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To accelerate endogenous healing

The Principles Of Wound Bed Preparation

Wound bed preparation is defined as ‘the management of the wound to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures’.31 The principles of wound bed preparation that will be discussed in this section are the entrenched concepts of TIME (Tissue; Infection/Inflammation; Moisture; Edge)72, 157 and biofilm-based wound care (BBWC)158 that guide best practice in wound assessment and management. Application of these principles promotes maintenance of a healthy wound bed and involves therapeutic wound cleansing and debridement, which aims to disrupt biofilm, prevent its reformation, and facilitate removal of necrotic, non-viable or infected tissue.

Fluid type
Safety profileCommentsKey model features
Potable tap water
Hypotonic
  • No cytotoxicity
  • Not sterile
  • Generally inert solution that varies in content169
  • Effect achieved through mechanical detachment of contaminants181
  • Safe alternative when sterile solutions are not available or feasible (e.g. low resource settings or community settings)177
  • In low resource settings with non-potable water, boiled and cooled water is an alternative165
  • When using potable tap water, run the tap to remove contaminates before using the water166
Sterile normal 0.9% salineIsotonicNo cytotoxicity
  • Inert, isotonic solution with no antimicrobial properties169
  • Effect achieved through mechanical detachment of contaminants181
  • Once opened, product is no longer sterile182
Sterile waterHypotonicNo cytotoxicity
  • Inert, hypotonic solution with no antimicrobial properties169
  • Effect achieved through mechanical detachment of contaminants181
  • Once opened, product is no longer sterile182
Surfactant wound cleansers (e.g. Poloxamer 407, undecylenamidopropyl betaine and macrogolum)Surfactant Low cytotoxicity to fibroblasts and keratinocytes in vitro180
  • Categorised based on type of chemical charge168
  • Commonly combined with antimicrobial /antimicrobially-preserved agents including octenidine dihydrochloride (OCT) or polyhexamethylene biguanide (PHMB)
  • Removes bacteria without damage to healing wound tissues180
Super-oxidised solutions (hypochlorous acid and sodium hypochlorite are present as antimicrobial preservatives)HypotonicVaries (see Table 11)
  • Contain naturally occurring hypotonic, oxidising agents183
  • Antimicrobial and antibiofilm action varies (see Table 11)

Povidone iodine

  • Antiseptic 
  • Iodophor
Dose dependent cytotoxic effect on osteoblasts, myoblasts and fibroblasts184, 185
  • Antiseptic solution
  • Broad spectrum antimicrobial185-189 and antibiofilm185-187 action (see Table 11)
Other agents containing antimicrobials and/or active preservativesVariesVaries (see Table 11)Range of antimicrobial/antimicrobially-preserved agents solutions, less commonly used solely as a cleansing agent (see Table 11)