Wet Wound Healing

Abstract

Wound treatment in a flexible transparent chamber attached to the perimeter of the wound and containing a liquid has been extensively tested in preclinical experiments in pigs and found to offer several advantages. It protects the wound; the liquid medium or saline in the chamber provides in vivo tissue culture-like conditions; and antibiotics, analgesics, and various molecules can be delivered to the wound through the chamber. The wound chamber causes no injury to the wound itself or to the surrounding intact skin. Topical delivery of, for instance, antibiotics can provide very high concentrations at the wound site and with a favorable direction of the concentration gradient. A series of 28 wounds in 20 patients were treated with a wound chamber containing saline and antibiotics. Most patients had significant comorbidity and had not responded to conservative or surgical management with débridement and delayed primary closure or skin grafts. Six wounds had foreign bodies present; four of these were joint prostheses. Seven patients were on corticosteroids for rheumatoid arthritis, lupus, or chronic obstructive pulmonary disease, and four patients had diabetes. Most patients were treated with the wound chamber in preparation for a delayed skin graft or flap procedure, but one was treated with a wound chamber until the wound healed. Twenty-five of the wounds (89 percent) healed, and five wounds (18 percent) required additional conservative management after the initial chamber treatment and grafting procedure. Of the three wounds that did not heal, one healed after additional chamber treatment, one had a skin graft that did not take, and one required reamputation at a higher level. Antibiotic delivery was less than one intravenous dose daily, which avoided the potential for systemic absorption to toxic levels. Antibiotics such as vancomycin and gentamicin could be used in concentrations of up to 10,000 times the minimal inhibitory concentration. Forty-eight hours after application, 20 percent or more of the original antibiotic concentration was present in the wound chamber fluid. In conclusion, the wound chamber provides a safe, powerful tool in the treatment of difficult infected wounds.

The importance of hydration in wound healing: reinvigorating the clinical perspective

“…In both pre-clinical and clinical studies, the hyper-hydrated wound environment proved to be safe for the treatment of a number of wounds. Wound healing under these hyper-hydrated conditions progressed in a similar manner to those where moist conditions were used 30,52 -the wounds showed less tissue necrosis, faster healing rates and a better quality of healing, compared with dry wounds.…”

“…49 Irrespective of the cause, the presence of maceration has led to the assumption that a surfeit of moisture will inevitably lead to sustained tissue damage. However, a number of studies have indicated that a wound that is overly hydrated may not result in tissue damage, [50][51][52] and rather suggest that a wound bathed in a hyper-hydrated environment may benefit from the advantages of moist wound healing. 30 This is demonstrated in Figure 10.…”

“…The studies examining the effect of a hyper-hydrated environment were carried out using synthetic tissue culture medias and are very different in composition from chronic wound exudates. [50][51][52][53] Studies have shown that ulcer-derived exudate is fundamentally different from acute wound fluids. 71,72 The underlying pathological processes involved in chronic wound recalcitrance means that chronic exudate is highly damaging to tissues with its high content of protein-degrading enzymes.…”

Evidence‐based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans

“…This trend is challenging to explain considering previous literature suggesting moist wound environment with occlusive dressings improves chronic wound healing by stimulating granulation tissue, and inducing autolytic debridement. 2,3,22,23 However, the possibility of ulcer infection is the most significant disadvantage of moist wound healing, along with risk of inducing an exudative phase in an otherwise dry ulcer. 24 Therefore it is possible that moist wound healing in fact did have negative effect on healing.…”

Wound bed preparation: A novel approach using HydroTherapy

“…More importantly high levels of wound tissue hydration (hyper-hydration) have proved to be effective in aiding the healing process. A number of studies have indicated that a wound that is overly hydrated may not result in tissue damage (Breuing et al, 1992;Svensjö et al, 2000;Vranckx et al, 2002;Vogt et al, 1995), and rather suggest that a wound bathed in a hyper-hydrated environment may benefit from the advantages of moist wound healing (Junker et al, 2013).…”