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Use of TIME in treating a hard-to-heal localised scleroderma wound

01 April 2021

Abstract

Objective:

Localised scleroderma is a rare disease and the wound is difficult to heal because of tissue fibrosis. We present the case of a patient with localised scleroderma treated using the TIME (tissue, infection or inflammation, moisture and edge of wound) clinical decision support tool (CDST) for wound management. This includes: assessment, bringing, control, decision and evaluation (the ABCDE approach). The patient was fully evaluated and multidisciplinary teams were involved in wound treatment. Complications of wound healing were controlled and treated, and the wound was continuously assessed until it healed.

Conclusion:

This method of wound management provides a sound theory for the evaluation and management of hard-to-heal wounds and is worthy of clinical application.

Localised scleroderma, also known as morphoea, is a rare autoimmune disease.1 The incidence of the disease is between 0.4 and 2.7 people per 100,000.2 It is caused by excessive subcutaneous collagen deposition which leads to tissue thickening, scarring and fibrosis.3 The clinical manifestation includes flaky, itchy skin lesions, which impair the barrier function of skin. Due to fibrosis of the affected tissue and vascular occlusion, once a skin lesions bursts, the wound can become difficult to heal.

The TIME principle (tissue, infection/inflammation, moisture and edge of wound) has been widely used in wound practice.4,5 However, it only focuses on the wound and does not completely meet the holistic needs of clinical practice.6 The TIME clinical decision support tool (TIME CDST) evolved from the TIME principle, and provides a sound theory for assessing and managing hard-to-heal wounds.7 The TIME CDST consists of five parts:

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