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Understanding Wound Bed Preparation

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Diabetic Foot Reconstruction

Abstract

Wound bed preparation is neccesary to support the next stage of wound healing which may include secondary healing, primary closure, graft, or flap. This includes medical optimization of comorbidities, nutritional enhancement, and local preparation such as maximizing perfusion, reducing bacterial counts, and removing nonviable tissue. Wound bed preparation can be performed in the clinic setting or preferably in an operating room. There are advantages and limitations to both approaches. Further, there are techniques, devices, and biologics that can assist in accelerating wound bed preparation.

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Authors and Affiliations

  1. Department of Plastic Surgery and Department of Orthopedic Surgery, Wound Program, University of Texas Southwestern, Dallas, TX, USA

    Paul J. Kim

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  1. Paul J. Kim
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Correspondence to Paul J. Kim .

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Editors and Affiliations

  1. Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea (Republic of)

    Joon Pio Hong

  2. Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea (Republic of)

    Hyunsuk Suh

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 I am a consultant for 3M Inc. (St. Paul, MN) and Integra LifeSciences Inc. (Plainsboro NJ).

5.1 Electronic Supplementary Material

Video 5.1

This video depicts the first excisional debridement performed in the operating room on an infected diabetic foot ulcer. Note the extensive soft tissue loss and grossly infected nonviable tissue that must be excised. The first operation should have a singular goal of removal of all nonviable tissue without a thought to the next stage of soft tissue reconstruction. The surgeon should handle the tissue delicately and remove only what is necessary at the same time aggressively exploring and removing nonviable tissue. Tendons are often pathways for infection. Tendons should be transected proximally when healthy appearing tissue is identified. At the completion of the excisional debridement, only healthy bleeding tissue should remain in the wound base and along the perimeter. The tissue should be then left to demarcate until the next staged operation which may be another excisional debridement or closure/coverage. (MP4 1301529 kb)

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© 2022 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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Kim, P.J. (2022). Understanding Wound Bed Preparation. In: Hong, J.P., Suh, H. (eds) Diabetic Foot Reconstruction. Springer, Singapore. https://doi.org/10.1007/978-981-16-9816-3_5

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  • DOI: https://doi.org/10.1007/978-981-16-9816-3_5

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-9815-6

  • Online ISBN: 978-981-16-9816-3

  • eBook Packages: MedicineMedicine (R0)

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