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Ref M Flanagan The Philosophy of Wound Bed Preparation in Clinical Practice 2003
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Preparing the Wound Bed
| Treat the cause |
- Assess the patient for healability. Adequate blood supply must be present and host factors (coexisting diseases, drugs) must all be considered.
- Correct treatable cause of tissue damage.
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| Patient centred concerns |
- Make the patient part of the decision making process. Pain and quality of life should be documented and should form part of the treatment plan.
- Provide education and support for patient centred care to increase coherence with a treatment process.
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| Local wound care |
- Assess and monitor the wound history and physical characteristics (location, size, base, exudate, surrounding skin, staging and pain).
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| Debridement |
- Debride healable wounds, removing necrotic and non-viable tissue (surgical, autolytic, enzymatic and mechanical). Non-healable wounds should have only non-viable tissue removed and active debridement to bleeding tissue is contraindicated.
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| Persistent inflammation and bacterial balance |
- Assess the wound for bacterial balance, infection or persistent inflammation.
- Use only non-sensitising topical antibacterial agents for local symptoms and signs of increased bacterial burden.
- Use systemic antibiotics if symptoms or signs of infection extend beyond the wound margin, or the ulcer probes to bone.
- For persistent inflammation, topical and systemic anti-inflammatories should be considered based on superficial, local or systemic disease process.
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| Moisture balance |
- Cleanse wounds with normal saline and water. The use of topical antiseptics should be reserved for wounds that are non-healable or those in which the local bacterial burden is of greater concern than the stimulation of healing.
- Select appropriate dressings for local moisture balance to stimulate granulation tissue and re-epithelialization.
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| Edge effect |
- Evaluate expected rate of wound healing to determine if treatment is optimal. If sub-optimal healing is noted, re-assess the cause and patient centred concerns.
- Use active wound therapies (biological agents, skin grafts, adjunctive therapies) when other factors have been corrected and if healing still does not progress.
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| Overall |
- For improved outcomes, education and evidence base must be tied to interdisciplinary teams with the cooperation of health care systems
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From: Preparing the Wound Bed 2003: Focus on infection and inflammation
Ostomy Wound management; 49(11):24-51
Sibbald RG, Orsted H, Schultz GS, Coutts P and Keast D
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