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

Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

A multi-centre clinical evaluation of reactive oxygen topical wound gel in 114 wounds

OBJECTIVE

This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds.

METHOD

This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible.

RESULTS

We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis.

CONCLUSION

SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds.

DECLARATION OF INTEREST

Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a consultant to Matoke Holdings.

Is it time to re-appraise the role of compression in non-healing venous leg ulcers?

OBJECTIVE

To evaluate the role of compression in non-healing venous leg ulcers (VLUs) of > 3 months' duration.

METHOD

Patients' records from three independent data sets of non-healing VLUs of > 3 months'duration were re-analysed.Two data sets were separate audits of clinical practice and the third comprised patients' records from a randomised controlled trial. Some patients in each data set were never treated with compression. The effect of compression on healing at 6 months was tested with logistic regression.

RESULTS

In each data set, patients in the compression and no-compression groups were matched according to ulcer size and duration; there were no differences in comorbidities. Comparing the no-compression with the compression groups, the healing rate at 6 months was 68% vs 48% in study 1, 12% vs 6% in study 2, and 26% vs 11% in study 3. Use of compression was found to be an independent predictor of not healing with an odds ratio of 0.422, 0.456 and 0.408 in studies 1, 2 and 3 respectively.

CONCLUSION

The healing rate of non-healing VLUs of > 3 months' duration in the no-compression groups was double that of VLUs in the compression groups. These findings have the potential for treatment modification if confirmed in a prospective trial.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.

Wound infection, dressings and pain, is there a relationship in the chronic wound?

The focus on quality of life issues in wound care has justly taken a far greater importance. With the acceptance that pain can be a major factor to the patient, and in particular, pain at dressing change comes the opportunity for avoidance and/or reduction strategies. Whilst pain has been associated with wound infection for millennia, it is only much more recently that this has received due attention from research and clinical practice. In this study, the nature of pain, changes in pain and pain associated with infection are the focal points. A Delphi approach, now a frequently used tool in wound care research, has been used to obtain expert opinion on these aspects of management.

Wound healing through synergy of hyaluronan and an iodine complex

Hyaluronan, a glycosaminoglycan (GAG), is a polysaccharide found in many locations in the human body, such as eye, skin and soft tissue. It is also found in other mammals and bacteria. As a component of the extracellular matrix, its role in wound repair, among others, is that of providing a temporary structure to support new tissue formation. Harnessing the therapeutic action of hyaluronan into a topical application of proven clinical benefit has proved challenging. A new development in hyaluronan technology, comprising sodium hyaluronate and iodine complex, offers a novel approach in exploiting the benefits of hyaluronan and delivering real clinical benefits for a wide range of wound types.

Biofilms: possible strategies for suppression in chronic wounds

Biofilms can delay wound healing significantly. The aim of this article is to highlight strategies that could be used to treat chronic wounds containing biofilms. Antibiofilm agents, their modes of action and efficacy in suppressing biofilms are discussed.

The causes and prevention of maceration of the skin

Maceration can interfere with the normal healing response of a wound. Nurses caring for patients with wounds need expertise in detecting and preventing this condition. This paper examines the risk factors for exudate production, methods of controlling exudate levels and the selection of appropriate dressings in order to avoid maceration.

The causes and prevention of maceration of the skin

A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds.

Identification of infection in granulating wounds by registered nurses

The purpose of the study was to investigate the methods used by registered nurses to identify infection in granulating wounds. Although this research was completed a few years ago recent observations confirm that the findings remain relevant and that accurate identification of wound infection continues to present a challenge. This study also set out to compare the subjects' and author's decisions on the infected status of the wounds. The author used criteria previously developed by Cutting & Harding (1994). Decisions made by the author were found to have a high level of accuracy when compared against a microbiological assay of the wounds.

From the Journals

THE DOCTOR-PATIENT RELATIONSHIP PREVENTING LEG ULCER RECURRENCE EVIDENCE-BASED PRACTICE IN BURN MANAGEMENT.

Criteria for Identifying Wound Infection

Criteria used to identify infection may often be restricted to the presence of pus, or pus with inflammation¹. Traditional criteria have been used in many surveys and their advantage is that they are simple, reproducible and easily recognised by different observers. However, identification of infection may be difficult in some circumstances, and identifying patients who are likely to develop infection is rare.

Reviews

WOUND MANAGEMENT.

From the Journals

INNOVATIVE TREATMENT FOR DIABETIC FOOT ULCERATION A MULTIDISCIPLINARY WOUND ASSESSMENT TOOL LOW-DOSE CYCLOSPORIN IN THE TREATMENT OF PYODERMA GANGRENOSUM INTERPRETING REPORTS OF COMMERCIAL DRUG TRIALS.

Reviews

CHRONIC WOUND CARE

A CLINICAL SOURCE BOOK FOR HEALTHCARE PROFESSIONALS (2nd edition).

Lasting relief from a distressing condition. Surgical intervention in hidradenitis suppurativa

Hidradenitis suppurativa is a painful skin condition which affects the skin glands. The condition can be successfully treated with surgery, but requires skillful and sensitive pre- and post-operative nursing care.