Identifying Healing Barriers (T.I.M.E.)

Introduction

It’s been more than two decades since the idea of wound bed preparation was first put into practice and widely accepted. Research shows patients aren’t assessed properly regardless of how long they’ve been using wound treatment methods. Inadequate assessments lead to unnecessary spending and a failure to receive the proper care and treatment, both of which have negative consequences. Wound bed preparation (WBP) aims to create the best possible conditions for wound healing. Advances in molecular science have led to the development of new technology and sophisticated therapeutics, including growth factors, cell growth in vitro, and bioengineered tissue. It is now known that the healing process involves a wide range of variables that must be closely monitored.

Since 2003, clinicians have utilized the acronym TIME, however, experts have since questioned the notion for focusing entirely on the wound and not so much on the holistic approach of the patient. There are four clinical areas that are integrated into the TIME method.

 

TIME incorporates the following principles:

Tissue

 

Using one or more of the five methods of debridement, remove non-viable or devitalized tissue. In order to recall the five types, BEAMS is utilized as an acronym: biological, enzyme, autolytic, mechanical, and surgical.   Adequate arterial blood supply necessitates sharp or surgical debridement. The wound healing process is designed to produce healthy and viable tissue. The extracellular matrix proteins and the wound bed base will be restored by wound bed preparation.

 

Infection/Inflammation

Infection and inflammation can be controlled and managed with wound bed preparation by reducing inflammation, bioburden, and biofilm. Bioburden and clinical infections can occur if the bacteria level is too high. Inflammatory diseases should always be considered. Depending on the indication, apply dressings and treatments that are bioactive, antimicrobial, antiseptic, or antibiotic in nature.

 

Moisture

Make sure the wound bed and periwound are well maintained at all times. Edema can be controlled and managed with the use of proper advanced wound care dressings. The migration of epithelial cells is slowed by maceration or desiccation. Edematous limbs should be compressed as directed. Apply hydrogel or petrolatum treatments, as needed, as directed. Absorbent dressings, such as alginates, hydrofibers, foams, and super absorbent dressings, are excellent for balancing moisture. Preparation of the wound bed will have a positive impact on epithelial cell migration and moisture balance.

 

Edges/Epithelial

An improvement in the wound’s edges is expected. As a result of epibole (rolled edges), undermining, and non-advancing wound edges, various therapeutic methods, such as debridement, skin grafts, biological agents, and/or supplementary therapies, may be necessary. As keratinocytes migrate and wound cells respond, a wound bed preparation helps to restore adequate proteases.

 

Conclusion

Wounds should be assessed looking at the WHOLE patient.   Wound bed preparation is greatly simplified with TIME with a more comprehensive evaluation of the patient’s psychosocial needs as well as the underlying etiologies of their wound. TIME can improve wound healing outcomes if used. 

Disclaimer

The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.

 

Future Reading and References

Halim, A. S., Khoo, T. L., & Saad, A. Z. (2012). Wound bed preparation from a clinical perspective. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 45(2), 193–202. https://doi.org/10.4103/0970-0358.101277

Journal of Wound Care. VOL 28, NO 3, March 2019. TIME CDST: an updated tool to address the current challenges in wound care.

EWMA POSITION DOCUMENT: Wound bed preparation in practice. https://ewma.org/fileadmin/user_upload/EWMA.org/Position_documents_2002-2008/pos_doc_English_final_04.pdf

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