Kathryn Vowden RGN, DPSN(TV) Clinical Nurse Specialist (Vascular and Wound Healing)Bradford Royal Infirmary Bradford, UK Peter Vowden MD, FRCS Consultant Vascular Surgeon Bradford Royal Infirmary Bradford, UKEmail: [email protected] This paper explores the concept of wound bed preparation and relates this to five key areas of care: bacterial balance, necrosis, exudate, cellular dysfunction and biochemical balance.
The formation of a healthy wound bed is a prerequisite to the use of many of today's advanced wound care products.This will frequently require a multidisciplinary and structured approach to care.These changes are underpinned by our ever-increasing knowledge of the biological microenvironment within a chronic wound and centre on the inter-relationship of functionally abnormal cells, bacterial balance, inappropriate biochemical messengers and dysfunctional wound matrix components.Multiple biological, synthetic and hybrid polymers are used for multiple medical applications.A wide range of different polymers is available, and they have further the advantage to be tunable in physical, chemical and biological properties in a wide range to match the requirements of specific applications.Chronic wounds present many challenges to the nurse and patient.
In wounds that are producing large amounts of fluid, devising strategies to minimise the impact on the patient’s physical and psychosocial wellbeing can be particularly demanding.
Dressings and exudate management The main roles of dressings in exudate management are to absorb excess exudate while keeping the wound bed sufficiently moist to enhance healing.
However, the wound should not be kept so wet that the surrounding normal skin becomes soggy (macerated) and prone to damage.
Odour is attributed to the volatiles produced by the bacteria within a wound Wound fluid, containing bacteria and cellular debris, is readily drawn up into the Cadexomer matrix cleansing the wound bed of extra debris and bacteria, thereby helping to promote wound healing.
This desloughing and removal of bacteria is believed to be responsible for the increase in wound healing and the rate of epithelialisation observed in clinical studies of chronic leg ulcers after treatment with Cadexomer Iodine.
The broad spectrum antimicrobial action is provided by the sustained release of iodine and the desloughing action is provided by the unique cadexomer matrix.