Selection and application in the treatment of persons with wounds has been an important concern of health-care professionals since the beginning of time. Wound healers in ancient times faced the same challenges that we face, and their careful documentation of care plans and case studies1,2 reveal wound treatments with common themes that foreshadow today's TIME acronym concept to prepare the wound bed for healing (Table 1).3 This acronym provides a succinct guide for clinicians making decisions about removing specific barriers to wound healing (Table 2).
The Smith papyrus parchment from ancient Egypt can be viewed as one of the first wound care algorithms. Interestingly, inflammation, wound margins, secretions, bandage, and granulation comprised key elements of this early wound care vocabulary, and these concepts remain relevant to today's practitioners. These common themes include a thorough assessment of the wound based on the actual inspection of the wound for its particular characteristics, choosing the right bandages for the wound with consideration of exudate while maintaining a moist environment, as well as attention to the whole person. The process of wound assessment followed by a decision as to the type of wound and expected patient outcome by a rudimentary priority triaging system are remarkably similar to current considerations when faced with an acute or chronic wound: "Can this person with this particular wound heal?" Historically, the use of bandages to dress a wound was perceived as an art, and much attention was paid to correct wrapping and application. The search for the ideal dressing continues to this day. Basic science has provided clinicians with a new understanding of the importance of balancing moist wound healing with removing the in creased amounts of substances that delay healing in wound fluid (increased matrix metalloproteinases, senescent cells, inadequate amounts of growth factors, decreased tissue inhibitors of matrix metalloproteinases).
This supplement to the Journal of Wound, Ostomy and Continence Nursing provides a thoughtful review of the evidence about one element of TIME-wound exudate management with absorbent dressings. This summary of current research is helpful in clinical decision making for dressing management in the 21st century. Wound care is a unique combination of art and science based on the best current evidence (research, clinical experience including expert opinion, and patient preference). Although practice may change based on new evidence, the search for healing in the most humane way and fastest time possible persists as the goal.
KEY POINTS
[check mark] The rudiments of modern wound care concepts have been in existence for many centuries.
[check mark] Wound bed preparation and TIME provide a logical approach to wound care.
[check mark] The characteristics of an "ideal dressing" are discussed in the literature.
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