Application of dressings that remove and sequester excess amounts of wound fluid may not only help in restoring the correct balance of moisture, but also support the wound healing process by preventing tissue deterioration caused by abundant protease activity.Several types of dressings, such as hydrogels, hydrocolloids, alginates, hydrofibers, foams, and superabsorbent dressings, are reviewed here and evaluated with regard to their efficacy for highly exuding wounds.Moisture balance is critical in wound care, ie, while excessive fluid generation causes maceration at the wound margins, dryness will hamper the migration of epithelial cells.Application of moisture-balancing dressings, negative pressure wound therapy (NPWT), or other fluid removal methods, as well as compression, will control disproportionate release of exudate, avoid maceration, reduce edema, and prevent wound desiccation to enable optimal conditions for cell migration and proliferation.The acronym stands for Tissue management (wound cleansing), Infection or inflammation (reduction of infection/inflammation), Moisture imbalance (humidification), and Edge of the wound (epithelialization support).
Debridement, skin grafting, biological agents, and other adjunctive treatment options have been suggested as corrective therapies to increase cellular migration and restoration of an appropriate protease profile.
It is imperative that clinicians reassess wound status during dressing changes so that appropriate interventions can be implemented.
Moist wound healing and exudate management Wound exudate, which is essentially blood depleted of most of its red cells and platelets, is a key component in all stages of wound healing, irrigating the wound and keeping it moist, supplying nutrients, and providing favorable conditions for cell migration and proliferation.
Several studies have shown that exudates from non-healing wounds contain significantly elevated levels of proteases, such as matrix metalloproteinases (MMPs) and polymorphonuclear (PMN) elastase.
So far, neutrophil-derived protease elastase and MMPs have received most of the attention in studies of chronic wounds.