Wound Bed Preparation with Prontosan^®

Introduction
 
Chronic wounds constitute a major problem for society, as they lead to social isolation
of the patient, prolonged inability to work and considerable effects on quality of life.
Within the framework of integrated wound care it is therefore important to build up a
specific wound management strategy in order to achieve rapid and uncomplicated
wound closure. Wound Bed Preparation with the TIME concept has already proved in
practice to be a useful strategy in the treatment of chronic wounds. In this, thorough
and gentle cleansing of the wound with a highly effective wound cleansing agent
(e.g. Prontosan) certainly plays a major role.
 
What is Wound Bed Preparation?
 
The Term “Wound Bed Preparation” was first described by Falanga et al in the 2000
and can be defined as the global wound management plan to accelerate endogenous
healing and to enhance the effectiveness of advanced wound care products. The
ultimate aim is to ensure formation of healthy granulation tissue resulting in complete
wound closure.
Wound Bed Preparation should not be seen as an isolated local therapy, as it treats the
patient holistically (e.g. recognition of factors that inhibit wound healing) and also
takes account of maintaining a high quality of life for the patient.
 
Wound Bed Preparation

• requires precise evaluation of the wound
• includes recognition of local and systemic risk factors that can inhibit wound
  healing
• means thorough wound cleansing, possibly also wound antisepsis, in order to
  reduce the bacterial burden
• includes the debridement (surgical, mechanical, enzymatic, autolytic, biosurgical)
  of avital tissue (necrotic tissue, fibrin coating)
• regulates the moisture balance of the wound (exudate management)
• restores the cellular and biochemical balance in the wound

Wound Bed Preparation and the TIME Concept
 
The TIME concept was first described by Schultz et al. in 2003 and is a systematic
approach in the treatment of chronic wounds so as to be able to identify clinical
aspects for optimum wound bed preparation.
 
The aim of the TIME concept is to create the most optimal wound bed possible, by
correcting the pathophysiological components listed below and minimising systemic risk
factors that can inhibit the healing process.
 
TIME
T = Tissue (tissue, avital or defective)
I = Infection or Inflammation
M = Moisture balance
E = Edge of wounds, non-advancing or undermined
 
The Role of Wound Cleansing in Wound Bed Preparation
 
One of the most important principles of proper wound bed preparation is certainly
wound cleansing, as only a clean wound can heal rapidly and without complications.
Avital tissue such as necrosis and fibrin coating, detritus and a high bacterial load can
considerably affect wound healing, resulting in stagnation of the wound healing
process.
It must be remembered that the treatment of a chronic wound can take several months,
and therefore highly effective, gentle and patient-friendly wound cleansing is of great
significance. Particular attention should therefore be given to the choice of wound
cleansing agent.
 
Important Criteria for a suitable Wound Cleansing Agent

• efficient removal of the “bacterial burden” or biofilm
• rapid and gentle elimination of the “bioburden”
• broad “therapeutic range”
• maintaining optimal wound moisture
• product can be warmed
• practical application
• increase in quality of life (elimination of wound pain and odour)
• no causing of pain when used
• compatible with common wound dressings

Prontosan and Wound Bed Preparation
 
Prontosan has already proved in practice to be a highly effective wound cleansing agent in wound bed preparation.

To find out more go to the Clinical Evidence and Case Study section.