Wound cleansing: a key player in the implementation of the TIME paradigm

Abstract

The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells.

Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds

“…Paying attention to each of the four core components of wound bed preparation is a practical guide to optimize healing of open, chronic wounds . These principles emphasize the importance of maintaining a healthy wound bed, with debridement of necrotic tissue including biofilm, wound cleansing, and antimicrobial therapy being key components of this goal …”

Original hardware-software method for treatment of infected superficial wounds in a liquid environment

“…Wound area was measured (Russian Federation patent № 2301626, 27.06.2007) immediately after wound formation (start point) and on 3, 5, 7, 11 and 14 days after the start of using the hardware-software treatment. This method of measuring wound surface area allows to perform evaluation without direct contact and with high accuracy and speed, because of the following steps: a) digital photography of the wound with juxtaposed standard "№1" (we used 10×10 mm piece of white paper), b) transfer of digital image to the computer, c) calculation of the wound area using the following formula: S wound = (N defect / N standard ) × S standard , S wound -wound area (skin defect) in mm 2 ; S standard -standard area in mm 2 ; N defect -the number of wound pixels on the digital image; N standard -number of pixels covering the standard on digital image.…”

“…To this moment many different methods for treatment of infected wounds have been developed and tested (Patent № WO2005105175, 26.04.2005), but development and modernization of techniques for surgical management of inflammatory conditions in order to improve its efficacy is still relevant [1][2][3][4][5][6]. Existing approaches to surgical treatment often involve placement of various opaque materials directly onto the wound [7][8][9][10], which limits the dynamic control of wound healing during the treatment [11] and increases the risk of delayed diagnosis that may lead to an increased rate of disabling complications of the wound healing process [12][13][14].…”

Wound bed preparation: A novel approach using HydroTherapy

“…Therefore, removal of devitalised tissue using a debridement technique is imperative in the first steps to healing wounds and is the basis of a number of specific guidelines developed to aid the clinician to do this (Pilcher, 2016). This guidance includes the TIME management process (see Table 1), which is the acronym given to Tissue management involving wound bed preparation; Control of Infection and Inflammation; Moisture imbalance; Advancement of the epithelial Edge of the wound as shown in Table 1 (Dowsett, 2008).…”

“…As previously discussed, when using the TIME framework for tissue management an essential element is to remove devitalised tissue using various methods of debridement (Pilcher, 2016). HydroTherapy aims to assist later steps in the process that involve restoration of bacterial balance (including reduction of bacterial biofilms), which relates to Infection and inflammation of this framework and through achieving a moist wound healing environment healing will be enabled.…”