Wound Bed Preparation for Chronic Diabetic Foot Ulcers

Table 2

The summary of wound bed preparation.

	WBP Components	Problems	Aims	Actions
(1)	Tissue management	Necrotic tissue: (i) Obscuring wound assessment; (ii) Nidus of bacterial infection; (iii) Damaging metalloproteinases	Management of tissue necrosis: (i) Reducing necrotic tissue burden; (ii) Restoring viable wound bed with functional extracellular matrix	(i) Surgical debridement; (ii) Mechanical debridement; (iii) Autolytic debridement; (iv) Chemical debridement; (v) Enzymatic debridement; (vi) Biological debridement
(2)	Inflammation and infection control	Biofilm: (i) Release of bacterial toxins, competitive metabolism, and inflammation.; Immunosuppression: (ii) Prone to infection	Restoration of bacterial balance	(i) Recognizing critical colonization and invasive infection; (ii) Topical antimicrobial dressings; (iii) Topical antiseptic solutions; (iv) Wound debridement; (v) Systemic antibiotic as indicated; (vi) Tight control of blood sugar
(3)	Moisture balance	(i) Excessive moisture leading to maceration of wound edges; (ii) Dry wound inhibits cellular activities and promotes eschar formation	Achieving balance moist wound healing environment: (i) Stimulation of actions of growth factors and cytokines, and proliferation of cells	(i) Depending on moisture status of wounds: moisture retention dressing or absorptive dressing; (ii) Biological dressing such as skin allograft; (iii) Negative pressure wound therapy; (iv) Systemic therapy to reduce edema and control inflammation; (v) Limb elevation and compression dressings if legs are edematous
(4)	Epithelial advancement	(i) Tissue necrosis as physical barrier; (ii) Callus or hyperkeratosis at wound edges	Promoting migrating and intact epithelium from edges, wound contraction, and restoration of skin functions	(i) Removing necrotic tissue; (ii) Removing callus and hyperkeratosis; (iii) Suppression of hypergranulation; (iv) Negative pressure wound therapy to promote wound contraction; (v) Consider advance biological agents or skin grafting