- 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 |
| Debridement |
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
|
Topical/systemic antimicrobials anti-inflammatories 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:
|
Responsive fibroblasts and keratinocytes present in wound |
Advancing edge of wound |