Correction of Hypoxia, a Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation

Abstract

Wound bed preparation is an organized approach to create an optimal environment for wound healing by the use of the most cost-effective therapeutic options. It has become an essential part of wound management and seeks to use the latest findings from molecular and cellular research to maximize the benefits of today's advanced wound care products. The international advisory panel on wound bed preparation met in 2002 to develop a systemic approach to wound management. These principles of this approach are referred to by the mnemonic TIME, which stands for the management of nonviable or deficient tissue (T), infection or inflammation (I), prolonged moisture imbalance (M), and nonadvancing or undermined epidermal edge (E). One critical element of pathophysiology, understanding of the hypoxic nature of the wound and correction of hypoxia as a critical element of wound bed preparation, is not covered. This article proposes to add correction of hypoxia to the TIME principle (TIMEO 2 principle) based on the evidence. The evidence that will support the reason and the need for modification of the wound bed preparation protocol is discussed.

Antioxidant Response of Chronic Wounds to Hyperbaric Oxygen Therapy

“…In this way, diverse processes essential for normal wound healing such as fibroblast proliferation, angiogenesis, collagen deposition or resistance to infection are oxygen-dependent [ 5 ]. The increase of oxygen levels in the hypoxic wound is essential for the cells involved in the healing process (neutrophils, fibroblasts, macrophages) to carry out their specific repair functions [ 6 ]. Linked to this observation, HBOT has been evidenced to diminish the number of major lower limb amputations among diabetic people [ 7 , 8 ].…”

Amputation stump perfusion is predictive of post-operative necrotic eschar formation

“…Less arterial inflow and oxygenation of the healing stump can potentiate hypoxia at the surgical site, increase free-radical formation, and lead to tissue damage and eschar formation. 32,33 Early detection of relative stump mal-perfusion in at risk diabetic patients can help inform the post-operative surveillance time-line and anticipated wound care needs.…”

A Prospective Case Control Study on the Effectiveness of Fogarty Catheter Thrombectomy in Ischemic Limbs Undergoing Above Knee Amputation

“…Less arterial inflow and oxygenation of the healing stump can potentiate hypoxia at the surgical site, increase free-radical formation, and lead to tissue damage and eschar formation. 9,10,11 Early detection of relative stump malperfusion in at risk diabetic patients can help inform the post-operative surveillance time-line and anticipated wound care needs.…”