Wound Bed Preparation and Local Wound Management
The organizing framework
Wound bed preparation is usually taught with TIME: Tissue that is nonviable must be removed; Infection and inflammation must be controlled; Moisture must be balanced; wound Edges must be able to advance. Every dressing decision should map to one of these four problems. A dry, eschar-covered wound and a wet, macerated wound need opposite interventions.
Debridement and cleansing
Know the debridement types: sharp/surgical, enzymatic, autolytic (hydrocolloid, hydrogel, films), mechanical (including monofilament pads and irrigation), and biologic (larval). Selective methods remove only nonviable tissue; mechanical wet-to-dry gauze is nonselective and generally discouraged. Cleanse with saline, sterile water, or potable water using enough pressure to remove debris without damaging tissue - roughly 4 to 15 psi, achieved with a 35-mL syringe and 19-gauge needle. Avoid harsh antiseptics (hydrogen peroxide, acetic acid, high-concentration povidone-iodine) in a healing wound bed; they are cytotoxic.
Dressing selection logic
Match the dressing to exudate: alginates and hydrofibers for heavy drainage, foams for moderate, hydrocolloids and films for minimal-to-none. Hydrogels donate moisture to dry wounds; they are wrong for macerated tissue. Films and thin hydrocolloids should not be used on infected or heavily exuding wounds because they trap moisture and bacteria. Protect periwound skin with barrier products.
Traps
- Choosing an antimicrobial dressing for a clean, granulating wound.
- Using a moisture-donating product on a wet wound, or an occlusive product on an infected one.
- Forgetting that offloading and pressure redistribution are part of local management.
Rule of thumb
Ask: Is the bed clean, is bioburden controlled, is moisture right, are edges advancing? If a wound is stalled despite good care, revisit the earlier steps before changing products.