Advancements in Wound Bed Preparation of Chronic Wounds.

Chronic wounds are notoriously challenging to heal as they are often halted in their normal healing process. The concept of TIME (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge advancement) has been widely utilized in clinical practice to prepare wound beds and promote healing, particularly in longstanding wounds. Traditional methods of wound bed preparation are often inadequate in healing chronic wounds or they may not be tolerated by patients. A variety of interventions have been developed in recent decades to address these components and improve chronic wound outcomes. Evolutions in tissue preparation include emerging enzymatic debridement agents and ultrasound-assisted debridement. Wound infection can be managed through a variety of new methods including advanced wound dressings, surfactants, and fluorescence imaging. Portable negative pressure wound therapy devices provide a new, convenient method for exudate management. Finally, epithelial advancement can be enhanced with technologies such as cellular, acellular, and matrix-like products (CAMPs), topical medications, and electrical stimulation.