Regardless of practice settings, wound care professionals unanimously agree that too little or too much wound site fluid can have negative effects on tissue repair. As a result, correctly regulating wound moisture or exudate levels is a vital aspect of care in patients with acute or chronic wounds. This article will discuss why it is essential to optimize moisture levels within the wound environment.
What Causes Wound Exudate?
Following a tissue injury, the normal physiological response of the body is an inflammatory process involving swelling, recruitment of protective, and repair cells. During the initial stages of wound healing, wound fluid will be produced with the volume varying according to the extent of tissue damage, and causative factors.
The factors contributing to increased wound moisture include:
- More extensive wound damage
- Presence of underlying inflammatory diseases
Is a Moist Wound Environment Critical in Wound Care?
Studies and research have shown a moist wound environment to significantly boost the wound repair rates in patients with wounds regardless of the etiologies. There are various reasons why a moist wound site is desirable in managing patients with acute or chronic injuries.
To begin with, wound exudate or moisture will prevent the formation of scabs or crusts which will inhibit faster-wound resolution. Also, the energy and time that would have been channeled into breaking down any scabs/crusts forms can be redirected into other wound repair processes, therefore, making wound healing more efficient.
Secondly, repair cells such as keratinocytes will be able to migrate more easily across wound defects using the moist environment as a transport medium. This will cause rapid recruitment of these repair materials and a faster rate of wound closure. Finally, wound fluid contains enzymes and growth factors required in autolytic wound debridement and repair tissue synthesis respectively.
How Much Moisture is Required for Proper Wound Repair?
Wound care experts will often rely on clinical observations to determine if the moisture within the wounds they manage is satisfactory. Signs of too little moisture include dry wound dressings causing excessive pain on removal, and a slowed rate of wound closure. An excessively moist wound will manifest as tissue edema, maceration, moisture-associated skin damage, and a slower rate of wound resolution.
Benefits of Optimizing the Moisture Levels Within a Healing Wound
There are numerous benefits associated with an optimized level of moisture within a healing wound. The most commonly cited advantages of adequate wound fluid include:
- Faster rates of wound healing
- Diminished wound site pain
- Lesser chances of wound infection
- Growth factor pooling
- Stimulation of collagen synthesis
- Easier recruitment of keratinocytes involved in tissue repair
- Facilitation of autolytic debridement
- Less scarring post-wound healing
Faster Rates of Wound Healing
As mentioned earlier, maintaining a moist wound environment prevents the formation of crusts and scabs that may slow the proliferation of repair materials. Once these mechanical hindrances are removed, wound healing will progress at a faster rate.
Diminished Wound Site Pain
A moist wound environment makes wounds less painful. With less pain, patients will be more amenable to their treatments and are less likely to default on wound care vital for their injuries to heal.
Lesser Chances of Wound Infection
Maintaining the appropriate levels of moisture within a wound site creates a hypoxic environment that discourages the growth of harmful infectious agents while promoting the formation of new blood vessels to improve tissue perfusion.
Growth Factor Pooling
Growth factors formed as a response to tissue injury and inflammation are usually preserved in wound fluid. A wound bathed in this fluid will benefit from a faster rate of healing as the growth factors present would stimulate the recruitment of the appropriate repair cells.
Stimulation of Collagen Synthesis
Moist wounds encourage the production of collagen material which is key to tissue repair, by concentrating fibroblasts within the wound site. The more fibroblasts are recruited to the injury site, the faster collagen is deposited and the quicker wound resolution is achieved.
Easier Recruitment of Keratinocytes Involved in Epidermis Repair
Keratinocytes play a key role in repairing wounded epidermis and a moist wound environment has been established to facilitate the recruitment of this particular repair cell type.
Facilitation of Autolytic Debridement
The formation of necrotic tissue within and around wound sites is almost inevitable in the wound healing process. These tissues must be removed by various methods of debridement. Maintaining a moist wound site will enable proteolytic enzymes present within wound fluid, break down and eliminate dead tissues. Once necrotic material has been removed by autolytic debridement wound healing will progress at a faster rate.
Less Scarring Post-Wound Healing
A wound management approach that maintains adequate moisture within the wound site will minimize inflammation, and promote faster deposition of repair materials. The overall effect is a more efficient repair process with less scarring after wound resolution.
Approaches to Controlling Wound Moisture Levels
The key strategies for maintaining wound moisture at optimal levels require wound care professionals to modify their wound dressing methods on an individual patient basis. There are numerous dressing types available today each with its benefits and drawbacks.
Wound care professionals must carefully consider each patient wound separately to determine the best choice. Wound dressings should be absorptive but not overly to prevent wound desiccation and its negative sequelae. Further regularly scheduled wound care assessments should be done to ensure satisfactory healing is ongoing at every stage of wound repair.