One of the most important factors in facilitating wound healing is dressing the wound appropriately to maximize healing.
The Ideal Wound dressing is….
Moist: A moist wound environment provides the ideal environment for healing. Moisture promotes the growth of new blood vessels, angiogenesis. It allows for the formation of “granulation” tissue, which is full of macrophages (white blood cells to kill infection); it keeps the wound soft, preventing or delaying fibrous granulation tissue (tough tissue that won’t pull together to heal) from forming, and it promotes growth factors (cytokines). Moisture also helps the body automatically slough off dead tissue (autolytic debridement), keeping the area cleaner, and helps to grow new skin (epithelialization.)
Provides: Warmth, protection, absorption.
Prevents Maceration: maceration, what we call “pruney” fingers or toes, happens when the skin is too moist, and the skin becomes over hydrated, wrinkles, and lets out carbon dioxide.
The Doctor needs to match the wound dressing to the situation. Absorbency, adhesiveness, moisture retention, permeability, frequency of change, ease of use, safety, efficacy, and cost: all of these factors combine to a complex decision making process.
Wound dressings can be broken down into three broad categories:
1. Passive – cover the wound, create a barrier between the bound bed and the outside world, allows exchange of gases & liquids, may absorb fluid, may create a moist healing environment. Ex: gauze, adhesive bandages, foam dressing, hydrocolloids, hydrogels.
2. Active – activates the microenvironment and stimulates healing by facilitating chemical reactions and biochemical processes, moisture control, bacteria reductions. Ex: hydrocolloids, hydrogels, silver impregnated products.
3. Biologic – Adds new materials to the wound bed, living cells, collagen, growth factors. Ex: grafts, living skin equivalents, scaffolds, collagen products.
Wound care is one of the largest and fastest areas of growth in the medical industry and will be addressed in later posts.