Q: Is it important to visualize chronic and acute wounds differently?   

A: Accuracy in the assessment of any wound is an essential component of wound healing. This is called global management of the wound; it includes analyzing local and systemic factors that contribute to healing.

As much as global management is important for wound healing, assessment of the wound bed also is crucial. Since the early 1960s, wound beds often have been covered for healing, but research has shown it is important to  reveal the surface for assessment of healing stages.

The pneumonic TIME (Tissue, Infection/ Inflammation, Moisture imbalance, Edge/ Epidermis) has been utilized for chronic wound bed assessments. It is important to assess the tissue for viability, signs of inflammation or infection, excessive or inadequate moisture, and signs of healing or non-healing  each time the wound is evaluated. 

Chronic wounds are a bit more complicated due to bioburden, progressive inflammation with minimal healing, formation of proteases and growth factors. Systemic factors include nutritional status, response to the dietary intervention, acute or chronic medical status, chronic medical conditions, medications that may impair healing, and functional and mobility status at the time of wound formation and healing. 

Chronic wound beds develop biofilm, proteases and inflammation that hinders cellular migrations and healing. Wound edges are thickened and inverted instead of showing approximation toward the other edges. Debridement to accelerate the epidermal development for non-advancing cells occasionally assists wound healing. 

The administrative leadership team should be aware of the simple fact that both acute and chronic wounds can heal, though they may be two separate species of the same animal.