Wound bed preparation
The 2000 proposals[3][4][5] recommended that wound management address the identifiable impediments to healing in order to achieve more successful outcomes.
Three publications appeared that year that focused on the concept of managing the healing processes of a wound exudate, bioburden and devitalized tissue.
The WBP model can be effectively applied only when a high level of precision is utilized in the assessment of the patient and their wound.
The corollary of this is that intervention demands an equally high level of precision and this should be preceded by a comprehensive wound assessment.
The purpose of wound assessment is: To identify: To determine: To gather data: Unfortunately, universal agreement as regards the precise mechanisms of how this should be accomplished is yet to be agreed.
As serum based fluid moves out of the vessels into the interstitial spaces the resultant soft tissue oedema manifests on the wound surface as exudate.
[10] The application of dressings, topical negative pressure, compression garments and leg elevation/exercise have been identified as methods for management of wound exudate.
Biofilm phenotype bacteria are microbial communities that are attached to a surface and are embedded in an extracellular polymeric substance (EPS) consisting of proteins, glycoproteins, nucleic acids (RNA, DNA) and polysaccharides (slime).
In contrast, planktonic phenotype bacteria are free-floating in nature and do not possess the defence structures afforded by the creation of the EPS slime.
Methods of effectively managing wound biofilms have been reported and include the use of topical agents, systemic antibiotics and regular episodes of debridement.
[16][18] Despite these advances it has been recognised that indiscriminate and widespread use of antibiotics both inside and outside of medicine is playing a substantial role in the emergence of bacterial resistance.
[19] On a more positive note, antiseptics have been reported to possess a clear cut role in the control of wound bioburden where there are indications or risk of infection.
It consists of the removal of foreign matter, dead (devitalized) tissue and other physical impedimenta to healing, such as ragged edges.
[21] Despite the move in the 21st century toward evidence-based practice, the only general consensus that exists here is that cleansing and excision reduce infection rates.
[27] Despite the plethora of work focussing on the value of water/saline in wound cleansing there is no current consensus as to whether water has an active role to play in the promotion of healing.
With this unclear position in mind, alternative cleansing agents such as antiseptics that possess the potential to improve clinical outcomes should be considered.
In general, recommendations for practice are based on consensus opinion often derived from clinical experience and in vitro and/or in vivo studies.
In a double-blind, randomised, stratified, controlled, parallel-group study[33] the influence of two antiseptics (octenidine, polyhexanide) versus a placebo of Ringer's solution on wound healing in a porcine model was conducted.
Surfactants lower the surface tension of the fluid medium making it easier to infiltrate wound coatings, debris and bacteria.
