Moist Wound Healing

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC The big debate continues in regards to using wet-to-dry dressings. One thing that is for certain though is that this type of dressing is frowned upon in long-term care facilities per the National Pressure Ulcer Advisory Panel (NPUAP) Guidelines for pressure ulcers. However, long-term care facilities are put at risk for citations when using wet-to-dry dressings for any wound type.

By: Emily Greenstein, APRN, CNP, CWON, FACCWS Being a wound care professional is often a lot like being a detective. You have to decide what caused the wound, what is contributing to its not healing and how you are going to get it to heal. I have decided to start a series of “cases” that are commonly overlooked or seen in the chronic wound care setting. The cases will focus on real-life scenarios—moisture-associated skin damage versus pressure injury, red leg syndrome versus venous stasis ulcer, how to identify pyoderma, and the importance of a moist wound healing environment. This series will also provide practical strategies for overcoming healing obstacles for slow, non-healing, and challenging wounds.

Wound bed preparation is vital to treating biofilm. Resistant to antibiotic treatment, biofilm not only stalls the healing process of chronic wounds but also puts patients at greater risk for amputation. Clinicians should follow the process of successful wound healing described in the TIMERS framework (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement, Repair/regeneration, and Social factors) to guide wound care. Proper wound bed preparation recognizes that biofilm prevention and treatment in chronic wounds incorporate aggressive wound debridement to suppress biofilm regrowth, disrupt the bacterial burden, and promote a healthy wound bed environment

By Bruce E. Ruben MD In the beginning, long before Johnson met Johnson and Band-Aids were invented, primitive men and women suffered minor cuts and abrasions and probably left them uncovered to heal. After all, the bleeding had stopped, a scab eventually formed and experience had taught them that their skin would heal in a week or two. So there was no great rush to find a use for those puffy, cottony, soft, white plants growing in the fields just yet.

Effective wound management often requires attending to multiple aspects of the wound itself, including properly preparing the wound bed and managing moisture and exudate, among other facets of wound care. Tissue viability is another crucial aspect of wound management. Unfortunately, many types of wounds, including acute and chronic wounds, contain devitalized tissue. Devitalized tissue inhibits healing in multiple ways. It can serve as a source of nutrients for bacteria, especially if the tissue is necrotic. Devitalized tissue also acts as a physical barrier for re-epithelialization, thereby preventing topical compounds from penetrating the wound bed when required. Further, this tissue can prevent angiogenesis, granulation tissue formation, epidermal resurfacing, and standard extracellular matrix (ECM) formation. It can also cover the wound and render it difficult for clinicians to assess the extent and severity of the wound adequately.

Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP Payne and Martin brought skin tears to the attention of wound and skin specialists and to the wound care community when they reported an incidence rate of 2.23% in individuals aged 55 years and older, living in a long-term care facility. A skin tear is "a wound caused by shear, friction, and/or blunt force resulting in a separation of skin layers." Skin tears may be partial- or full-thickness wounds, develop into chronic wounds without proper treatment and follow-up, and, most importantly, are preventable.

By the WoundSource Editors The concept of wound bed preparation has been utilized and accepted for over two decades. Wound bed preparation techniques can only be accurately employed after a thorough and complete assessment of the wound. Poor assessments result in a negative impact of needless costs and truancy of appropriate treatments and outcomes. The goal of wound bed preparation is to provide an optimal wound healing environment. Up-to-date research in molecular science has helped evolve new technology and advanced therapies that include growth factors, growing cells in vitro, and developing bioengineered tissue. Researchers now know that the healing process involves an array of elements that require monitoring and attentiveness.

By Keval Parikh and James McGuire DPM, PT, CPed, FAPWHc There are many different kinds of >wound dressings available. Choosing one to use depends on the unique characteristics of the wound. According to Watson and Hodgkin, the ideal wound dressing should exhibit a number of characteristics by providing the following: moisture and exudate management, prevention of saturation and strikethrough, diffusion of wound gases, microorganism protection, mechanical protection; localized temperature and pH control; removal/change comfort; wound odor management; cosmetic acceptability; non-allergenic composition; non-contamination of the wound bed; and cost-effectiveness.