Registered Nurses' Association of Ontario

Preparing the Wound Bed

  • The aim of local wound bed preparation is the removal of barriers to healing.
  • Important considerations when preparing the wound bed:
Clinical Observations Molecular and Cellular Problems Clinical Actions Effect on Clinical Actions Clinical Outcome

Denatured matrix and cell debris impair healing

Debridement (episodic or continuous) autolytic, sharp surgical, enzymatic, mechanical or biological

Intact, functional extracellular

matrix proteins present in wound base

Viable wound base
Infection, inflammation

High bacteria, cause

  • Increased inflammatory cytokines
  • Increased proteases
  • Decreased growth factor activity
  • Decreased healing environment




protease inhibitors

growth factors

Low bacteria, cause

Decreased inflammatory cytokines

Decreased proteases

Increased growth factor activity

Increased healing environment

Bacterial balance and reduced inflammation

Moisture Balance

Dessication slows epithelial cell migration 

Excessive fluid causes maceration of wound base/margin

Apply moisture balancing dressings

Dessication avoided

Excessive fluid controlled

Moisture balance

Edge of wound –non-advancing or undermined

Non-migrating keratinocytes 

Non-responsive wound cells, abnormalities in extracellular matrix or abnormal protease activity

Reasess cause, refer or consider corrective advanced therapies:

  • bioengineered skin
  • skin grafts
  • vascular surgery

Responsive fibroblasts and keratinocytes present in wound

Advancing edge of wound


Clinical Management
Assessment and Management of Venous Leg Ulcers
Point of Care Resources