Moist Vs Dry Wound Healing

Moist vs Dry Wound Healing
Amit Gawri
Wound life cycle
The black
wound
The yellow
wound
The red
wound
The pink wound
Wound bed preparation involves
 To facilitate healing of chronic wounds the concept of wound bed preparation was
introduced by Falanga in 2000
 DEBRIDEMENT: Removing necrotic/fibrinous tissue
 BACTERIAL CONTROL: Reducing the bacterial burden in the wound
 EXUDATE MANAGEMENT: Minimising wound exudate

Moist wound healing
Dry Moist Wet

Wound environment Wound environment Wound environment
• Slow wound • Optimal conditions • Unfavourable to
healing • Faster wound healing healing

• Dressing sticks • Reduced wound pain • Risk of leakage
• Painful • Risk of maceration
Early experiences with moist wound healing
• In 1962 George Winter compared the healing rates of wounds in pigs. He found that wounds
maintained in a moist environment healed twice as fast as wounds that were allowed to dry out
and form a scab
• In 1963 this was confirmed as effective for humans by C.D. Hinman & H. Maibach.
This momentous discovery was termed ”Moist Wound Healing” (MWH)
• MWH can be provided by occlusive and semi-occlusive dressings

Dry versus moist wound healing
Occlusive dressing
Epidermis
No dressing 1. Moist environment
2. Stratum corneum
3. Scab
4. Epithelialisation
Myths about moist wound healing
• Despite the discovery 40 years ago of moist wound healing, dry wound healing practices still continue.
• Some of the reasons given for not applying MWH include:
 Increased bacteria
 Increased infection
 Increased slough/pus
 Increased maceration
 Cannot ’see’ the wound
 Not enough oxygen in the wound
 The wound size will increase
• Over the last 40 years of practise these concerns have proven to be myths
• In fact moist wound care has become the standard treatment for most wound types
Myth - Increased bacteria
• Controlled studies have revealed that bacterial colonisation under occlusion does not
impair wound healing. In fact, infection rates with occlusion are usually less than those
with non-occlusive dressings
• Where wounds are granulating or epithelialising quickly, they are more likely to remain
free from dead tissue
Infection
Wounds with bacterial imbalance and no sign of infection

Infection has long been a theoretical complication of moist wound environments. However, a retrospective
review of 30 years of evidence suggests that the infection rate decreases under moisture retentive dressings
• MWH dressings keep the wound bed moist and viable  minimising dead
tissue where microorganisms flourish
• Occlusive dressings can be used to treat most wounds if there are no

signs of infection
Slough/Pus
It is not uncommon for slough and dressing material (such as
hydrocolloid or alginate gel) to be mistaken for pus
• Cleanse the wound before assessing whether pus is present
• Ensure the appearance of slough and pus are defined correctly

Maceration
If maceration is present, it means that exudate is not sufficiently controlled
Excess fluid comes into contact with the surrounding peri-ulcer skin
may  maceration which often looks whitish
Clinician should choose a more suitable moist dressing that absorbs

wound exudate & keeps surrounding peri-ulcer skin dry while
keeping the ulcer bed moist
Wound size increase
MWH creates an environment in the wound that allows progression through the phases
of wound healing, wounds that have black eschar or yellow slough to begin with may
appear larger after just a few days of MWH application.
This is due to the fact that debris has been removed  wound
will be able to granulate faster, as the cells are able to move
across the wound bed in a fluid environment
Cost efficiency of MWH
• Decreases the frequency of dressing changes
• Frees clinical time to focus on other patient-related activities
• Major community nursing benefits in visiting the patient less frequently
• Cost-effectiveness studies on wound healing all show that, when time and labour are taken into
account, moist wound healing dressings that remain in place for a few days are more cost-
effective than traditional gauze-type dressings
Dry versus moist wound healing
• Dry wound healing • Moist wound healing
• Dries out the wound • Maintans a moist wound bed

which promotes the wound
• Formation of crust healing
• Frequent change of dressing • Protects the wound from
due to leakage. The wound microorganisms and bacteria
gets cold.
• Maintains a constant
• Dry wound healing can be a temperature in the wound bed
slow process – does not
support faster wound healing • Less frequent dressing
changes - no disturbance of the
wound healing process

Moist Vs Dry Wound Healing

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Moist vs Dry Wound Healing

 DEBRIDEMENT: Removing necrotic/fibrinous tissue

 BACTERIAL CONTROL: Reducing the bacterial burden in the wound

 EXUDATE MANAGEMENT: Minimising wound exudate

Dry Moist Wet

• Slow wound • Optimal conditions • Unfavourable to

healing • Faster wound healing healing

• MWH can be provided by occlusive and semi-occlusive dressings

Wounds with bacterial imbalance and no sign of infection

• Occlusive dressings can be used to treat most wounds if there are no

• Cleanse the wound before assessing whether pus is present

• Ensure the appearance of slough and pus are defined correctly

If maceration is present, it means that exudate is not sufficiently controlled

Clinician should choose a more suitable moist dressing that absorbs

• Decreases the frequency of dressing changes

• Frees clinical time to focus on other patient-related activities

• Major community nursing benefits in visiting the patient less frequently

• Dries out the wound • Maintans a moist wound bed

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