Timeline review of wound bed preparation and TIME/TIMERS

Wound bed preparation: A structured approach to wound healing was first published in 2000 and updated in 2003, 2006, 2011, 2015, and 2021 (Sibbald et al, 2021).

TIME: A clinical assessment tool was developed in 2002; updated with modifications in 2003.

TIMERS: A clinical assessment tool with modification to TIME was published in 2019: addition of R (Repair and Regeneration) and S (Social factors and Patient-related factors).

1990s: Wound bed preparation (WBP): In the 1990s, there was an emergence of advanced technologies, bioengineered skin and topical growth factors, and wound care professionals believed that these products could potentially be the solution for correcting the molecular and cellular challenges of chronic, hard-to-heal wounds. However, the products failed to heal the wounds because of incomplete understanding of wound needs before the application of advanced wound care therapies for positive outcomes. Research was ongoing to determine what factors to consider to prepare the wound bed for advanced technological products.

2000: Research and discussion of wound bed preparation continued among wound care experts, and in 2000, Dr. R. Gary Sibbald defined wound bed preparation as a ‘changing paradigm that links treatment to the cause and focuses on three components of local wound care: debridement, wound-friendly moist interactive dressings and bacterial balance’ (Sibbald et al, 2000).

Three components (Tissue, Inflammation/Infection, Moisture Balance): The wound bed preparation concepts continued to evolve with an understanding that identifying the cause of a wound should be the foremost priority for management of localized wound care. The definition and choice of descriptive words for wound bed preparation has been modified over the years, but the three initial concepts defined by Dr, Sibbald still remain essential components for wound bed preparation in 2024 – tissue (debridement), inflammation/infection (pathogens/biofilm), and moisture balance (exudate).

2002: Fourth Component (Edge): The use of these main terms encouraged a systematic approach to wound management as a valuable tool for wound assessments. However, wounds were stalling at the wound edge (margin). To resolve this issue and encourage epithelial advancement for complete wound closure, a fourth component – wound edge (margin) (epidermal edge) - was added to wound bed preparation to implement wound bed preparation for wound edges that were not progressing with epithelial cells migrating across the wound edge (Schultz et al, 2004).

June 2002: TIME: Development of the assessment tool, TIME, by international wound care experts active in wound care management for the purpose of providing a structured, systematic approach to wound bed preparation for complete wound closure.

2019: TIMERS: In 2018, a group of international wound care experts convened to review the TIME principles and discuss and consider adding the following to TIME – R: Repair and Regeneration and S: Social factors and Patient-related factors. In 2019, a consensus document was published to modify the TIME acronym to a new term, TIMERS (Batas, 2023; Atkin et al, 2019).

Acute wounds: Wound bed preparation and TIME were initially developed with a focus on chronic, hard-to-heal wounds. However, physicians who provide wound care for acute wounds such as plastic surgeons, or burn surgeons may also benefit from use of this concept, as many traumatic wounds can become chronic if recovery is not optimal.

2024: The structure of wound bed preparation continues today because of the advances in research and understanding of wound pathophysiology, and new and improved technologies have been implemented in a rational and systematic method upon correct preparation of the wound bed prior to application.