound bed preparation: a systematic approach to wound management , 2003, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[102]  U. Persson,et al.  Diabetic foot ulcers in a multidisciplinary setting An economic analysis of primary healing and healing with amputation , 1994, Journal of internal medicine.