Why do moist wounds heal faster? How do I create a moist wound healing environment? Learn all about moist wound healing.

Learn all about moist wound healing Learn all about moist wound healing. Understand the role of the skin The role of the skin in wound healing How does the skin work? The three different layers of skin Four factors that affect the integrity of the skin Understand the role of the skin.

Understand the role of the skin Understand the role of the skin. View references Greaves, N. Current understanding of molecular and cellular mechanisms in fibroplasia and angiogenesis during acute wound healing. Journal of Dermatological Science; — Sorg, H. Skin Wound Healing: An Update on the Current Knowledge and Concepts.

European Surgical Research; Harper, D. The physiology of wound healing. Surgery; 32 9 : Flanagan, M. Journal of Wound Care. Oliveira Gonzalez, A.

Wound healing - A literature review. An Bras Dermatol. Martin, M. Chapter 3: Physiology of Wound Healing. In Flanagan M. Editor , Wound Healing and Skin Integrity. Principles and Practice pp. Wound Repair and Regeneration.

European Surgical Research. Diegelmann, R. Wound Healing: An Overview of acute, fibrotic and delayed healing. Frontiers in Bioscience. Wound bed preparation in practice.

London: MEP Ltd. Li, J. Pathophysiology of acute wound healing. Clinical Dermatology. Romanelli, M. Exudate Management Made Easy. Wounds International. Trengove, N. Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors.

Wound Repair and Regeneration; 7: Cutting, K. Wound exudate: composition and functions. British Journal in Community Nursing. Orsted, H. Basic Principles of Wound Healing. Wound Care Canada. Dowsett et al. Closing the gap between the evidence and clinical practice — a consensus report on exudate management 11 3 def.

exudate pooling Snyder RJ Managing dead space: an overview. Podiatry Management. October Get in touch. First name. Last name. Job title. Medical Speciality -- Select an option -- Community Nurse General Practice Nurse Medicines Management Podiatry Pressure Injury Prevention Procurement Tissue Viability Vascular Other.

Place of work -- Select an option -- Hospital Community GP Surgery Nursing Home Care Home. Work place name. Work place address. Accurate assessment of pain is essential when selecting dressings to prevent unnecessary pain, fear and anxiety associated with dressing changes.

Prepare patients for dressing changes, using pharmacological and non-pharmacological techniques as per the RCH Procedure Management Guideline. Factors affecting wound healing can be extrinsic or intrinsic. It is essential for optimal healing to address these factors.

Effective wound management requires a collaborative approach between the nursing team and treating medical team. Referrals to the Stomal Therapy, Plastic Surgery, Specialist Clinics or Allied Health teams via an EMR referral order may also be necessary for appropriate management and dressing selection, to optimise wound healing.

Open and prepare equipment, peel open sterile equipment and drop onto aseptic field if used dressing pack, appropriate cleansing solution, appropriate dressings, stainless steel scissors, tweezers or suture cutters if required.

Clean and assess the wound wound and peri wound should be cleaned separately if washing the patient. Single-use equipment: dispose after contact with the wound, body or bodily fluids not into aseptic field.

Multiple-use equipment: requires cleaning, disinfection and or sterilisation after contact with the wound, body or bodily fluids. Scissors should be cleaned with an alcohol or disinfectant wipe before and after use. See also RCH Procedure Skin and surgical antisepsis.

Standard or surgical aseptic technique is used as per the RCH Procedure Aseptic Technique. Select personal protective equipment PPE where appropriate. Outlined in the Procedures: Standard Precautions and Transmission based precautions.

Debridement is the removal of dressing residue, visible contaminants, non-viable tissue, slough or debris. Debridement can be enzymatic using cleansing solutions , autolytic using dressings or surgical. Determining when debridement is needed takes practice. For complex wounds any new need for debridement must be discussed with the treating medical team.

It is important to select a dressing that is suitable for the wound, goals of wound management, the patient and the environment. Dressings that have direct contact with the wound and have the ability to change the wound e. Should only be used for weeks.

Needs to be bigger than the wound as it will shrink in size. For best results change frequently more than once daily. Stop using when wound is granulating or epithelising. It is an expectation that all aspects of wound care, including assessment, treatment and management plans are documented clearly and comprehensively.

Documentation of wound assessment and management is completed in the EMR under the Flowsheet activity utilising the LDA tab or Avatar activity , on the Rover device, hub, or planned for in the Orders tab.

For more information follow the Parkville EMR Nursing — Documenting Wound Assessments phs. Clinical images are a valuable assessment tool that should be utilised to track the progress of wound management.

See Clinical Images- Photography Videography Audio Recordings policy for more information regarding collection of clinical images. Wound management follow up should be arranged with families prior to discharge e. Hospital in the Home, Specialist Clinics or GP follow up.

The evidence table for this guideline can be viewed here. Please remember to read the disclaimer. The revision of this clinical guideline was coordinated by Mica Schneider, RN, Platypus. Approved by the Clinical Effectiveness Committee.

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A skin wound that doesn't heal, heals slowly or heals but tends to recur is known as a chronic wound. Some of the many causes of chronic ongoing skin wounds can include trauma, burns , skin cancers , infection or underlying medical conditions such as diabetes.

Wounds that take a long time to heal need special care. The healing process of a skin wound follows a predictable pattern. A wound may fail to heal if one or more of the healing stages are interrupted.

The normal wound healing stages include:. The cause of the chronic wound must be identified so that the underlying factors can be controlled. For example, if a leg or foot ulcer is caused by diabetes, your doctor will review the control of your blood sugar levels and may recommend that you see a podiatrist to prevent recurring ulcers in future.

In the case of an ulcer due to varicose veins, surgical treatment of the veins may be required. The treatment recommended by your doctor depends on your age, health and the nature of your wound.

General medical care may include:. This page has been produced in consultation with and approved by:. Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.

All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.

The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Home Skin. Wounds - how to care for them. Actions for this page Listen Print. Summary Read the full fact sheet.

On this page. Causes of chronic wounds The healing process Barriers to wound healing Diagnosis methods Treatment options Self-care suggestions See your doctor Where to get help. Causes of chronic wounds Some of the many causes of a chronic skin wound can include: being immobile pressure injuries or bed sores , where persistent localised pressure restricts blood flow significant trauma injury to the skin surgery — incisions cuts made during operations may become infected and slow to heal deep burns underlying medical conditions such as diabetes or some types of vascular disease specific types of infection such as the Bairnsdale or Buruli ulcers Mycobacterium ulcerans trophic ulcers, where a lack of sensation allows everyday trauma to lead to an ulcer — such as in diabetic neuropathy and leprosy.

The healing process The healing process of a skin wound follows a predictable pattern. The normal wound healing stages include: Inflammatory stage — blood vessels at the site constrict tighten to prevent blood loss and platelets special clotting cells gather to build a clot.

Once the clot is completed, blood vessels expand to allow maximum blood flow to the wound. This is why a healing wound at first feels warm and looks red. White blood cells flood the area to destroy microbes and other foreign bodies. Skin cells multiply and grow across the wound.

Fibroblastic stage — collagen, the protein fibre that gives skin its strength, starts to grow within the wound. The growth of collagen encourages the edges of the wound to shrink together and close. Small blood vessels capillaries form at the site to service the new skin with blood.

Maturation stage — the body constantly adds more collagen and refines the wounded area. This may take months or even years. This is why scars tend to fade with time and why we must take care of wounds for some time after they have healed.

Barriers to wound healing Factors that can slow the wound healing process include: Dead skin necrosis — dead skin and foreign materials interfere with the healing process. Infection — an open wound may develop a bacterial infection. The body fights the infection rather than healing the wound. Haemorrhage — persistent bleeding will keep the wound margins apart.

Mechanical damage — for example, a person who is immobile is at risk of bedsores because of constant pressure and friction. Diet — poor food choices may deprive the body of the nutrients it needs to heal the wound, such as vitamin C, zinc and protein.

Medical conditions — such as diabetes , anaemia and some vascular diseases that restrict blood flow to the area, or any disorder that hinders the immune system.

Age — wounds tend to take longer to heal in elderly people. Medicines — certain drugs or treatments used in the management of some medical conditions may interfere with the body's healing process.

Smoking — cigarette smoking impairs healing and increases the risk of complications. Varicose veins — restricted blood flow and swelling can lead to skin break down and persistent ulceration. Dryness — wounds such as leg ulcers that are exposed to the air are less likely to heal.

The various cells involved in healing, such as skin cells and immune cells, need a moist environment. Diagnosis methods The cause of the chronic wound must be identified so that the underlying factors can be controlled.

Diagnosis methods of a chronic wound may include: physical examination, including inspection of the wound and assessment of the local nerve and blood supply medical history, including information about chronic medical conditions, recent surgery and drugs that you routinely take or have recently taken blood and urine tests biopsy of the wound culture of the wound to look for any pathogenic disease-causing micro-organisms.

Treatment options The treatment recommended by your doctor depends on your age, health and the nature of your wound.

General medical care may include: Cleaning to remove dirt and debris from a fresh wound. This is done very gently and often in the shower. Vaccinating for tetanus may be recommended in some cases of traumatic injury. Exploring a deep wound surgically may be necessary. In light of this understanding of the role of biofilms and the immune responses that occur during wound healing, HOCl emerges as an attractive wound care product.

When it comes to surgical procedures in the dermatology clinic, excisions generally and Mohs micrographic surgery specifically, are probably what first come to mind.

Mohs surgery is associated with a low infection rate—around 0. However, the risk for infection is increased for patients that have squamous cell carcinomas on the lower extremities. The keratotic nature of these tumors may facilitate the harboring of bacteria. Additionally, wounds on the extremities may be associated with higher tension and poor oxygenation, both factors that argue for a comprehensive approach to wound care.

Following injection of neurotoxins, it is not advised to massage the injection site, as manipulation of the area may encourage the neurotoxin to spread. In such cases, an HOCl spray formulation such as Lasercyn, Intraderm may be indicated to cleanse the treatment area. However, when placing dermal fillers, and especially deep fillers, massage may be indicated.

HOCl-based, silicone infused gel may be useful in this setting. The silicone in the formulation may provide an emollient-type effect, making it easier to massage the skin post-injection. Use of HOCl for surgical prep may be preferred to use of chlorhexidine, which is potentially irritating and is drying.

In fact, the inflammation induced by chlorhexidine can even interfere with histologic interpretation of Mohs specimens. Use of petrolatum plus HOCl may be a reasonable way to provide a moist wound healing environment at the post-surgical site and reduce infection risk. The petrolatum can be discontinued after one to two weeks, while the HOCl can be applied indefinitely.

Outside of dermatology, HOCl is extensively used in diabetic foot ulcers and lower extremity ulcers to keep these ulcers clean and promote healing in a non-irritating way.

Silicone is one of the mainstays of wound care, whether via silicone gel sheets or products that are infused with silicone and are applied post-procedurally.

HOCl can be applied in conjunction with silicone-based products; a formulation of silicone plus HOCl is also available Regancyn, Intraderm. Energy-based Procedures. Energy-based procedures, and especially fractional resurfacing and microneedling, are increasingly popular in dermatology and lead to the creation of microwounds.

Though perhaps not overly emphasized, pre- and post-procedure cleansing and wound management are important considerations. Dermatologists previously favored occlusive dressings, including petrolatum-based ointments, following microneedling and laser resurfacing procedures.

However, these occlusive topicals may actually be comedogenic, leading to outbreaks of acne in such patients. This is especially worrisome when the patient is actually being treated for acne or acne scarring.

A lighter topical formulation, such as HOCl, can provide a similar sealing benefit but without the risk for developing acne. Furthermore, since HOCl is anti-inflammatory and antimicrobial, it may further serve to reduce the risk for acne formation.

The anti-inflammatory effect of HOCl is beneficial for long-term post-laser skincare. Patients should apply HOCl topically each day until the skin is fully healed. However, continued use for another two to four weeks continues to reduce inflammation, with the potential to reduce short-term erythema and even reduce risk for long-term pigmentary alteration.

Patients can generally reinstitute make-up and skin care as soon as the skin has fully healed after a procedure, which is typically by day five to seven for most fractional ablative and other laser procedures. To minimize the risk of infection from potentially contaminated products or the risk for skin reactions, a longer period of abstinence from topical skincare may be recommended—usually about two weeks post-procedure.

Hypochlorous acid topical preparations may be used in conjunction with any make-up or topical skincare or cosmeceutical regimen. As longer lasting fillers come to market, there is increasing concern about biofilms and the risk for delayed granuloma formation.

Hypochlorus acid may be particularly useful in this setting because of its broad antimicrobial activity as well as its tolerability compared to alcohol and the other skin preps available. This mechanical cleansing will help to remove make-up or other residue from the skin and provides a light debriding effect.

Weiss recently treated a patient who had developed scarring after a CO2 laser procedure performed outside his practice. The improvement has been greater than would have been expected using standard post-operative skincare.

Silicone-based products are commonly used for individuals who are prone to develop hypertrophic or keloid scars. Itch is a major component of these scars, and a hallmark of their formation; it is theorized that scratching and manipulation of the site may contribute to scar formation.

As an alternative or adjunct to steroid injections, which have numerous potential side effects, including possible atrophy and hypopigmentation, antipruritic HOCl applied topically can help to drive down the histamine cycle and stabilize mast cells.

The selection of an appropriate pre-procedural skin preparation agent and a suitable post-procedure wound management product will depend on multiple factors.

Topically applied HOCl is emerging as an option with a broad range of potential uses. It is antimicrobial, anti-inflammatory, and antipruritic. It increases oxygenation to healing wounds and has activity against biofilm. It also has applications across a range of general dermatology conditions.

HOCl is a pH neutral superoxidized agent made to emulate nature. In our clinical experience it has proven useful across the range of cosmetic and medical dermatologic procedures and also has application for a range of additional medical dermatology presentations, such as pruritus.

Todd E. Schlesinger, MD, FAAD is Medical Director, Dermatology and Laser Center of Charleston in South Carolina. Robert A. March Optimizing Wound Healing for Cosmetic and Medical Dermatologic Procedures Among the options for wound management is hypochlorous acid, a broad-action antimicrobial and anti-inflammatory agent.

Ashish Bhatia, MD ; Jeffrey Hsu, MD ; Todd Schlesinger, MD ; and Robert Weiss, MD. facebook Created with Sketch. twitter Created with Sketch. linkedin Created with Sketch. email-new Created with Sketch.

link Created with Sketch. Courtesy of Robert A. Weiss, MD Healing of a post-op surgical wound in a year-old using Lasercyn Spray with daily dressing changes.

CLINICAL TIP: TINEA PEDIS IN DIABETICS When patients have tinea pedis, it opens up the opportunity for superinfection with fissures. COSMETIC TREATMENT TIP: MASSAGE Following injection of neurotoxins, it is not advised to massage the injection site, as manipulation of the area may encourage the neurotoxin to spread.

Ashish Bhatia, MD, FAAD is in private practice in Schaumburg, IL. Expectations: Put it in Writing Adam M. Rotunda, MD, FAAD, FACMS arrow-right Created with Sketch. Previous Article.