Chronic wound healing is multidimensional. Wound bed preparation, articulated as the TIME framework by Schultz et al. in 2003, is the global standard.
TIME
- T — Tissue: debride necrotic and slough tissue.
- I — Infection/Inflammation: control bioburden.
- M — Moisture balance: avoid both desiccation and maceration.
- E — Edge: monitor epithelial advancement.
Dressing families
- Hydrocolloid — superficial, low-to-moderate exudate.
- Polyurethane foam — moderate-to-high exudate, pressure offloading.
- Alginate / hydrofiber — cavities, heavy exudate, mild haemostasis.
- Silver — local infection or high bioburden, short courses only.
- Hydrogel — dry wounds, autolytic debridement.
Negative-pressure wound therapy (NPWT)
Topical negative pressure (75–125 mmHg) accelerates granulation in complex wounds. Cochrane review (2018) found moderate evidence for faster closure after partial diabetic foot amputations.
References
- Schultz GS, et al. Wound bed preparation: a systematic approach. Wound Repair Regen. 2003;11(Suppl 1):S1–S28. https://doi.org/10.1046/j.1524-475X.11.s2.1.x
- Winter GD. Formation of the scab and the rate of epithelization. Nature. 1962;193:293–294. https://doi.org/10.1038/193293a0
- Liu Z, et al. NPWT for foot wounds in diabetes. Cochrane Database Syst Rev. 2018;10:CD010318. https://doi.org/10.1002/14651858.CD010318.pub3