During the cleansing phase, moist wound dressings The most basic type of moist wound dressing is the tradi-
achieve a thorough cleansing of the wound and render tional gauze dressing, moistened with normal saline or
possible mechanical debridement without damaging cells. Ringer's solution. However, this is also the type of dress-
Inactivation of immunocompetent cells can also be avoid- ing most liable to create problems. Gauze dressings dry
ed by the moist environment (Seiler). out rather quickly and stick to the wound, an unfortunate
property that causes freshly formed cells to be torn away
During the granulation phase, a physiological microcli- with the dressing as the latter is changed. Moreover,
mate similar to a cell culture medium is created within ensuring a permanent supply of moisture to the compress
the wound, which encourages cellular proliferation and is time-intensive, not easy to manage and is difficult to
consequently the formation of granulation tissue. Turner/ reconcile with compression therapy.
Beatty et. al (1990) have reported that permanent moist
therapy causes a significantly more rapid reduction in the The so called hydroactive wound dressings, in compari-
wound area and a larger amount of granulation tissue. son, are an innovation that represents a major advance,
not only in regard to efficacy but also practicality. They
In the epithelisation phase, the conditions for mitosis and include the gel forming calcium alginate dressing
migration of epithelial cells improve under moist dress- Sorbalgon, the wound pad dressing TenderWet, the
ings. This generally results in more rapid epithelisation hydroactive foam dressing PermaFoam, the absorbent
with better cosmetic results. hydrocolloid dressing Hydrocoll and the transparent
hydrogel dressing Hydrosorb. With these dressings,
Patients frequently report that their pain is relieved under wounds can be kept permanently moist without difficulty.
moist wound treatment. In addition, the dressing change Moreover, the differentiated physical principles of action
itself is atraumatic and causes less pain because modern of the various wound dressings ensure that the specific
dressings, as used for moist wound treatment usually do requirements of many different wound conditions can be
not adhere to the wound, i.e. have atraumatic properties. selectively fulfilled.
At the same time, this “nonstick” effect eliminates the
stripping off of cell layers when the dressing is changed – Wound management in the cleansing phase
the undisturbed state of the wound so important for heal- Experience has shown that this initial phase demands
ing is preserved. great patience and will need more time to complete the
longer the ulcer has existed. This is because the deranged
However, the success of moist wound treatment depends metabolic situation in the area of skin which is responsi-
on a critical prerequisite: the wound requires a perma- ble for the venous ulcer not only maintains the chronicity
nent, uninterrupted, balanced supply of moisture. If at of the wound but also greatly hinders the self-cleansing
any stage drying out is allowed to occur, the cells mechanisms. The vicious cycle can only be broken by ade-
inevitably die as a consequence. Further necroses develop quate treatment: compression therapy is indispensable to
and can even eventually deepen the wound. improve the hemodynamics and selective cleansing proce-
dures are also of major importance.
Phase-specific wound management [36.37]
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