Is it better to promote moist wound healing after dermatological surgery or not?

by Verónica Ruiz

IS IT BETTER TO PROMOTE MOIST WOUND HEALING AFTER DERMATOLOGICAL SURGERY OR NOT?

Postoperative care of the surgical wound is crucial to optimize clinical results and prevent complications such as infection and wound healing.

After a surgical intervention, the surgeon usually provides a series of specific recommendations regarding wound care, which will be carried out until the removal of the stitches.

When reviewing the medical literature in this respect, there is no standardized protocol that defines the guidelines to be followed in the care of surgical wounds in dermatology, which means that we find a great variability of postoperative care in clinical practice.

However, we do have a series of evidence-based scientific recommendations that can guide us in providing you with clear instructions on wound care.

We will see next, what moist wound healing and non-moist wound healing consist of and what their advantages and disadvantages are.

 

Moist wound healing

The wound microenvironment is defined as the external environment immediately adjacent to the wound and in direct contact with its surface.

The healing in a humid environment consists of keeping the wound covered with an occlusive dressing, which facilitates permanent contact of the wound with its own exudate, thus respecting the microenvironment of the wound.

The actual concept of moist wound healing (MWH) was introduced by Dr Winter in the 1960 decade, who demonstrated in a porcine model, that the healing of the wounds was carried out more quickly when they were covered with a plastic dressing than when they were left exposed to the air, since the scab that was generated in the latter produced a delay in the migration of the keratinocytes, which caused the healing to be slower.

This observation represented at the time, a revolutionary change from the traditional care or dry care.

A year later, Hinman and Maibach applied the concept of MWH on human skin wounds.

The physical barrier that provides the occlusion of the surgical wound has the following advantages for healing:

  1. It reduces evaporation from the surface of the wound, which helps to maintain a physiological temperature in the wounds own microenvironment preventing dehydration, providing greater oxygen availability and reducing inflammation, which also contributes to reducing local pain.
  2. It maintains a slightly high acidic it pH level at the wound (5.5 – 6.6), which increases the local oxygen flow, which favours the activity of fibroblasts and collagen synthesis which has a certain antibacterial effect, thus prevents infection.
  3. The humid environment provides a favorable environment for the cellular migration necessary for an adequate epithelization of the wound to take place and also facilitates the activity of local enzymes that will debride the devitalized tissue. The CAH has shown to be beneficial in treating open wounds, ulcers and sutured surgical wounds.

The MWH has shown to be beneficial in treating open wounds, ulcers and sutured surgical wounds.

 

Non-moist wound healing

The traditional care or in dry ambience consists of maintaining the wound clean and dry without there being a barrier of the occlusive opposition that contains the exudate and maintains the microenvironment of the wound itself.

In this type of care, non-occlusive opposites, such as a gauze, or different antiseptics and antimicrobials can be used, with care being performed on a daily basis.

Healing in a dry environment has the following drawbacks for wound healing:

  1. The simple fact of discovering and cleaning the wound frequently, together with the inevitable evaporation, causes the local temperature of the skin to drop and we must bear in mind that the skin takes 40 minutes to recover its original temperature and three or four hours for the mitotic cell activity to return to normal. The decrease in local temperature reduces the input of oxygen, which hinders the formation of blood vessels (angiogenesis).
  2. Exposure to air gives a rise to an alkaline environment at the wound level, hindering fibroblast activity and collagen synthesis.
  3. The dry environment also provides greater accessibility for the entry of micro-organisms and delays in keratinocyte migration, leading to slower healing.

Furthermore, the increase in the frequency of opposing changes that dry care supposes with respect to MWH, provides more discomfort to the patient, and may cause greater pain associated with care related to greater trauma to the wound and with withdrawal of the opposing team, in addition to a possible skin irritation due to frequent changes in it.

Summary:

the wounds need a permanent and balanced supply of moisture.

MWH has benefits and advantages in wound healing compared to dry care: however, the absence of sufficient scientific evidence does not allow the establishment of specific standardized guidelines and protocols regarding wound care, which results in the instructions provided patients after dermatological surgery are highly variable.

Therefore, it is recommended that the guidelines prescribed by dermatologists in relation to wound care reflect more recent medical changes to improve your experience and clinical results.

 

REFERENCES

  • Winter G. Effect of air expossure and occlusion on experimental human skin wounds. Nature 1963;200:377-8.
  • Kerstein MD. Introduction: Moist wound healing. Am J Surg 1994;167 (Suppl 1A): 1s.
  • Levine R. Effect of Occlusion on Cell Proliferation During Epidermal Healing. J Cutan Med Surg 1998; 2 (4):193-98.
  • M S Agren, T Karlsmark, J B Hansen, J Rygaard. Occlusion versus air exposure on full-thickness.