Chronic Wounds are a national epidemic, masked by many co-morbidities. Nearly 60 million people in the U.S. are living with diabetes and/or vascular disease, which are the leading causes of chronic wounds. Patients that suffer from non-healing wounds often find themselves with unnecessary hospitalizations and lower extremity amputations. Patients with chronic wounds have longer lengths of stay, unplanned readmissions, and higher cost of treatment. The U.S. spends in excess of $50 billion annually on treating chronic wounds, and a staggering $8 billion on amputation procedures alone. Fueled by an aging population, increased obesity, and a rising rate of diabetes, chronic wounds are projected to increase at a compound annual growth rate of nearly 3% over the next five years.¹

Aggressive and appropriate wound management is essential to gain positive outcomes that enhance patient satisfaction and save health care dollars. The TIME Concept² of wound bed preparation is a key factor in wound management. The “T” stands for Tissue management - this means debridement. This is often the single most important factor in allowing wound healing to move forward. Debridement means the removal of all necrotic soft tissue. This also allows for the removal of a significant source of bacterial burden while activating platelets. While the wound may become larger after debridement, the wound edge has now been stimulated and healing can occur. Higher frequency of debridement improves healing outcomes³, so some form of debridement at every visit is important. The “I” stands for Infection and Inflammation - this must be controlled if the wound is to proceed to closure. Appropriate antibiotics may be used in some form or fashion, depending on the patient status. The “M” stands for Moisture Balance - excessive moisture or drainage must be controlled so as to not decrease cellular migration. The “E” stands for Epithelial Edge Advancement - advancing of the wound edges. Weekly, or every visit, cleansing of the wound edge, stimulates and allows for keratinocyte migration and eventual wound closure.

Dressings and advanced wound modalities play an important role in each step of the TIME Concept. It is important to choose the appropriate dressing that will aid in each step of the wound healing process. We now have the ability to control the wound environment by what we apply to the wound and when we apply it. The goal is to restore normal wound physiology that will then increase wound healing.

The 4-Week Model⁴, will allow us to move forward with our dressing choices without losing valuable time. If we do not see evidence of 50% closure by four weeks, it is time to re-evaluate the patient and select a new dressing choice.

Regards,

Matthew Garoufalis DPM, CWS

Professional Foot Care Specialists, PC
5241 S Cicero Ave
Chicago, Illinois 60632