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

Wound bed preparation extends the existing practice of using a holistic approach to evaluate and remove all barriers to healing, so that wound repair can progress normally. The overall goal of management is to achieve a stable wound that has healthy granulation tissue and one that is characterized by a well-vascularized wound bed. This would involve the removal of factors that delay healing.

Therefore, the way in which chronic wounds are viewed and managed should be based on a model that is both different from the acute wound paradigm and representative of the complex nature of nonhealing ulcers.[35] By generating such a model, the scientific understanding and clinical management of nonhealing wounds could be optimized. Because it is based on the clinical knowledge and physiology of nonhealing ulcers, wound bed preparation provides a model that is effective for the evaluation and treatment of chronic wounds.

Understanding and removing the barriers to healing will help to produce a wound bed with healthy granulation tissue that is ready for the next stage of repair.[32,36] The main barriers to healing in a chronic wound are necrotic tissue, bacterial imbalance, and altered exudate levels and composition. Wound bed preparation aims to remove these barriers to healing, and this is characterized by on-going debridement, reduction of bacterial burden, and effective exudate management. Since normal cellular and biochemical processes are disrupted in chronic wounds, a greater understanding of the wound microenvironment is essential in achieving a wound bed ready for the next stage of repair. The cellular and biochemical differences that occur in chronic wounds have been termed cellular dysfunction and biochemical imbalance, respectively, and constitute further barriers to healing.

This review aims to discuss each of the components of wound bed preparation with regard to science and practice and to explain how they can have a beneficial effect in the context of wound management. In addition, the various therapeutic options available at present to treat chronic wounds and the future treatment strategies are also tabulated in Table 2 .