Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle
- 15 July 2013
- journal article
- review article
- Published by Wiley in JDDG: Journal der Deutschen Dermatologischen Gesellschaft
- Vol. 11 (9), 819-829
- https://doi.org/10.1111/ddg.12138
Abstract
The number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis. Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.Keywords
This publication has 80 references indexed in Scilit:
- The microbiome in wound repair and tissue fibrosisThe Journal of Pathology, 2012
- 2D luminescence imaging of pH in vivoProceedings of the National Academy of Sciences of the United States of America, 2011
- Wound healing in the 21st centuryJournal of the American Academy of Dermatology, 2010
- Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: A systematic review and meta-analysisJournal of the American Academy of Dermatology, 2010
- Comparison of the antimicrobial activity of Ulmo honey from Chile and Manuka honey against methicillin-resistant Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.BMC Complementary and Alternative Medicine, 2010
- Evaluation of Silver Nanoparticle Toxicity in Skin in Vivo and Keratinocytes in VitroEnvironmental Health Perspectives, 2010
- Antimicrobial effect of silver-impregnated cellulose: potential for antimicrobial therapyJournal of Biological Engineering, 2009
- Commensal bacteria regulate Toll-like receptor 3–dependent inflammation after skin injuryNature Medicine, 2009
- Dressings for venous leg ulcers: systematic review and meta-analysisBMJ, 2007
- The burden of skin diseases: 2004Journal of the American Academy of Dermatology, 2006