An acute wound is a wound that progresses through the phases of normal healing resulting in closure of the wound, without complications.
Antimicrobial dressing properties
Biofilms are microorganisms embedded in a thick, slimy barrier of sugars and proteins that acts as a barrier that shields microorganisms from the patient’s natural immune system and from many antimicrobial agents. Biofilms are a structured community of microbes with genetic diversity and variable gene expression (phenotype) that creates behaviours and defences used to produce unique infections (chronic infection).
Biofilms are characterised by significant tolerance to antibiotics and biocides while remaining protected from host immunity. Biofilm can develop within 2–4 days of initial colonisation, and become very tightly attached to extracellular matrix components or the
wound bed, making them difficult to remove by surface irrigation or superficial debridement.
Wounds with delayed healing of any etiology.
Hard to heal wounds that have not healed or progressed, or are not expected to heal, within 4–6 weeks of proper wound care.
Chronic wounds do not follow normal healing process, usually remain stuck in inflammatory stage which results in clinical challenges that these recommendation address.
Chronic wounds are greater than 30 days despite best practice intervention. Wounds in the course of diabetes mellitus, chronic venous insufficiency, peripheral arterial disease and pressure injuries are regarded as chronic from their very beginning.
In the context of a wound dressing, conformability means that it the dressing should closely follow closely the contours of the wound bed, to eliminate the gap between the wound bed and the dressing. Close conformability enables effective exudate management, protects the wound edges and periwound skin from maceration and reduces the risk of infection.
The European Wound Management Association defines debridement as the “act of removing necrotic material, eschar, devitalized tissue, serocrusts, infected tissue, hyperkeratosis, slough, pus, hematomas, foreign bodies, debris, bone fragments, or any other type of bioburden from a wound with the objective to promote wound healing.
Exudate is the fluid that leaks from a wound and is the result of the inflammatory process. Exudate is usually clear or amber coloured and contains proteins, enzymes (especially matrix metallopeptidases / metalloproteinases or MMPs), leucocytes (granulocytes, macrophages), sugar, tissue cells, bacteria, and fungi.
While exudate production is a normal feature of healing wounds, over or under production of exudate or exudate of the wrong composition can delay healing. In chronic wounds, exudate slows down or even blocks cell proliferation, interferes with growth factor availability and contains elevated levels of inflammatory mediators and activated MMPs 8-10.
Effective exudate management allows moist wound healing and prevents maceration of the wound edge and periwound skin.
The accumulation of exudate in the gap between the wound bed and the wound dressing. Exudate pooling is likely in wounds with irregular topographies, pockets, or cavities and this can impact negatively on wound healing by causing maceration and potential infection.
Exudate pooling can also occur when the exudate is not absorbed by the wound dressing or the volume of fluid exceeds the dressing’s absorptive capacity. Choosing an appropriate dressing can help manage exudate and avoid exudate pooling.
Wounds that physiologically have the potential to heal in a timely fashion.
An infection that only affects the wound. Local infection is contained in one location, system or structure. Microbes are replicating at a rate that invokes a host response.
Maceration occurs when skin has been exposed to moisture for too long. A telltale sign of maceration is skin that looks soggy, feels soft, or appears whiter than usual. There may be a white ring around the wound in wounds that are too moist or have exposure to too much drainage.
Matrix metalloproteinases (MMPs)
Matrix metalloproteinases (MMPs), also known as matrix metallopeptidases or matrixins, are metalloproteinases that are calcium-dependent zinc-containing endopeptidases; other family members are adamalysins, serralysins, and astacins. The MMPs belong to a larger family of proteases known as the metzincin superfamily.
Does not have the potential to heal without surgical intervention, due to factors such as vascular supply or malignancy.
Non-healing – has the potential to heal but is not healing due to patient or system factors. For example, a venous leg ulcer is not healing because the patient is unwilling or unable to use compression therapy or compression therapy is not available.
Also referred to as patient adherence, or patient acceptance, and means the how a patient is following the treatment plan. Patient compliance is a term used in the same context, however there is a move away from the term compliance due to its negative connotations.
Tissue surrounding a wound. Periwound area is traditionally limited to 4cm outside the wound’s edge but can extend beyond this limit if outward damage to the skin is present.
Polyhexamethylene Biguanide / Polyhexanide is an active component used to treat local wound infections.
The force, or pounds, per square inch that will adequately disengage bacteria detritus from the wound surface. A range of 4-15 psi has been determined to be the safest and most effective range depending on the perceived need to clean. As a general rule, lower pressures are adequate for cleansing clean granulating wounds with higher pressures reserved for those wounds requiring deeper cleansing.
The invasion of surrounding tissue by infective organisms that have spread from a wound. Microorganisms proliferate and spread, to a degree that signs and symptoms extend beyond the wound boarder. Spreading infection may involve deep tissue, muscles, fascia, organs or body cavities.
Microorganisms spreading throughout the body via the vascular or lymphatic systems invoking responses in the person and/or metabolically.
The space between the dressing and the wound bed. A gap between the wound bed and the wound dressing, or dead space, should be avoided as it negatively influences would healing. Increased bacterial invasion and impaired healing results from unfilled dead-space between the wound bed and the wound dressing.
Undermining is caused by erosion under the wound edges. Wound undermining occurs when the tissue under the wound edges becomes eroded, resulting in a pocket beneath the skin at the wound’s edge. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt.
Undermining with depth or tunneling
Serration of tissue at deeper levels in the wound bed or where the edge of the wound is not attached and a probe will extend into the underlying space.
When referring to dressing properties, vertical absorption means the fluid or exudate is taken upward or wicked from the wound bed into the dressing. The dressing then holds the exudate meaning it doesn’t spread laterally or to the
sides to leak onto the wound edges or periwound skin. Vertical wicking decreases the chance of maceration of the wound edges and periwound skin.
Wound etiology refers to the cause of the wound and includes co-morbidities.
Progression, or lack thereof, is improved, unchanged or deteriorated.