Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
TIMES MODEL
of wound bed preparation
Wounds UK
THE TIMES TABLE: REMOVING THE BARRIERS TO WOUND HEALING
Tissue, non-viable Infection, inflammation Moisture Edge of wound: non- Surrounding skin
or deficient or biofilm imbalance advancing, undermining
NPUAP
The overall appearance of the wound Wounds contain bacteria, which may Exudate is a normal part of wound Lack of new, healthy tissue at the The wound management strategy may
bed indicates the ‘health’ of the tissue proliferate and cause infection — healing, and drying out can impede the wound edges, or the presence of rolled effect the surrounding skin —
within the wound bed. delaying healing, and increasing pain, healing process. edges, indicate wound healing is not the condition of which can, in turn, affect
exudate and malodour. progressing normally. the wound healing process.
Devitalised tissue provides an ideal High levels of moisture (often
environment for microbial growth and, Even where infection is not apparent, containing harmful proteases) can Key actions: Key actions:Figure 1: before
in most cases, should be removed to healing may also be impeded by the break down new wound tissue and » Mechanically debride (e.g. » Address the causes of skin issues
expedite healing. presence of biofilm. macerate periwound skin. Debrisoft) encrusted exudate » Manage hyperkeratosis/dry skin/
at wound edges to remove local eczema/oedema/skin damage
Key actions: Key actions: Key actions: barriers to healing » Mechanically debride hyperkeratosis
» Mechanical debridement (e.g. » Mechanically disrupt biofilm (e.g. » Dry wound: Mechanically debride » Assess why the edge is not (e.g. using Debrisoft)3
Debrisoft®) is recommended1 by using Debrisoft) to break it up to remove loose dry skin; then progressing — consider biofilm » Protect the skin from further
» Use a moisture-donating dressing and allow antimicrobials to work hydrate with a moisture-donating management (see I) or referral for damage in line with best practice
(e.g. ActiFormCool®) to soften » After disruption, use an dressing (e.g. ActiFormCool) biopsy and local formulary guidelines
remaining devitalised tissue (if antimicrobial dressing » High exudate levels: Mechanically » Protect delicate edge tissue » Encourage self-care
needed) between dressing changes (e.g. Suprasorb® X+PHMB) debride to reduce the body’s (e.g. dressing with Lomatuell® Pro)
for 2 weeks, then review automatic response to produce
moisture; then select an absorbent
dressing that retains exudate
effectively (e.g. Flivasorb®)
Mechanical debridement using Debrisoft was highlighted as rapid, safe, easy-to-use and virtually pain-free2
ASSESS, DRESS, COMPRESS
T I M E S
reported reported no reported reported
reported
reduction local signs of reduction in improved improvement
in slough infection excess granulation when address-
exudate tissue quality ing a skin
condition