Wound bed preparation: DIM before DIME
AbstractChronic wounds are often recalcitrant to healing and they often do not follow the expected trajectory (30% smaller in 12 weeks).1,2 They are disabling and constitute a significant burden on patients activities of daily living and the healthcare system. Of persons with diabetes, 23% develop a foot ulcer annually, while the lifetime risk of a person with diabetes developing a foot ulcer is as high as 25 percent.3 It is estimated that venous leg ulcers affect 1% of the adult population and 3.6% of people over 65 years old.4 As our society continues to age, the problem of pressure ulcers is growing. To address this burgeoning problem, this article will incorporate the wound bed preparation model into a practical clinical guide for the treatment of chronic wound (see Figure 1). 5,6,7 Central to this paradigm is the importance of treating the cause and addressing patient centered concerns prior to optimising local wound care. The three important components of local care are: debridement, infection and inflammation, moisture balance (DIM). If wound bed preparation is optimised and healing is stalled, the additional E or the edge of non-healing wounds represents the potential use of advanced active therapies to stimulate healing. Remember this, DIM before DIME.8
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