Observations from the 2018 American College of Wound Healing and Tissue Repair meeting.
As a kid, I'm sure you were told countless times to make your bed. You may not have appreciated it at the time, but having a clean bed was a way to control the chaos of your room, to get the day started with an early sense of accomplishment and to set you up for a productive day.
The same principles apply to wound care. Nearly everyone at ACWHTR 2018 had experience using advanced technologies such as negative pressure wound therapy and skin grafts. To a person, each of the providers we spoke with recognized that using these advanced technologies on an unclean, unhealthy wound would be an exercise in frustration and nothing more than an expensive failure.
Notably, several speakers offered the same reason why wound beds can quickly become problematic: biofilm. Just like an unmade bed will only get messier by the day, biofilm communities begin forming within 24 hours of any debridement and become entrenched shortly thereafter. And once those biofilm communities form, our current understanding indicates that manual debridement is the only way to disrupt them. Just like we must make our bed each day, we must debride the biofilm off a patient's wounds each day until the body is strong enough to keep them clean on its own.
Advanced would healing therapies may be just the right solution, but before you use them be sure you've got a good, clean, healthy foundation on which they can succeed.