Moisture
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Diagnose and correct or modify treatable causes of tissue damage. | Level of Evidence Not Assessed |
| 2 | Differentiate the wound’s ability to heal: healable, maintenance, or nonhealable wound. | Level of Evidence Not Assessed |
| Address Patient-Centered Concerns | ||
|---|---|---|
| 3 | Assess and support the management of patient-centered concerns to enable healing. | Level of Evidence Not Assessed |
| 4 | Provide patient education and support to increase adherence to treatment plan. | Level of Evidence Not Assessed |
| Provide Local Wound Care | ||
|---|---|---|
| 5 | Assess and monitor the wound history and physical characteristics (location and measure). | Level of Evidence Not Assessed |
| 6 | Debride healable wounds, removing nonviable, contaminated or infected tissue (surgical, autolytic, enzymatic, mechanical, and larval). | Level of Evidence Not Assessed |
| 7 | Cleanse wounds with low-toxicity solutions (eg, normal saline or water). Topical antiseptic solutions should be reserved for wounds that are nonhealable or those in which the bacterial burden is of greater concern than the stimulation of healing. | Level of Evidence Not Assessed |
| 8 | Assess and treat the wound for increased bacterial burden or infection. (Distinguish from persistent inflammation of nonbacterial origin.) | Level of Evidence Not Assessed |
| 9 | Select a dressing that is appropriate for the needs of the wound, the patient, and the caregiver or clinical setting. | Level of Evidence Not Assessed |
| 10 | Monitor the quantity and quality of wound exudation to prevent periwound maceration. | Level of Evidence Not Assessed |
| 11 | Evaluate expected rate of wound healing. If suboptimal, reassess the patient according to recommendations 1 to 9. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 12 | For improved outcomes, education and evidence base must be tied to interprofessional teams with cooperation of health care systems. | Level of Evidence Not Assessed |
Background
Since Winter’s seminal work, numerous studies had confirmed the importance of moisture balance in wound healing irrespective of the dressing categories. Most wounds produce exudate as an integral part of inflammatory response along the normal wound healing trajectory. It is generally accepted that wound drainage diminishes as inflammation subsides followed by a progression to the granulation and re-epithelialization stages of the wound healing process. Chronic wound fluid analysis has demonstrated persistently elevated levels of inflammatory cytokines and proteases over and beyond normal acute wounds. Removal of moisture from wound surface may help to sequester excess proteases to avoid degradation of extracellular matrix and growth factors. On the other hand, inadequate moisture promotes wound desiccation, cell death, and eschar formation. Wound healing is impaired as epithelial cells are required to burrow their way from the wound periphery into the wound center. A balanced moist wound surface may facilitate the activities of leukocytes, fibroblasts, keratinocytes and their metabolites including growth factors and cytokines that are crucial to tissue proliferation.Selection of dressing materials and frequency of dressing change must be tailored to meet the needs of the patients and the wound characteristics. From a functional perspective, dressings can be categorized on a continuum according to their abilities to absorb fluid and donate moisture.
In general, foam dressing and hydrofiber are absorbent while hydrogel is used to provide moisture to wounds. Film and hydrocolloid are occlusive to entrap moisture.
References
| Essential Publications |
|---|
| 1 | Dressings |
Quality Indicator
|
Type: Narrative Review |
| Harding KG, Jones V, Price P. Topical treatment: which dressing to choose. Diabetes Metab Res Rev 2000;16(Suppl 1):S47-50. | |||
| Various dressings that provide a moist environment for the wound area are discussed in this paper. There is a lack of evidence showing that these dressings improve healing of chronic wounds, but these dressings have been proven to be beneficial to patients due to reduction in pain, odour, and wound leakage. Types of moist dressings described in this paper include films, foams, hydrogels, hydrocolloids, alginates, and medicated dressings. | |||
| 2 | Dressings |
Quality Indicator
|
Type: Narrative Review |
| Hilton JR, Williams DT, Beuker B, Miller DR, Harding KG. Wound dressings in diabetic foot disease. Clinical Infectious Diseases 2004;39(Suppl 2):S100-3. | |||
| In this paper, various dressings are evaluated based on the needs of patients with diabetic foot ulcers. Types of dressings analyzed in this paper include nonadhesive dressings, foam and alginate dressings, hydrogels, dressings containing inidine and silver, and occlusive dressings. | |||
| 3 | Dressings - Foam |
Quality Indicator
|
Type: Prospective Correlation study |
| Zoellner P, Kapp H, Smola H. A prospective, open-label study to assess the clinical performance of a foam dressing in the management of chronic wounds. Ostomy Wound Manage 2006;52(5):34-6, 38, 40-2 passim. | |||
| The purpose of this study was to evaluate the efficacy of polyurethane foam dressing in wound healing and patient pain tolerance. The use of foam dressings was associated with improved wound healing and reduced pain levels. The authors conclude that foam dressings are effective for treating exuding chronic wounds. | |||
| 4 | Moist wound healing |
Quality Indicator
|
Type: Prospective Correlation study |
| Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293-294. | |||
| This is the original study of wound healing in the skin of pedigree Large White pigs 12-14 weeks old. Experimental wounds were kept moist using polythene film while the control wounds on the same animals were kept open to the air. The moist wounds were found to epithelialize more quickly than the dry wounds. This study has influenced our understanding of the importance of moisture in wound healing. | |||
| 5 | Moisture balance |
Quality Indicator
|
Type: Narrative Review |
| Okan D, Woo K, Ayello EA, Sibbald RG. The role of moisture balance in wound healing. Adv Skin Wound Care 2007;20(1):39-53. | |||
| An overview of moisture balance and its importance in wound healing is presented in this article. Detailed recommendations for wound assessment and treatment that incorporate moisture balance were provided. Absorbent and hydrating dressings, various other dressings such as crystalline saline, and wound pouching and negative pressure therapy are discussed as treatment options. | |||
| 6 | Platelet-derived growth factor |
Quality Indicator
|
Type: RCT |
| Steed DL. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers. Plastic and Reconstructive Surgery 2006;117(7S):143S-149S. | |||
| The efficacy and safety of platelet-derived growth factor in wound care was evaluated in this study. 922 patients participated in this blinded study that compared platelet-derived growth factor with a placebo. Treatment with platelet-derived growth factor significantly increased complete healing (p < 0.001) and significantly reduced healing time (p = 0.01). Both groups experienced similar adverse events and recurrence rates. The author concluded that platelet-derived growth factor was effective at treating diabetic foot ulcers. | |||