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Dry Wound VS Moist Wound, Which Heals Faster? How to Choose Wound Dressings? Wound Care Tips Remeds


Dry Wound VS Moist Wound, Which Heals Faster?  Wound Care Tips by Wound Specialist Remeds
Dry Wound VS Moist Wound, Which Heals Faster? Wound Care Tips by Wound Specialist Remeds

Traditionally, we've been told that wounds should be kept clean and dry, and the scab formation is a good sign that the wound is healing, but what if this theory is fundamentally flawed?


Dry wound healing, with its emphasis on scab formation, may hinder the overall speed of healing. The scab, while protective, can act as a physical barrier, limiting the movement of essential cells involved in tissue repair, hence re-epithelialization is slowed down.


Scab formation and excessive dryness can also contribute to heightened scar formation. In some instances, the lack of moisture may cause the wound to contract excessively, resulting in larger and more prominent scars.

If dry wound healing is not the best way to manage most superficial wounds, what would be the alternative practice for wound healing?




Scab formation slows down the wound closure and may result in scarring
Scab formation slows down the wound closure and may result in scarring


Moist wound healing, on the other hand, has gained prominence in recent years as a preferred approach in wound care, and for good reason. This method involves maintaining a controlled, moist environment around a wound during the healing process.


The theory of Moist Wound Healing was first introduced by Dr. George D Winter in 1962 when he discovered that superficial wounds healed 2 times faster in a moist environment compared to a dry environment.[1] This practice is further supported by subsequent studies and generally adopted by professionals nowadays.


Here are several reasons why moist wound healing is the preferred approach:

  • Promotes optimal tissue regeneration - epidermal cells can move smoothly across the surface of the wound for re-epithelialization in a moist environment.

  • Promotes autolysis of necrotic tissue in the wound - moist environment allows endogenous proteolytic enzymes to break down dead tissue. This can contribute to a cleaner wound bed and faster healing.

  • Reduces scarring.

  • Minimizes pain and discomfort.

  • Prevent tissue dehydration and death.


When to Consider for Moist Wound Healing:
  • Chronic Wounds

  • Pressure Ulcers

  • Surgical Wounds

  • Superficial Wounds

  • Wounds in aesthetically sensitive areas


How to Create Moist Wound Environment?

The key to creating a moist wound healing environment is to choose the right type of dressings.


How to choose wound dressings? To determine the right type of dressings, assessing the wound types and the level of exudate (fluid drainage) of the wound is important.


 

Level 1 Moist Wound Healing : Wound care for dry wounds or wounds with minimal exudates - Hydrogels


Hydrogels, are gel-based dressings that provide moisture to rehydrate the dry wound bed.




Hydrogels
Hydrogels


Hydrogels also:

  • soften the necrotic tissue (dead tissue) to achieve the effect of natural and painless debridement of dead tissues (autolytic debridement).

  • has a cooling effect when applied to the wound to help alleviate pain and discomfort, providing relief to the patient.


Hydrogels are indicated for dry wound and minimally draining wounds such as:

  • Pressure Ulcers

  • Deep cavity wounds

  • Surgical wounds

  • Wounds with necrotic tissue or slough

  • Infected wounds under medical supervision*

  • Radiation dermatitis

  • Minor burns


Examples of hydrogels available are Duoderm Gel, Intrasite Gel, Cavidagel Ag and Hyzo Gel.



Duoderm hydroactive gel
Duoderm hydroactive gel


Hyzo Gel
Hyzo Gel




Hyzo Gel
Cavidagel Ag


Intrasite Gel Hydrogel Dressing
Intrasite Gel Hydrogel Dressing


 


Level 2 Moist Wound Healing : Wound care for wounds with low to moderate exudates - Hydrocolloids


Hydrocolloids are occlusive or semi-occlusive dressings that consist of a gel-forming material, typically a combination of gelatin, pectin, and carboxymethylcellulose. Hydrocolloids absorb exudate to form a hydrated gel over the wound, maintaining a controlled level of moisture around the wound which is conducive to healing.



Hydrocolloids dressings
Hydrocolloids dressings
  • It is self-adhesive and has a backing that adheres to the skin, also called artificial skin’. This helps create a seal around the wound, preventing leakage and protecting against external contaminants. However, the dressing needs to be changed when it becomes less adhesive with the overloading of the exudates.

  • Hydrocolloid dressings are flexible and conform easily to the contours of the wound bed.

  • Similar to hydrogel dressings, hydrocolloid dressings support autolytic debridement of slough and dead tissues and speed up wound healing.


Hydrocolloid dressings are indicated for lightly to moderately exuding wounds such as:
  • Pressure ulcers

  • Partial thickness wounds

  • Surgical wounds

  • Diabetic foot ulcers

  • Wounds with necrotic tissue or slough

  • Minor burns


Hydrocolloid dressings are NOT recommended for:
  • Infected wounds due to the semi-occlusive nature of the dressing

  • Moderate to highly exudating wounds - Reports showed hypergranulation with prolonged use of hydrocolloids in moderate to highly exudating wounds, hence assessing the wound tissue from time to time is important when applying hydrocolloids in the long term to prevent hypergranulation.


How to use hydrocolloid dressings correctly?
  • The frequency to change hydrocolloid dressing is every 3 to 7 days, however, if the exudates start to leak, it's time to change the dressings.

  • Cut the dressings 1-2 inches larger than the wound for a secured seal.

  • Monitor for peri-wound maceration.



OxyMax hydrocolloids wound dressings
OxyMax Hydrocolloids Wound Dressing


Convatec Duoderm CGF & Duoderm Extra Thin
Convatec Duoderm CGF & Duoderm Extra Thin Hydrocolloids Dressings

Examples of hydrocolloids dressings available in Malaysia are Adventa OxyMax, Duoderm CGF, Duoderm Extra Thin.



 


Level 3 Moist Wound Healing : Wound Care for Heavily Exudating Wounds - Alginate Dressings & Foam Dressings



Alginate Dressings


Alginate dressings is available in sheet form or rope form
Alginate dressings, made of calcium alginate fibres derived from brown seaweed is available in sheet or rope form


  • Alginate dressings are highly absorptive, non-occlusive dressings made of soft, non-woven calcium alginate fibres derived from brown seaweed or kelp.

  • Alginate dressings can absorb up to 20 times their weight of exudate, turning it into a gel-like consistency. This helps to maintain a moist wound environment while preventing pooling of excess fluids.


  • Alginates are available in sheet form or spun into ropes form. In rope form, they are also great for filling small, draining wound cavities.


Alginate dressings are indicated for moderately or heavily exuding wounds such as:
  • Stage III - IV Pressure Ulcers

  • Surgical wounds

  • Diabetic foot ulcers

  • Tunneling wounds

  • Donor sites

  • Infected wounds - for alginate dressings that contain silver to provide antimicrobial action

Alginate dressings also provide hemostasis (stop bleeding) for postoperative wounds with minimal bleeding.


Alginate dressings are NOT recommended for:
  • Lightly exuding wounds - it's important to reserve alginate dressings only to moderate to heavily exuding wounds as using of alginate dressings on wound with minimal exudate will dry out the wound bed.

  • Dry eschar

  • Third degree burn

  • Wounds with heavy bleeding


How to use Alginate dressings correctly?
  • Change alginate dressings every 1 to 3 days, although it may stay up to 7 days depending on the condition of the wound. Change frequently enough to prevent saturation of the outer dressing and leakage of drainage onto surrounding skin, which can cause maceration.

  • Use secondary dressing to keep alginate dressings in place.

  • Make sure to irrigate the wound thoroughly to remove all of the alginate before applying a new dressing.


Examples of alginate dressings are KALTOSTAT®Alginate Calcium Sodium Dressing, KALTOSTAT® Alginate Rope, Oxymax Silver Alginate Dressing, Almedico Silver Calcium Alginate Dressing.




KALTOSTAT®Alginate Calcium Sodium Dressing
KALTOSTAT®Alginate Calcium Sodium Dressing

KALTOSTAT® Alginate Rope
KALTOSTAT® Alginate Rope


Oxymax Silver Alginate Dressing
Oxymax Silver Alginate Dressing


Almedico Silver Calcium Alginate Dressing
Almedico Silver Calcium Alginate Dressing

 


Level 3 Moist Wound Healing : Wound Care for Heavily Exudating Wounds - Foam Dressings


Foam dressings are made from polyurethane base, laminated with a semi-occlusive film backing. Foam dressings are:

  • highly absorbent

  • promotes autolytic debridement of wounds.

  • provide a cushioning effect, making them suitable for protecting intact skin over bony prominences and friction areas.

Foam dressings
Foam dressings




Sacrum foam dressings
Foam dressings for sacrum



Foam dressings for Heel
Foam dressings for heel

  • They are available in pad, sheet, or other shapes with adhesive borders with transparent film coating which conform well to the contours of the wound, eg. foam dressing designed to contour to the sacral and heel area for prevention and treatment of bedsores.

Foam dressing designed for heel area
Foam dressing designed for heel area


Foam dressing designed for sacral area
Foam dressing to protect sacral area from friction and prevent bedsores in bedridden patient



  • Foam dressings may be impregnated or layered in combination with other materials such as enzyme deriders or ionic silver for antibacterial function.


Foam dressings are indicated for moderately to heavily exuding wounds such as:
  • Stage II - IV pressure ulcers

  • Surgical wounds

  • Infected ulcers - for foam dressings with ionic silver for antibacterial purpose


Foam dressings are NOT Recommended for:
  • Dry or non-draining wounds unless used for prevention or protection.

  • Third degree burns

  • Necrotic wounds

  • Hard eschar


How to use Foam dressings correctly?
  • Foam dressing can be left in place for up to 4 to 7 days, however, it should be changed when saturated with exudates.

  • For non-adherent foam dressing, may require secondary dressing to keep it in place.

  • Monitor for peri-wound maceration.


Examples are Convatec Aquacel Foam Dressing, Convatec Aquacel Ag Foam Adhesive Sacral, Allevyn Foam Dressing, Allevyn Gentle Border Heel , 3M™ Tegaderm™ High Performance Foam Adhesive Dressings etc.



Aquacel Foam Dressings
Convatec Aquacel Foam Dressings


Convatec Aquacel Ag Foam Adhesive Sacral
Convatec Aquacel Ag Foam Adhesive Sacral


Allevyn Foam Dressings
Allevyn Foam Dressings


Allevyn Gentle Border Heel
Allevyn Gentle Border Heel


3M™ Tegaderm™ High Performance Foam Adhesive Dressings
3M™ Tegaderm™ High Performance Foam Adhesive Dressings





 

Moist Wound Healing by Medicated Honey Dressings



MEDIHONEY Medicated honey dressings
MEDIHONEY medical grade honey gel

  • Medical grade honey dressings contain Manuka honey which has been proven to support moist wound healing.

  • The high sugar content of honey results in the osmotic effect and provides an optimal moist environment for wound healing.

  • Other than that, medicated honey dressings is antibacterial due to the low pH of 3.2 to 4.5, high sugar content, and low water content of honey creating an unfavorable environment for bacterial growth and reproduction.

  • With this, it also helps to reduce wound odour caused by bacterias.

  • Besides, anti-inflammatory action of medicated honey reduces edema and exudates, which can subsequently improve wound healing.

  • More importantly, medicated honey dressings provides autolytic debridement of slough and eschar as the proteolytic enzymes and immune cells contained in the extracellular fluids can be drawn from deeper tissues of the wound to the surface by osmotic actions facilitated by the honey. Honey also produces hydrogen peroxide through the enzyme glucose oxidase which is thought to contribute to the debridement process.


Medicated honey dressings is indicated for partial- and full-thickness wounds :
  • Stage II - IV Pressure Ulcers

  • Diabetic foot ulcers

  • Surgical wounds

  • Malodorous wounds

  • Superficial wounds

  • Donor sites

  • First- and second- degree burns (superficial and partial-thickness)


How often to change medicated honey dressings?

The frequency of dressing changes depends on how rapidly the honey is diluted by the wound fluid, which normally can be left on the wound for up to 3-7 days.


Examples of medicated honey dressings available are MEDIHONEY 80% Active Leptostermum Honey Gel, Activon 100% Medical Grade Manuka Honey Gel.


MEDIHONEY Gel
MEDIHONEY Gel




Activon 100% Medical Grade Manuka Honey Gel
Activon 100% Medical Grade Manuka Honey Gel


 
In short, moist wound healing is useful in certain chronic wounds such as pressure ulcers, diabetic foot ulcers, and surgical incisions as a moist environment promotes autolytic debridement of slough and necrotic tissue, reducing scarring and promoting wound healing.
The factor of wound types and level of exudates need to be taken into account for choosing the most compatible wound dressings for the wound itself.

However, the moist environment can also be double-edged sword when it comes to certain wounds that would only be deteriorated in moist environment.

When Not to Use Moist Wound Healing?
  • Gangrene wounds - Dry gangrene may progress to wet gangrene as the moist environment may promote bacterial growth, for example gangrenous diabetic foot ulcer.

  • Ischemic or neuropathic ulcers

  • Wounds for patients undergoing palliative care should be assessed by doctor for wound management


There is no such one-size-fits-all methodology in wound care, it's crucial to consult with a healthcare professional to determine the most appropriate approach for a specific wound. Each case is unique, and a tailored treatment plan based on the individual characteristics of the wound is essential for optimal healing outcomes.


Article by : Pharmacist Goh Khang Phing


 

Not sure which type of wound dressings is the best for your loved one?

WhatsApp us today or give us a call for a FREE consultation about our wound care service today to start receiving your personalized Wound Care treatment at your home by our skillful and experienced nurses.


Remeds Home Wound Care Service
Home Wound Care Service by Remeds Penang

Remeds' Wound Care Team is specialized in treating all kinds of wounds including chronic and non-healing wounds such as:

  • Bedsores / Pressure ulcers

  • Diabetic ulcers

  • Surgical wounds

  • Burn wounds

  • Arterial/ Venous ulcers

  • And other chronic non-healing wounds. Click to find out more >


 

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References:

  1. Winter, G. D. (1962, January 1). Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig. Nature. https://doi.org/10.1038/193293a0

  2. Junker, J. P., Kamel, R. A., Caterson, E. J., & Eriksson, E. (2013, September 1). Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Advances in Wound Care. https://doi.org/10.1089/wound.2012.0412

  3. Nuutila, K., & Eriksson, E. (2021, December 1). Moist Wound Healing with Commonly Available Dressings. Advances in Wound Care. https://doi.org/10.1089/wound.2020.1232

  4. Rajendran, S. (2018, September 20). Advanced Textiles for Wound Care. Woodhead Publishing.

  5. Weller, C. (2009, January 1). Interactive dressings and their role in moist wound management. Elsevier eBooks. https://doi.org/10.1533/9781845696306.1.97

  6. Kirwan, H., & Pignataro, R. M. (2016, January 1). The Skin and Wound Healing. Elsevier eBooks. https://doi.org/10.1016/b978-0-323-31072-7.00002-6

  7. Kapoor, N., & Yadav, R. (2021, January 1). Manuka honey: A promising wound dressing material for the chronic nonhealing discharging wounds: A retrospective study. National Journal of Maxillofacial Surgery. https://doi.org/10.4103/njms.njms_154_20

  8. Yılmaz, A., & Aygin, D. (2020, June 1). HONEY DRESSING IN WOUND TREATMENT: A SYSTEMATIC REVIEW. Complementary Therapies in Medicine. https://doi.org/10.1016/j.ctim.2020.102388





































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