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Printable Handouts
Navigable Slide Index
- Introduction
- The TIME acronym
- TIME: the principles of wound bed preparation
- Background of wound bed preparation
- Evidence-based medicine
- The myth of the RCT?
- More research is needed
- The VULCAN study
- In the meantime guidelines are needed
- Updating TIME
- Developments over past 10 years
- TIME: Tissue
- The concept of debridement
- Rationale for debridement
- Methods of debridement
- Autolytic debridement
- Autolytic debridement (examples)
- Enzymatic debridement
- Types of enzyme preparations
- Hydrotherapy wound irrigation and NPT
- Larvatherapy
- Larvatherapy procedure
- Surgical debridement
- Surgical debridement (examples)
- Surgical debridement (more examples)
- Advantages and disadvantages
- NPWT in TIME
- TNP in chronic wound care
- Systematic review of TNP for wounds
- TIME: Infection and Inflammation
- Ignaz Semmelweis (Puerperal sepsis)
- Louis Pasteur
- Joseph Lister and antiseptic surgery
- Fleming and Penicillium discovery
- Determinants for infection
- Signs of acute infection
- Signs of clinical infection: chronic wounds
- Chronic wounds are not static wounds
- Critical colonisation
- Reducing bioburden
- The two week challenge
- Clinical guide for wound infection
- Counting bacteria and biofilms
- The problem of antibiotics underdose
- HCAIs and resistant organisms
- New organisms: new antibiotics, they run out
- When should antibiotics be given for infections?
- Antibiotic stewardship
- Biofilms
- Biofilms are ubiquitous
- Infection and inflammation: biofilms
- Are biofilms visible and is slough a biofilm?
- Biofilm management
- Biofilms: need for a diagnostic
- More than 60% of chronic wounds have biofilms
- Diagnostics and wounds
- The ideal surgical dressing
- Antimicrobial dressings
- Infection: topical antimicrobial agents
- Silver and silver dressings
- Are antiseptics toxic and do they delay healing?
- Mechanism of action of antiseptics
- Theoretical risk of antiseptic use
- Management of chronic wound infection
- TIME: Moisture
- TIME: Edge
- Summary
- TIME (2012): the principles
- TIME to expand the focus (2012)
- TIME: 10 years on - and beyond?
- Conclusions and acknowledgements
Topics Covered
- TIME acronym for managing wound bed preparation 10 years old; needs updating
- Awareness of evidence based medicine and need for more quality research
- Guidelines still needed; depend on best available evidence and “expert”consensus
- 10 year developments considered
- Tissue developments: new debridement methods, negative pressure therapy (NPT)
- Infection developments: better understanding of microbiology, biofilms and antiseptics, antimicrobial therapy and new dressings
- Moisture control: improvements with better dressing management and NPT
- Edge: accurate monitoring and adjunctive therapies
- TIME part of holistic care: TIME revisited in International Wound Journal 2012; 9 (supplement)- the focus expanded and still evolving
Talk Citation
Leaper, D. (2014, October 7). Wound bed preparation and TIME [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 6, 2024, from https://doi.org/10.69645/CJGF2424.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. David Leaper, Consultant: Ethicon; Speaker's Bureau: Smith & Nephew
Other Talks in the Series: Wound Healing
Transcript
Please wait while the transcript is being prepared...
0:00
I'm
very pleased to be contributing
to these Henry Stewart
talks on wound healing.
And my topic is wound bed
preparation with the acronym TIME.
I'm Professor David Leaper, Emeritus
Professor of Surgery at Newcastle
upon Tyne, and Visiting Professor
at Imperial College, London.
And that's me in the
bottom left-hand corner.
0:23
The TIME acronym
was originally aimed
to describe the observable
culturistics of chronic wounds
within the framework of
wound bed preparation.
It was developed by an
international advisory board
just over 10 years ago.
The concept of wound bed preparation
has been taken from plastic surgery
where a wound is prepared to
be optimal for a skin graft.
But in this context,
in chronic wounds,
wound bed preparation is a
preparation of a chronic wound
to allow successful healing
by secondary intention.
The TIME acronym, which I'll
describe throughout the lecture,
is based on T for
tissue debridement,
making the wound as
clean as possible.
Controlling infection and bioburden
and inflammation, that's the I. M
is for moisture balance.
Wounds heal optimally
when they are optimally
moist-- not too much
moisture, not too dry.
And finally, E for
the epithelial edge,
ensuring the healthiest epithelial
edge at the healing edge.
And also looking after the
periwound skin and making sure
it doesn't become too macerated.
1:37
This is a very busy slide and
summarises the concepts first
published in 2003 on the principles
for wound bed preparation.
And again, we can see
on the left-hand side
the acronym for tissue
cleaning, managing infection
and inflammation, managing moisture
and looking after the wound edge.
The proposed physiology and the
background for undertaking this
is given, and the clinical
actions and their effects.
And finally, the concepts of
the vast clinical outcomes.
Now, I shall be going
through this in the lecture
in the next few slides.