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The importance of wound-bed preparation

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VOL: 98, ISSUE: 02, PAGE NO: 47

Caroline Dowsett, MSc, DipN, RGN, is nurse consultant, tissue viability, Newham Primary Care NHS Trust

The concept of wound-bed preparation is emerging as a new concept in chronic wound management to ensure that maximal benefits are obtained from advanced wound care products, such as growth factors and bio-engineered skin products. How important is this new concept to those involved in wound care, and how does it impact on patient care?

The concept of wound-bed preparation is emerging as a new concept in chronic wound management to ensure that maximal benefits are obtained from advanced wound care products, such as growth factors and bio-engineered skin products. How important is this new concept to those involved in wound care, and how does it impact on patient care?

Some of you may feel that wound bed-preparation is not a new concept and that the principles are part of overall good wound management which aims to achieve an optimal wound-healing environment. When you consider the key elements of effective wound-bed preparation, as identified by Falanga (2000), you might be forgiven for taking this view. These include the removal of necrotic tissue, control of oedema, achieving a well vascularised wound bed, decreasing bacterial burden and controlling wound exudate.

Many clinicians are already undertaking wound debridement, either sharp or autolytic, and compression bandaging is routinely used to control oedema in patients with venous disease. If we are getting it right, why then do we continue to see a large number of patients with chronic complex wounds that fail to heal? The elements that make up the concept of wound-bed preparation are often seen in isolation from each other, when they all, in fact, link together. Many clinicians will have their own views on how best to manage excess exudate or decrease bacterial burden. Wound-bed preparation as a concept allows clinicians to break down various aspects of wound care into individual components while also allowing a global view of expected outcomes to be achieved.

If this concept is really going to benefit patients we should become involved in the debate and look at ways to facilitate its implementation in clinical practice, or demonstrate that it already exists through patient outcomes.

And let's not forget the patient in this debate. Wounds cannot, and should not, be seen in isolation, and many factors will affect the healing process, such as nutrition and mobility. Only by addressing these other issues can we expect any intervention to be a success, whatever the concept.

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