Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing

Stuart Enoch, MBBS, MRCSEd, MRCS (Eng), Keith Harding, MB ChB, MRCGP, FRCS

Disclosures

Wounds. 2003;15(7) 

In This Article

Abstract and Introduction

Abstract

Wound healing involves a well-orchestrated, complex process leading to repair of injured tissues. However, chronic wounds do not follow the normal pattern of repair. This is due to underlying physiological problems associated with their development, which unless corrected would continue to cause wound deterioration. The key to effective wound care lies in a combination of three approaches: treatment of underlying medical problems, assessment and treatment of local wound bed, and effective management of any patient-centered concerns. An essential component of this recommended approach is restoration of healthy granulation tissue in the wound bed. Wound bed preparation brings a number of existing procedures, including debridement, treatment of infection, and management of exudate levels, together into a systematic approach to help restore the chronic wound bed environment. The aim of wound bed preparation is to remove the barriers to healing and initiate the repair process. This review explores the scientific rationale behind this concept and examines how wound bed preparation offers healthcare professionals an improved paradigm for the treatment of chronic wounds. By implementing wound bed preparation, the formation of healthy granulation tissue will be optimized and the efficiency of biotechnological therapies improved, which would ultimately reduce the time to wound closure.

Introduction

Wound healing involves a complex series of events, which encompass chemotaxis, cell division, neovascularization, synthesis of new extracellular matrix (ECM) components, and the formation and remodeling of scar tissue. Soluble mediators, such as growth factors, cytokines, matrix metalloproteinases (MMPs), and their regulators, control many of the processes involved in wound healing via their effects on various cell types and the ECM.[1,2] In acute wounds, these processes, which are triggered by tissue injury, involve the four overlapping but well defined phases of hemostasis, inflammation, proliferation, and remodeling (Figure 1). Physiological events in a nonhealing wound, however, do not follow this traditional model of wound repair. The concept of wound bed preparation addresses this issue and provides a model that is appropriate for understanding and treating chronic wounds.

Figure 1.

This flow chart illustrates the normal process of wound healing.

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