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Change in chronic wound management, new TIMERS guideline further improves wound care

Pank Jit Sin
17 Jul 2019
2nd from left: Alejandro Blanco and Judy Haviland.
New wound care guidelines and innovations in hyaluronic acid technology promise to significantly improve wound healing outcomes, says a wound care consultant. 


Judy Haviland, of Melbourne, Australia, said: “We’re getting a little more sophisticated in how we look at wounds” and there has been a paradigm change in view of wound care. Going forward, instead of just closing wounds, clinicians will begin to look at the quality of healing to prevent recurrence in chronic wounds. Haviland is director of Judy Haviland Consulting Pty Ltd, and is actively involved in clinical research work involving products that treat acute wounds and burns as well as those for chronic wounds.

With greater expectations, wound care clinicians are embracing new technologies to improve the quality of tissue repair in patients with complex wounds. New innovations are being introduced in the form of hyaluronic acid technology which result in significant improvement in wound healing outcomes.

From TIME to TIMERS
TIME, which is an acronym coined in 2003, was a tool for wound care clinicians to use in wound bed preparation. ‘T’ stands for tissue: the need to check for nonviable or deficient tissue—any such tissue would need to be debrided before a dressing can be applied. ‘I’ stands for inflammation or infection: the presence of infection creates a barrier to wound healing. ‘M’ stands for moisture balance: a correct balance is necessary for proper wound healing. Finally, ‘E’ refers to the epidermal margin: the edges of the wound can tell clinicians whether it has been properly dressed.

Just in March, the letters R and S were added to the TIME concept creating the acronym TIMERS. R refers to regeneration ie, the observation of tissue repair, and to initiate additional treatment should wound healing be slow or stalled following conservative therapy. S refers to social and patient factors where patient engagement is important in increasing the chances of wound healing. [J Wound Care 2019;28(3 Suppl 3):S1–S49]

Chronic wound care cost takes disproportionate resources
Wounds—especially those chronic in nature—can have significant impact on patients’ quality of life, as it leads to pain, distress and sometimes, amputation and death.

Worldwide, the cost of chronic wound treatment is disproportionately high compared with other healthcare expenditures. Haviland said: “People are beginning to realize what the cost of treating wounds really is, not just to the patient, but to the whole society.”

Haviland was speaking at the launch of the Hyalo4 Wound Management Programme by EP Plus for hard to heal wounds. It is a new bioactive wound management programme. One of the key ingredients in the new range is low molecular weight (LMW) hyaluronic acid, said Alejandro Blanco, international area manager, Fidia Farmaceutici S.p.A. Unlike the hyaluronic acid found in cosmetic product, which is composed of many fragment sizes, those in Hyalo4 are of purified medical grade quality. In wound healing, LMW hyaluronic acid fragment size matters, as it prevents oxygen free radical damage to granulation tissue thus leading to faster healing. [Int J Tissue React 2002;24(2):65–71]

Also present at the launch was Professor Harikrishna Nair, head, Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur and Pang Tse-Ming, group managing director, EP Plus Group Sdn Bhd. 
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