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

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


Wounds. 2003;15(7) 

In This Article


Wound bed preparation is already changing the way clinicians view the management of chronic wounds. If healthcare professionals and patients are to benefit from optimal use of wound treatments, a greater understanding of the basis of good wound bed preparation is essential.

The therapeutic rationale for the treatment of chronic wounds has for many years been based on the acute wound model. However, the acute model of wound healing, which proceeds through the well-defined steps of inflammation, proliferation, and remodeling, is not completely representative of the chronic nonhealing wound. Wound bed preparation is a practical and evidence-based approach to the management of chronic wounds, since it reassesses the science behind the barriers to healing. By defining what it is that prevents chronic wounds from progressing to wound closure, wound bed preparation provides a clinical strategy that will ultimately lead to the removal of all local barriers to the healing process, so that wound repair can progress normally. Furthermore, since wound bed preparation addresses issues, such as cellular dysfunction and biochemical imbalance, a more integrated approach to wound care can be achieved (Figure 2).

Figure 2.

This is a representation of the differences in the microenvironment of the wound bed in healing and nonhealing wounds and the concept of wound bed preparation.

The concept of wound bed preparation provides the means by which chronic wounds can be considered in a new and appropriate manner and allows the clinician to identify and address the barriers to wound healing. Furthermore, wound bed preparation is the basis upon which more effective strategies can be developed to address the reasons why chronic wounds do not heal.