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

Maintenance Debridement and Wound Bed Preparation

Traditionally, debridement has been undertaken as a single therapeutic step within defined time frames. This procedure is usually only repeated if necrotic tissue reappears, since it is assumed that healthy granulation tissue will form after complete debridement. Although this may be applicable for acute wounds, it is unlikely to remove the necrotic burden that continually accumulates in a chronic wound. In the case of nonhealing chronic wounds, it may be more appropriate to perform regular or even continuous debridement.

An important aspect of wound bed preparation is the recognition that chronic wounds have underlying pathogenic abnormalities that cause necrotic tissue to accumulate. Therefore, in order to facilitate wound progression, repeated removal of necrotic tissue will be necessary throughout the lifespan of the chronic wound. In this way an extended "maintenance" phase of debridement has been proposed.[33] This is more likely to be effective than a single intervention. Wound bed preparation advocates that clinicians should consider a steady state removal of the necrotic burden and that regular and efficient debridement is necessary to reduce necrotic burden and obtain healthy granulation tissue.[85]

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