ABSTRACT
A refractory pressure ulcer should be treated not only by surgery but also with team medical care in order to avoid recurrence after the initial treatment. At our hospital, plastic surgeons are responsible for organizing the team care. As part of the team care strategy, physical therapists (PTs) and occupational therapists (OTs) provide education to improve the mobility of spinal-cord-injury patients, e.g., improving muscle strength of the upper extremities for adequate transfer and ability to perform wheelchair push ups. For elderly patients, nurses assess the risk of pressure ulcer development using the Braden's scale and set up a nutrition support team. Additionally, if patients have difficulty swallowing, a speech therapist treats the dysphagia. And PTs and OTs treat their impaired activities of daily living. Finally, medical social workers arrange home-health-care services when the patient returns to their home. The management of chronic wounds has progressed from merely assessing the status of the wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation, TIME, has simultaneously evolved to provide a systematic approach to removing the barriers to natural healing and enhancing the effectiveness of advanced therapies. Wound bed preparation and the TIME framework are most likely to be successful when used alongside the wound bed preparation care cycle.