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Wound-Bed Preparation

Collier M (2002) Wound-Bed Preparation, Nursing Times 98 (2)



Moist wound healing is now accepted by professionals in the majority of health care settings. Both excoriation and maceration involve the presence of fluid on the skin over a period of time. However, the effects of that fluid on the skin, in particular surrounding a wound, can be very different. The nature of excoriation depends on the components (toxins) within the fluid and will result in the stripping of the top layers of epidermis (Collier 2000). It requires a healing process to correct, whereas maceration is the softening or sogginess of the tissues due to the retention of "excessive" moisture (Cutting 1999) which might simply be caused by tap water, such as from prolonged bathing, only requiring the tissues to "dry out" to correct. Moist wound healing (Bloom 1945, Bull et al 1948; Winter, 1962) and wound bed preparation (Falanga, 2000) also involve the presence of fluid - this time within the margins of a wound - but the difference is that ensuring the presence of a moist wound healing environment (through the use of "interactive" wound management materials, for example) should create the ideal environment for wound healing to take place (Turner, 1985). Wound bed preparation, however, involves practioners in taking both decisions and actions, not only to facilitate a moist wound bed but also to facilitate the presence of components within the moisture which have been reported to have a positive influence on wound healing (Calvin, 1998; Robson et al, 1998), such as growth factors.