Advanced Wound Care Clinic
TIMERS
the wound bed preparation framework used at every visit, Tissue, Infection/Inflammation, Moisture, Edge, Regeneration, Social factors
Atkin et al., J Wound Care 2019 (TIMERS update of original Falanga TIME 2004)
ABPI first
every leg wound is risk-stratified by Ankle-Brachial Pressure Index before any compression is applied
NICE NG19, NICE CG168/QS67, National Wound Care Strategy Programme
~70%
of chronic leg ulcers seen in the UK are venous in origin, a category that requires both wound care and treatment of the underlying venous reflux
NICE QS67, ESVS 2022 Clinical Practice Guidelines on Chronic Venous Disease
The Tissue Viability Nurse role at KONCEPT® is delivered in line with the NMC Code (Nursing and Midwifery Council, 2018, updated 2023) and contemporary Tissue Viability Society and Royal College of Nursing competency frameworks. The TVN works within an explicit scope of practice agreed with the supervising Consultant Vascular & Endovascular Surgeon, with clear escalation criteria for findings outside that scope (active limb-threatening ischaemia, suspected osteomyelitis, suspected malignancy in a wound, Charcot foot, fast-spreading infection or systemic sepsis).
The clinic operates under the National Wound Care Strategy Programme (NHS England) minimum-standards framework for assessment, documentation and pathway selection, which is the reference UK NHS standard for chronic-wound care in 2024 to 2026.
Every wound is assessed against the TIMERS framework, Tissue, Infection/Inflammation, Moisture, Edge, Regeneration, Social factors, published by Atkin et al., J Wound Care 2019, as an update to the original TIME framework (Falanga, Wound Repair Regen 2004). Findings are documented in the clinical record with wound measurements (length, width, depth, undermining) and photographs.
The wound is classified by aetiology, because management differs by category. The categories follow NICE and ESVS guideline definitions:
Per NICE NG19, NICE CG168/QS67 and the National Wound Care Strategy Programme, every patient with a leg wound has the Ankle-Brachial Pressure Index measured before any compression is applied. The result determines the safe compression class:
| ABPI | Compression decision |
|---|---|
| 0.8 to 1.3 | Full compression therapy can be applied |
| 0.5 to 0.79 | Modified or reduced compression only, with vascular input |
| Below 0.5 | No compression, urgent vascular referral |
| Above 1.3 | Calcified vessels, full vascular assessment before any compression |
ABPI is part of the wound clinic visit and is performed on the same day where clinically indicated. Where vessels are calcified, toe pressures or arterial duplex are arranged.
Wound bed preparation is delivered in line with the TIMERS framework. Sharp debridement of non-viable tissue and biofilm management are performed under local anaesthetic where clinically indicated, within the agreed TVN scope and with escalation to the surgeon where deeper debridement is required. Autolytic, enzymatic and mechanical debridement strategies are used as appropriate.
Dressings are selected based on the assessed wound bed and exudate level. The clinic uses standard NHS-supply-formulary equivalents, advanced dressings (foam, alginate, hydrofibre, hydrocolloid, silver and iodine where infection-controlled, super-absorbent dressings) and biologic dressings where indicated, including the Kerecis® Omega3 Wound acellular fish-skin matrix for selected non-healing wounds.
Where ABPI permits and the underlying cause has been addressed, compression is fitted in line with the British National Formulary class system (Class 1, 2, 3) and the NICE QS67 venous-ulcer pathway. See the compression therapy page for the device range.
Negative pressure wound therapy is considered for selected wounds based on the published indications and contraindications (subatmospheric pressure applied to a wound to promote granulation, manage exudate and reduce dressing frequency). It is not used over untreated osteomyelitis, untreated infection, malignancy in the wound, or where arterial supply is inadequate without revascularisation. Patient selection and device parameters are agreed with the supervising consultant.
Findings outside the TVN scope are escalated, on the day where urgent, to:
The NHS provides comprehensive wound-care services through district nurses, community Tissue Viability teams and acute vascular surgery. The NHS pathway remains the right route for many patients. KONCEPT® is designed to complement, not replace, that care.
| Step | Standard NHS approach | What KONCEPT® adds |
|---|---|---|
| Access to a Tissue Viability service | Referral via GP or district nurse, then to community or acute TVN team. Timing varies by region and local provision | Direct booking with an NMC-registered TVN. Same-week appointments subject to availability |
| Structured wound assessment | Variable by service provider. National Wound Care Strategy Programme is the reference standard the NHS is rolling out | TIMERS-framework assessment, photographs and ABPI on the same visit where clinically indicated |
| Advanced dressings and biologics | Provided where local-formulary guidance applies, subject to NHS prescribing pathways | Day-case advanced wound care including Kerecis® Omega3 Wound fish-skin graft where clinically appropriate |
| Onward vascular input | Vascular outpatient referral, timing varies by region, specialty and clinical urgency | Same-site Consultant Vascular & Endovascular Surgeon escalation pathway |
| Continuity with your NHS GP | Hospital and community letter to your NHS GP after each visit, subject to local processes | Clinical summary letter to your NHS GP on request, with your consent, after each KONCEPT® visit |
NHS provision varies by region and clinical context, and the NHS pathway remains appropriate for many patients. KONCEPT® encourages continued NHS GP involvement and shares clinical summaries with your NHS GP on request.
These are the situations where the wound clinic is not the appropriate first stop and the safer route is elsewhere:
KONCEPT® serves patients across Kingston upon Thames, Surbiton, New Malden, Wimbledon, Richmond upon Thames, Putney, Teddington, Hampton, Esher, Cobham, Walton-on-Thames, Thames Ditton and Twickenham. The clinic sits opposite Kingston railway station (Waterloo 28 minutes direct), with parking nearby and easy access off the A3 from Wimbledon, Putney and central London.
A Tissue Viability Nurse (TVN) is a Nursing and Midwifery Council registered nurse with specialist competency in the assessment and management of complex wounds. The role is defined by the Tissue Viability Society and supported by the Royal College of Nursing. At KONCEPT®, the TVN practises within an agreed scope under the supervision of a Consultant Vascular & Endovascular Surgeon.
The terms are sometimes used interchangeably. In the UK, “Tissue Viability Nurse” specifically denotes a nurse with advanced wound-care competency, working within an explicit scope of practice and usually with consultant oversight. “Wound care nurse” is a more general term.
Chronic and non-healing wounds, including venous leg ulcers, arterial and mixed ulcers, diabetic foot ulcers, pressure ulcers, post-surgical wounds with delayed healing, traumatic wounds and lymphovenous ulcers.
TIMERS stands for Tissue, Infection/Inflammation, Moisture, Edge, Regeneration and Social factors. It is the wound bed preparation framework published by Atkin et al. in the Journal of Wound Care in 2019, an update of the original TIME framework (Falanga 2004). It is the structured approach used at every visit at our clinic.
Per NICE NG19, NICE CG168/QS67 and the National Wound Care Strategy Programme, the Ankle-Brachial Pressure Index is measured before any compression is applied because compression on a leg with undiagnosed arterial disease can cause tissue damage. ABPI risk-stratifies the safe class of compression and identifies patients who need urgent vascular input.
Debridement is the removal of non-viable or contaminated tissue from a wound bed to allow healthy granulation tissue to form. Methods include sharp debridement (with a scalpel or curette, under local anaesthetic where indicated), autolytic debridement (with moisture-retentive dressings), enzymatic debridement and mechanical debridement. The method chosen depends on the wound and the patient.
Negative pressure wound therapy (NPWT) is a treatment that applies controlled subatmospheric pressure to a wound through a sealed dressing connected to a pump. It can promote granulation, manage exudate and reduce dressing frequency in selected wounds. It is not used over untreated osteomyelitis, untreated infection, malignancy in the wound, or where arterial supply is inadequate without revascularisation.
A fish-skin graft (we use Kerecis® Omega3 Wound) is considered for selected non-healing wounds where standard care has not achieved closure and the wound bed is ready. See the Kerecis® fish-skin grafts page for the full pathway and evidence base.
No, for self-pay patients you can book directly. Most insurers also allow direct booking. A small number still require a GP referral letter, we will confirm what your insurer needs when you enquire.
Most wound-care activities are not painful. Where sharp debridement is needed, local anaesthetic is used. Pain is assessed at every visit and managed actively, including with topical analgesics during dressing changes where indicated.
The schedule depends on the wound. Some wounds need weekly visits, others fortnightly, and some, as the wound stabilises, every 3 to 4 weeks. The TVN sets the schedule at each visit and adjusts as the wound responds.
With your consent, yes. A clinical summary letter is shared with your NHS GP after each visit on request.
Self-pay fees for the consultation, ABPI, structured wound assessment, dressings and any procedures are published on the vascular surgery pricing page. A written quote is provided before any procedure is booked.
46–48 Wood Street, Kingston upon Thames, KT1 1UW. Opposite Kingston railway station (Waterloo direct, 28 minutes). Parking is available nearby. The clinic is on the ground floor and step-free.
Book a Tissue Viability Nurse appointment in Kingston. The first visit identifies the wound aetiology, sets out a structured plan, and arranges any same-site escalation to the consultant or to the diabetic foot service.