
{"id":49,"date":"2023-11-30T10:12:32","date_gmt":"2023-11-30T10:12:32","guid":{"rendered":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/?page_id=49"},"modified":"2026-05-15T09:15:59","modified_gmt":"2026-05-15T08:15:59","slug":"wounds","status":"publish","type":"page","link":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/conditions\/wounds\/","title":{"rendered":"Wounds"},"content":{"rendered":"<p>Assessment is the foundation of all clinical practice; without a robust holistic assessment it is difficult to achieve a clear management plan.<\/p>\n<p>This section provides information and tools to aid clinicians in clinical practice and to support them to develop clear and achievable management plans.<\/p>\n<h2>Guidelines<\/h2>\n<h2><span style=\"font-size: 16px\">The following guidelines are available to assist clinicians:<\/span><\/h2>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/Oxfordshire_guidelines_for_managing_bacterial_loads_in_wounds_v2.sflb_1.pdf\">Oxfordshire Guidelines for Managing Bacterial Loads in Wounds\u00a0<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/Wound-management-standard-V7-FINAL-Feb-2019.docx\">Wound management standard V7 Feb 2019<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Wound prevention, assessment &amp; management<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>We advocate the use of TIMES principles to provide a systematic approach to the assessment and management of wounds. TIME is based on assessment and intervention in four clinical areas with the aim of producing a well vascularised wound bed that facilitates the effectiveness of other therapeutic measures.<\/p>\n<p>The objectives underpinning TIME are:<\/p>\n<ul>\n<li><strong>T<\/strong>\u00a0 &#8211;\u00a0Tissue \u2013 assess for and treat any non-viable or deficient tissue<\/li>\n<li><strong>I<\/strong>\u00a0&#8211; \u00a0 Infection or Inflammation \u2013 identify and treat<\/li>\n<li><strong>M<\/strong>&#8211; \u00a0Moisture Imbalance \u2013 restore balance<\/li>\n<li><strong>E<\/strong> &#8211;\u00a0 Edges\/Epidermal Margin\u00a0 \u2013 identify and optimize wound edges<\/li>\n<li><strong>S<\/strong> &#8211; Surrounding Skin &#8211; identify and treat any issues with the surrounding skin<\/li>\n<\/ul>\n<p>This framework should be used in addition to obtaining a complete and in-depth medical history and discussion with the patient (and relatives\/NOK if appropriate). Regular assessment and review of wound surface area, depth and undermining are also crucial when formulating a management plan. Wound photography is an invaluable tool to monitor progress or deterioration in the wound. Wound photography and mapping are both also fantastic tools in encouraging active participation with patients and can provide a real boost to patient morale.<\/p>\n<p>The following tools and documents are available to assist clinicians and can be found under the resources Tab:<\/p>\n<ul>\n<li>Abbey pain scale progress sheet<a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/wound-assessment-toggle-new.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-185308 size-medium\" src=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/wound-assessment-toggle-new-224x300.jpg\" alt=\"wound assessment toggle - new\" width=\"224\" height=\"300\" \/><\/a><\/li>\n<li>AMBL2 Tool \u2013 Assessment\/management of bacterial loading in wounds<\/li>\n<li>Calculating wound surface area\/size reduction<\/li>\n<li>Lower limb assessment form<\/li>\n<li>Pain assessment and management leaflet<\/li>\n<li>Skin barrier management pathway<\/li>\n<li>Potassium Permanganate Procedure<\/li>\n<li>Protocol for the use of Topical Steroids in Wound Care<\/li>\n<li>Wound assessment and evaluation form<\/li>\n<li>Wound healing pathway\/risk tool<\/li>\n<\/ul>\n<p><strong>Want to find out more about wound assessment &amp; management?<br \/>\nHead to the training tab where you can find information about how to book on to our training sessions and access our training resources via the Training &amp; Resources tabs.<\/strong><\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Wound Infection and Biofilm<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/Biofilm-Wound-Care-Pathway-V1.pdf\">Biofilm Wound Care Pathway<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/AMBL2-V1.pdf\">AMBL2 Tool<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Oxfordshire Wound Management Formulary<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>It is important that within the NHS we are able to justify our clinical decisions and expenditure on wound management products. In Oxfordshire we currently spend \u00a31.8 million annually on dressings, bandages and tapes; therefore the wound management formulary has been developed with the explicit aims of:<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-422 alignright\" src=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/09\/Wound-Care-Formulary-picture-213x300.png\" alt=\"\" width=\"148\" height=\"208\" srcset=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/09\/Wound-Care-Formulary-picture-213x300.png 213w, https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/09\/Wound-Care-Formulary-picture.png 508w\" sizes=\"auto, (max-width: 148px) 100vw, 148px\" \/><\/p>\n<ul>\n<li>Promoting evidence based practice by providing a framework within\u00a0which it is safe to practice<\/li>\n<li>Encouraging safe, effective and appropriate use of dressings<\/li>\n<li>Promoting continuity of care<\/li>\n<li>Promoting rational prescribing<\/li>\n<li>Promoting cost effectiveness<\/li>\n<\/ul>\n<p>Product selection should be based upon a comprehensive and holistic assessment of the patient and their wound. Once the wound aetiology and the intended treatment outcome have been confirmed, an appropriate product can be selected. If a patients wound fails to progress as expected then a referral to tissue viability should be considered.<\/p>\n<p>The wound management formulary was revised in 2025 by Berkshire, Oxfordshire and Buckinghamshire [BOB] ICB alongside the TVN teams for these respective areas. The formulary went live in Oxfordshire on 1st August 2025.<\/p>\n<p><strong>We have updated our Wound Care Formulary document to reflect these new changes. You can access the new formulary here:<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2026\/05\/Wound-Care-Formulary-May-26-1.pdf\">Wound Care Formulary May 26 1<\/a><\/li>\n<\/ul>\n<p>A summary spreadsheet of the formulary highlighting the changes can be found here:<\/p>\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/07\/BOB-Oxfordshire-Wound-Formulary-Summary-2025-website-version.xlsx\">BOB Oxfordshire Wound Formulary Summary 2025 website version<\/a>.<\/li>\n<\/ul>\n<p>If you were unable to attend one of the Formulary Launch bitesize training sessions, you can watch a recording of the sessions <a href=\"https:\/\/www.youtube.com\/watch?v=EN32XV8j5yQ\">here<\/a>. If you would like to access the formulary launch presentation you can do so <a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/07\/BOB-Wound-Formulary-launch-OXCON-Bitesize-training.pdf\">here<\/a>.<\/p>\n<p>Please see additional resources to support you with the move to the new formulary below:<\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2026\/04\/OHFT-OUH-Wound-Formulary-Comparison-Guidance-V2Nov25.pdf\">OHFT-OUH Wound Formulary Comparison Guidance V2Nov25<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/07\/Hartman-RespoSorb-Silicone-Border-training.pdf\">Hartman RespoSorb Silicone Border training<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/07\/Haddenham-Healthcare-Clinistretch-support.pdf\">Haddenham Healthcare &#8211; Clinistretch support<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>We value your feedback, if you are experiencing any challenges with specific products on the formulary, you can complete a feedback from via your HALO account. This will allow us to collate any concerns and review the products as necessary.<\/p>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Skin Tears<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-228900 alignright\" src=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/skin-tears.jpg\" alt=\"\" width=\"217\" height=\"173\" \/>Skin tears are acute, traumatic wounds caused by the mechanical forces of shear, friction or trauma, including the removal of adhesives, resulting in a partial or complete separation of the outer skin layers from the inner tissue (ISTAP, 2018). They can occur anywhere on the body but are most commonly seen on the hands, arms and lower legs. 70\u201380% of skin tears occur on hands or arms. Skin tears can be painful and distressing for the patient.<\/p>\n<p>It is estimated that prevalence of skin tears may be underreported and in fact be greater than pressure ulcers. To date, no prevalence data is available for the UK, so the cost to patients and the NHS is not fully known. The ageing population means that incidence of skin tears is increasing (elderly patients have fragile skin and are at increased risk)<\/p>\n<p>Skin must be protected in at-risk patients and skin tears managed to avoid further damage and prevent progression from an acute to a more chronic, potentially hard to heal wound.<\/p>\n<ul>\n<li>Skin Tear Pathway &#8211;\u00a0<a href=\"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/conditions\/resources\/\">Resources &#8211; Tissue Viability<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/Skin-Tear-Pathway-Training-Presentation.pdf\">Skin Tear Pathway Training Presentation<\/a><\/li>\n<li>Skin Tear Pathway Training video is available on the \u00a0<a href=\"https:\/\/www.youtube.com\/playlist?list=PLKw7kjGJdcXA3hhckrvMnbPDpL2c-fHoE\">Tissue Viability\u00a0training playlist<\/a><\/li>\n<\/ul>\n<h3>Management of skin tears in residential homes<\/h3>\n<p>The following resources are available to support Care Leaders in Residential Homes in providing 1<sup>st<\/sup> Aid to a skin tear:<\/p>\n<ul>\n<li>Skin Tear Pathway (V2 &#8211; For leaders in residential homes) &#8211; <a href=\"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/conditions\/resources\/\">Resources &#8211; Tissue Viability<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/Skin-Tear-Pathway-V2-Training-Presentation-Care-Leaders-in-Residential-Homes.pdf\">Skin Tear Pathway V2 Training Presentation &#8211; Care Leaders in Residential Homes<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/Skin-Tear-Pathway-Competency-Checklist-for-Care-Leaders-in-Residential-Homes.pdf\">Skin Tear Pathway Competency Checklist for Care Leaders in Residential Homes<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Burns<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<ul>\n<li>Oxfordshire Community Burns Wound Pathway &#8211; <a href=\"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/conditions\/resources\/\">Resources &#8211; Tissue Viability<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2024\/05\/Oxfordshire-Community-Burns-Wound-Guidance.docx\">Oxfordshire Community Burns Wound Guidance<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2024\/05\/Burns-First-Aid-Guidelines.docx\">Burns First Aid Guidelines<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">Haematomas<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<ul>\n<li>Haematoma Pathway &#8211;\u00a0<a href=\"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/conditions\/resources\/\">Resources &#8211; Tissue Viability<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/details>\n<details class=\"nhsuk-details nhsuk-expander\">\n                    <summary class=\"nhsuk-details__summary\">\n                        <span class=\"nhsuk-details__summary-text\">VAC therapy<\/span>\n                    <\/summary>\n                    <div class=\"nhsuk-details__text\">\n<p>Negative Pressure Wound Therapy (NPWT)\u00a0is the use of controlled suction to promote healing. \u2018VAC\u2019 is often used generically to denote NPWT, and means \u2018Vacuum assisted closure.\u2019 NPWT is helpful for promoting healing in circumstances where tissue perfusion is compromised, and also in some cases where excessive exudate cannot be controlled by other means.<\/p>\n<p>NPWT involves applying a suction force (i.e. vacuum) across a sealed wound, using a reticulated foam interface or specified types of gauze.\u00a0 Both the suction effect and the mechanical forces generated at the interface with the wound lead to a variety of changes in the wound, positively influencing the healing process.<\/p>\n<p>Please follow the links below for further information and guidance.<\/p>\n<ul>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/06\/VAC-Discharge-Process-Version-7-June-25.docx\">VAC Discharge Process (Version 7 June 25)<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/VAC-counting-in-and-out-dovument-V1.2-01.02.21.pdf\">VAC counting in and out document<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/Protocol_for_the_use_of_Negative_Pressure_Wound_Therapy_3_V2_2.sflb_.docx\">Protocol for the use of Negative Pressure Wound Therapy (NPWT) in the community<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/ActiVAC-User-Manual.pdf\">ActiVAC User Manual<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/08\/VAC-Therapy-Competency-Framework-Version-2.0-07-08-25.doc\">VAC-Therapy-Competency-Framework-Version-2.0-07-08-25<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/VAC-Therapy-Basic-Dressing-Application-Guide.pdf\">VAC Therapy &#8211; Basic Dressing Application Guide<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/VAC-Therapy-Patient-Information-Booklet.pdf\">VAC Therapy &#8211; Patient Information Booklet<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2025\/08\/SOLVENTUM-Wound-Therapy-Patient-Passport.pdf\">SOLVENTUM &#8211; Wound Therapy Patient Passport<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2024\/09\/VAC-Picture-Framing-Liner.pdf\">VAC &#8211; Picture Framing Liner<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/ActiVAC-Trouble-Shooting-Guide-DSL14-0481.UK-REV11-14.pdf\">ActiVAC Trouble Shooting Guide<\/a><\/li>\n<li><a href=\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/sites\/51\/2024\/09\/VAC-Training-Videos-Resources.docx\">VAC Training Videos Resources<\/a><\/li>\n<\/ul>\n<\/div>\n                <\/details>\n","protected":false},"excerpt":{"rendered":"<p>Assessment is the foundation of all clinical practice; without a robust holistic assessment it is difficult to achieve a clear&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":23,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-49","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/49","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/comments?post=49"}],"version-history":[{"count":48,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/49\/revisions"}],"predecessor-version":[{"id":539,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/49\/revisions\/539"}],"up":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/23"}],"wp:attachment":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/media?parent=49"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}