A properly healing wound goes through the following stages: hemostasis, inflammation, proliferation and remodeling. In chronic wounds, this course is disturbed and remains in one of the phases for a long time. A chronic wound is when the healing process is not finished after 4-8 weeks, depending on the extent of the wound. Chronic wounds are most often the result of ongoing diseases, e.g. uncontrolled diabetes, ischaemic disease of the lower limbs, long-term immobilization.
With proper care and the application of the TIME principles, the wound can be healed and the patient's suffering can be reduced. The TIME principles were introduced by the European Wound Management Association as an acronym for English
- Tissue debridement – that is, removal of necrotic tissue in the wound
- IInfection and / or inflammation – control of infection and / or inflammation
- Moisture balance – moist wound environment
- Edge of the wound, epithelium – - the edge of the wound, epidermis
- By following the TIME healing stages, the whole process is faster.
The first stage is achieved by mechanical, autolytic or enzymatic debridement of the wound from necrotic tissues. The cleansing effect is achieved by the use of surgical instruments, ointments or gels (eg Medisorb G) and by the use of fly larvae (Lucilia sericata). Cleansing the wound of necrotic tissues reduces the possibility of infection and it removes the mechanical barrier to the proliferation of new tissues.
The second stage, i.e. infection and / or inflammation control, is to keep the microorganisms at a level that allows the autolysis of necrotic tissues and inhibits the growth of pathogenic bacteria such as blue pus, staphylococcus aureus, pathogenic fungi or others. A controlled inflammatory process promotes healing. This effect can be achieved through the use of antiseptics, eg Octenisept, Prontosan, preparations containing ionized silver, Medisorb R Ag, Medisorb P SILVER.
The moist environment in the wound favors the proliferation of new tissues, according to the principle that life develops in water. Keeping a moist environment in the wound promotes healing. Moisture levels should also be monitored, and dressings that absorb exudate but maintain a certain level of moisture should be used to optimize the cell multiplication process and preserve the extracellular matrix. Hydrocolloid dressings, e.g.Medisorb H,polyurethane foams, e.g.Medisorb P PLUS, Medisorb P PLUS ADHESIVEor alginate dressings, e.g. Medisorb A, are ideal for controlling the moisture in the wound. Medisorb A.
Medisorb A, are ideal for controlling the moisture in the wound. The final stage of the TIME principles is the epithelialization process, i.e. covering a wound with epithelial tissue. It starts at the edges of the wound and gradually covers the entire wound. The newly created epidermis requires protection that ensures gas exchange, “breathing” and at the same time protects it from damage. Ultra-thin, flexible and vapor-permeable polyurethane films, such as Medisorb F, are perfect for this, and in the early epithelialization phase, when the epidermis is only on the wound margin, hydrocolloid dressings, such as Medisorb H , can be used.
The process of chronic wound healing should be supported by actions reducing the impact of comorbidities that promote the formation of chronic wounds. It is important to treat diabetes, ischemic diseases and widely understood prevention programmes. Activating patients who are immobilized for a long time, e.g. after orthopedic surgeries, frequent repositioning of bedridden patients. A satisfactory standard of living can be achieved with proper diet, exercise and care of those parts of the body that are particularly prone to wounds.
