Wound bed preparation Resources

In the treatment of chronic, hard-to-heal wounds, managing destructive chronic wound exudate, removing devitalised tissue and addressing wound biofilm/infection are high priorities (Atkin et al, 2019). To optimise the rate and likelihood of a chronic wound healing, it is important to identify its cause and any factors that may impede the healing process (Wounds UK, 2018). This can only be achieved by undertaking holistic wound assessment followed by effective wound management — having a logical set of actions, or pathways to follow, aids this (Atkin et al, 2019; Box 1). When managing lower limb ulcers, accurate diagnosis is crucial so that they can be categorised as venous, arterial or mixed aetiology. The case study presented here highlights the care pathway of a mixed aetiology leg ulcer, including wound bed preparation.

The ability to recognise the need for debridement is a vital skill for general practice nurses (GPNs), since it is an important part of preparing the wound for healing. Debridement removes dead tissue within the wound that can otherwise provide a physical barrier to healing, while also providing an ideal environment for micro-organisms, increasing the risk of infection. In order for healing to progress, it is important to debride the wound promptly. Failure to do so can result in wound chronicity and an associated impact on resources and patient quality of life. While there are different methods of debridement available, this article focuses on autolytic and mechanical, explaining how they work and their benefits and limitations.

Wound assessment is a vital skill for general practice nurses (GPNs); however, time pressures can sometimes impede the effective assessment of wounds in primary care. This article aims to provide GPNs with a rapid wound assessment approach that is evidence-based and person-centred. The author details the main points of wound assessment and outlines a holistic approach that considers biological, psychological and social factors, with the aim of improving GPNs’ assessment skills. An approach to wound assessment known as TIMES (tissue, infection, moisture, edge and surrounding skin) will be discussed. This will enable GPNs to understand the key factors that influence wound healing. The investigations used to identify any underlying disease processes that may affect wound healing are also considered. The author aims to assist GPNs to improve their wound assessment skills, which will, in turn, help them to exercise their best clinical judgement at all times.

Debridement is a key component of wound bed preparation, which should not be seen as a one-off procedure, but rather as something to be done on a regular basis and included in the patient care pathway. It plays a vital part in removing dead and contaminated tissue, which harbour bacteria posing a barrier to timely healing. Debridement can also remove the presence of biofilm. Wound cleansing is also an integral part of wound care practice. However, there is little evidence about the best method, frequency, or solution to use, which causes wound cleansing often to be seen as a controversial procedure. With developments in the wound care product market and smarter dressings and wound care therapies becoming available, little attention has been given to the use of cleansing solutions. Wound cleansing is technically defined as the use of fluids to remove loosely adherent debris and necrotic tissue from the wound bed to create an optimal wound healing environment.