The Use of Moist Dressings in the Wound Bed

For years, wound care theory revolved around the idea that a wound bed should be kept dry. The thought was that a moist environment equaled an increased chance of infection. Thanks to George Winter's research in the 1960s, moist-wound healing has become a staple in wound care today.

History

• George Winter, a British-born physician, is known as the pioneer of moist-wound healing. His research showed that wounds that were kept moist healed faster than wounds which were kept dry and allowed to scab over. He performed his research by creating wounds on the backs of pigs, and tried to heal them by either a moist or dry method. His research still holds true today, as moist-wound healing is still the preferred method of treatment for physicians and wound care experts worldwide.

Benefits

• There are numerous benefits to moist-wound healing, with the most important of course being decreased healing time and risk of infection. This is accomplished by allowing newly formed skin cells to move across the wound bed more freely. Not only is the moist environment important, wound bed temperature is also an important factor. This is where the new age of dressings are so vital. They are designed to be left on a wound up to seven days, thus helping maintain a high wound bed temperature and an optimum healing environment.

Dressing Types

• There are numerous dressing types out there which either hydrate a dry wound bed or absorb excess drainage while maintaining a moist-wound bed, so only the basics will be covered

  Hydrogels: These are pre-moistened sheets of polymer gels created with the sole purpose of hydrating a wound bed. These can be used to loosen and debride slough and/or eschar, but is not traumatic to the easily friable granulation tissue that is vital to wound closure.

  Alginates: These are highly absorptive dressings actually composed of seaweed components. When exudate comes into contact with this dressing, it turns to a gel, which can continue to absorb drainage while keeping the wound bed moist.

  Hydrocolloids: These are similar to Alginates in that they can absorb a moderate amount of drainage while maintaining a moist-wound bed. The benefit to using this type of dressing is that they are typically self cohesive and do not need a secondary dressing to keep it in the wound bed.

Theories/Speculation

• Research has shown that the more frequently a dressing is changed, the more the temperature of the wound bed (remember, skin can normally maintain body temperature, but a wound is basically a hole in the skin) is lowered, according to journalofwoundcare.com. Newer dressings can absorb a moderate amount of drainage while keeping the wound bed moist at the same time. This eliminates the need for multiple dressing changes per day, thus allowing the wound bed's temperature to stay elevated. This creates an optimal environment for wound healing and give it the best chance to heal.

Considerations

• The main consideration when choosing the right dressing to keep a wound bed moist is the amount of drainage the wound is producing. For example, a hydrogel should not be placed in a wound which is producing a moderate to large amount of drainage. The wound bed will be moist, but so will the peri-wound, which can increase the size of the wound and can increase the risk of infection. Hydrogels should only be used when there is little to no drainage. Alginates/Hydrocolloids should be considered if there is a moderate amount of drainage coming from the wound. If you have tried these options, and the wound is still macerated with multiple dressing changes per day, then other options should be considered, such as negative pressure therapy. This provides either constant or intermittent suction on a wound, removing drainage and debris from the wound bed, and helps to close the wound faster than with traditional dressings.