Clinical Approach to Chronic Wound Management in Older Adults

Wahila Alam MD; Jonathan Hasson MD, MBA; May Reed MD


J Am Geriatr Soc. 2021;69(8):2327-2334. 

In This Article

General Principles of Wound Management

Management of chronic wounds includes both disease-specific approaches as mentioned above, as well as targeted treatments to promote wound healing.[36] To achieve successful closure of a chronic wound, a systematic framework of wound bed preparation[37] is recognized as the best practice for wound healing. It is represented by the acronym TIME (tissue, inflammation/infection, moisture, and edges) (Table 1). In clinical practice, this means preparing the tissue for healing by removing devitalized tissue, controlling excessive inflammation and infection, maintaining moisture balance with appropriate dressing use, and maintaining healthy edges to promote epithelialization.

The concept of wound bed preparation is applicable to potentially healable wounds. For non-healable wounds (where the underlying cause cannot be corrected) or maintenance wounds (with patient/health system challenges-despite correctable cause), a different approach may be needed. This may include periodic aggressive debridement and management of inflammation/infection.[38]