L. BALTÀ DOMÍNGUEZ, M. BERENGUER PÉREZ, F-J. CORPAS ALCALÁ and C. SANTIAGO FERNÁNDEZ(1) P. WILKEN(2) (1) SAP Muntanya. Institut Català de la Salut, Barcelona, Spain (2) URGO GmbH, Sulzbach, Germany

1. DEVELOPING A TIME CONCEPT TREATMENT
IN A POST-TRAUMATIC WOUND WITH
HEMATOMA IN THE LOWER EXTREMITY
L. BALTÀ DOMÍNGUEZ, M. BERENGUER PÉREZ, F-J. CORPAS ALCALÁ and
C. SANTIAGO FERNÁNDEZ(1)
P. WILKEN(2)
(1) SAP Muntanya. Institut Català de la Salut, Barcelona, Spain
(2) URGO GmbH, Sulzbach, Germany

2. INTRODUCTION
In patients with venous disease, one element that causes wounds is the occurrence of
accidental traumas.
The overall evaluation of the person with a wound has been found to be fundamental for
their treatment and recovery, and its objective is to detect those aspects which might have
a negative impact on wound healing.
The TIME concept is a strategy recommended for health professionals that helps us to
assess chronic wounds during each wound care procedure, enabling us to detect problems
and determine the actions to be taken to achieve better, faster healing.

3. OBJECTIVES
To deslough non-viable tissue (TIME), control inflammation/infection (TIME), ensure
optimum management of exudates (TIME) and stimulate epithelial margins (TIME), the aim
being to obtain the complete epithelialisation of the wound.

4. METHODOLOGY
Two clinical cases are described, dealt with in Primary Care treatment consultations for
traumatic wounds in which haematoma/significant soft pressure ulcer was present during
the initial assessment.

5. 78 year-old female patient with a history of: arterial hypertension, type-2 diabetes
mellitus, dyslipidaemia, arthritis, osteoporosis and glaucoma.
On 18.04.2012 she suffered an accidental fall, presenting trauma in the pretibial area of
the right leg.
At fifteen days the patient had developed pain, redness, local heat and drainage of
serious exudate via the right lateral area of the wound where she presented a small open
wound.
Presence of haematoma and soft pressure ulcer which moves on palpation and is not
resorbed under compression therapy.
It was decided to carry out surgical desloughing to remove all the necrotic tissue.
After desloughing the patient presented an open wound 8 cm in length x 8 cm in width
x 2.5 cm deep, with abundant sero-haematic exudates, residues of necrotic tissue (30%)
and slough (35%).
CLINICAL CASE 1

6. 17.05.2012
CLINICAL CASE 1
13.07.2012 10.08.2012
14.09.2012 16.10.2012

7. 70 year-old female patient, with a history of: arterial hypertension, type-2 diabetes
mellitus and arthritis.
On 15.05.2012 she suffered a spontaneous fall on the public highway, and was admitted
to the Care Centre after fifteen days, presenting soft slough.
It was decided to carry out surgical desloughing, and after the necrotic tissue was
removed the patient presented a wound 10 cm long, 8 cm wide and 3 cm deep.
The patient presented 70% sloughy tissue and 30% granulation tissue.
CLINICAL CASE 2

8. 07.05.2012 14.05.2012 11.06.2012
02.07.2012 30.07.2012
CLINICAL CASE 2

9. CLINICAL CASES
In both cases, after surgical desloughing, desloughing with polyacrylate hydro-desloughing
fibre and TLC dressing* was initiated due to the high content of slough covering the wound
bed, protecting the skin around the wound with a non-irritating barrier film and applying
short-stretch compression bandages.
Once desloughing had been carried out, treatment with a polyurethane foam type dressing
was continued with TLC-NOSF dressing*.
In view of the persistent high quantity of sero-purulent exudate a surface culture was
carried out and the following result was obtained: Pseudomonas aeruginosa (in the first
case) and Escherichia coli (in the second case).
In both wounds a dressing was applied consisting of pure activated charcoal impregnated
with silver, wrapped in a double mesh of nonwoven nylon fibres, enabling the infection to be
effectively controlled, with optimum exudate management.
The rest of the treatment was maintained: protection of the skin surround the wound and
short-stretch compression bandages, with protection of bone prominences.
*Brand names: the TLC dressing* is UrgoClean® and the TLC-NOSF dressing* is UrgoStart®

10. RESULTS
The course of both clinical cases presented confirms that the presence of haematoma /
soft pressure ulcer (slough) requires desloughing in order to obtain total epithelialisation of
both wounds after 2 months of treatment.
The evaluation of the dressing applied, in terms of reducing the bacterial load, exudate
management (favouring drainage), odour reduction, convenience of application, enabling
removal in one piece and easy adaptability and an improvement in the quality of life of the
patient.

11. The wounds treated applying the TIME concept enable us to treat the wound bed and
stimulate the scarring process by reducing the oedema, the exudates and the bacterial
load.
Moreover, the use of the TIME concept reduces the economic cost of the treatment of
wounds by making rational and effective use of the dressings and material required for
each healing procedure.
CONCLUSION
*Brand names: the TLC dressing* is UrgoClean® and the TLC-NOSF dressing* is
UrgoStart®