Correction of Hypoxia, a Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation

Abstract

Wound bed preparation is an organized approach to create an optimal environment for wound healing by the use of the most cost-effective therapeutic options. It has become an essential part of wound management and seeks to use the latest findings from molecular and cellular research to maximize the benefits of today's advanced wound care products. The international advisory panel on wound bed preparation met in 2002 to develop a systemic approach to wound management. These principles of this approach are referred to by the mnemonic TIME, which stands for the management of nonviable or deficient tissue (T), infection or inflammation (I), prolonged moisture imbalance (M), and nonadvancing or undermined epidermal edge (E). One critical element of pathophysiology, understanding of the hypoxic nature of the wound and correction of hypoxia as a critical element of wound bed preparation, is not covered. This article proposes to add correction of hypoxia to the TIME principle (TIMEO2 principle) based on the evidence. The evidence that will support the reason and the need for modification of the wound bed preparation protocol is discussed.

Keywords: Chronic wounds; Hyperbaric oxygen therapy; Hypoxia; TIMEO2 principle; Wound bed preparation.

Figure 1

Suggested Updated Guidelines for Wound Bed Preparation Modified From DIME Principles.

Figure 2

Suggested Updated Protocol for Correction of Hypoxia.

Figure 3

Wound Healing Impairment With Decreasing Transcutaneous Oximetry (PtcO₂).

Figure 4

Physiological Effects of Increased Po₂.

Figure 5

Relationship Between In-Chamber PtcO₂ and HBO Therapy Success (Fife: summary of findings).