Wound Assessment (TIME & WBP Frameworks)

The TIME framework (Tissue, Infection/Inflammation, Moisture, Edge) is an evidence-based systematic approach to wound bed preparation (WBP) that addresses the molecular and cellular abnormalities preventing chronic wound healing. The T (Tissue non-viable or deficient) component addresses devitalized tissue (slough, eschar) that harbors bacteria, sustains inflammation, and physically blocks cell migration. Debridement removes this tissue and senescent cells, converting a chronic wound to an acute wound molecular environment with fresh expression of growth factors (PDGF, TGF-β, VEGF). The I (Infection or Inflammation) component recognizes that chronic wounds exist in a state of persistent inflammation with elevated pro-inflammatory cytokines (TNF-α, IL-1β), excessive matrix metalloproteinase (MMP) activity, and biofilm formation in 60-90% of chronic wounds. Topical antimicrobials (silver, cadexomer iodine, medical-grade honey) address superficial infection, while systemic antibiotics target deep tissue infection. The M (Moisture imbalance) component addresses both excessive moisture (causing maceration and MMP-laden wound fluid degrading periwound skin) and insufficient moisture (desiccating the wound bed and impeding epithelial cell migration). The E (Edge non-advancing or undermined) component identifies wounds with rolled edges (epibole), undermining, or non-migrating epithelium suggesting fibroblast senescence or...