Ousey, Karen

Rippon, Mark G.

English

University of Huddersfield Repository

University of Huddersfield RepositoryOusey, Karen and Rippon, Mark G.Hydration, Its Role In Wound HealingOriginal CitationOusey, Karen and Rippon, Mark G. (2015) Hydration, Its Role In Wound Healing. In: Wounds UK Annual Conference 2015, 9th - 11th November 2015, Harrogate, UK. (Unpublished) This version is available at http://eprints.hud.ac.uk/26525/The University Repository is a digital collection of the research output of theUniversity, available on Open Access. Copyright and Moral Rights for the itemson this site are retained by the individual author and/or other copyright owners.Users may access full items free of charge; copies of full text items generallycan be reproduced, displayed or performed and given to third parties in anyformat or medium for personal research or study, educational or not-for-profitpurposes without prior permission or charge, provided:• The authors, title and full bibliographic details is credited in any copy;• A hyperlink and/or URL is included for the original metadata page; and• The content is not changed in any way.For more information, including our policy and submission procedure, pleasecontact the Repository Team at: E.mailbox@hud.ac.uk.http://eprints.hud.ac.uk/Hydration, Its Role In Wound HealingKaren Ousey, PhD., Mark G. Rippon, PhD.Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, UK 1. INTRODUCTIONAll biological processes require water and balancing ofmoisture levels is key to maintaining the ideal state. There areseveral mechanisms responsible for maintaining the idealmoisture balance in skin. Wounding disrupts this hydrationbalance. Evidence suggests that a moist wound environmentand maintenance of tissue hydration aids healing, clinicalexperience with chronic wounds suggests that excessivewound exudate is damaging to the wound and surroundingskin.2. HYDRATION IN SKINThe outermost layers of the skin, the epidermal stratumcorneum, are important for maintenance of skin hydration1(Figure 1). Both the physical structure and its chemicalcomposition are key to water retention within the epidermis.Water also plays an important role in the normal functioning ofthe skin itself. Fluid retention in skin also depends upon themaintenance of an optimal skin hydration level2. The dynamicsupply (via blood circulation) and removal of fluid (vialymphatic system drainage) from the skin is an ongoingprocess and any disruption in this fine balance can result inclinical problems. For example, uncontrolled influx or deficientremoval of water can lead to tissue oedema. The uncontrolledloss of water as a result of a breach in the skin’s integrity (i.e.,wounding) can result in tissue dehydration.3. WOUND HEALING AND HYDRATIONOptimal wound healing is very dependent upon theappropriate level of tissue hydration2 and it has beensuggested to be the single most important external factor3.Skin wounding results in an imbalance of the skin’s hydrationstatus and exposure of tissues to air leads to tissue drying.The disruption of blood vessels and the increased outflow offluid in an attempt to maintain moisture balance leads toexudate formation.The initiation of the blood coagulation system quickly “plugs”the open wound to limit fluid loss and to protect tissues frombacterial contamination. Once plugged, wound healing cancommence.4. MOIST WOUND HEALINGSkin wounds exposed to air dry out. This drying of the woundand the initiation of the blood coagulation system leads to theformation of a wound scab/eschar. Landmark studies fromGeorge Winter in the 1960s showed that wounds exposed toair and allowed to dry healed poorly when compared towounds kept moist4. Numerous studies performed sinceWinter’s early work has provided evidence of the benefits of amoist wound healing environment (see Table)5. The adoptionof the concept of moist wound healing in wound care has ledto the development of a number of types of modern wounddressings, all designed to manage various levels of exudate.More recently, some dressings have been developed to helpbalance and maintain an optimised level of wound hydration(Figure 2). Clinical experience in chronic woundmanagement, however, has suggested that excessive levelsof fluid in and around the wound are detrimental to positiveclinical outcomes, resulting in tissue maceration, skinreddening and tissue damage.Benefits of moist wound healingFaster wound healingPromote epithelialisation ratePromote dermal/wound bed healing responsesReduced scarringRetention of growth factors to wound siteLower infection ratesReduced pain perceptionEnhanced autolytic debridement5. WET WOUND HEALINGDespite the assumption that excessive hydration of wounds should be avoided, several studies have suggested that wet wound healing, i.e., the presence of free fluid at the wound site, may be beneficial for wound healing. The immersion of wounds with saline or cell culture solutions to create “wet wounds” results in enhanced wound healing, reduced tissue necrosis and scarring compared with dry wounds. Wet wounds show little evidence of tissue maceration.6. WOUND HYDRATION IS GOOD?Optimising the hydration/moisture balance of the woundoptimises healing. Both moist and wet wound healing offerssignificant healing benefits compared with dry wound healing.The clinical experience of excessive wound hydration beingdamaging to tissue and the studies suggesting that wetwounds heal with similar benefits previously ascribed to moisthealing seem, at first glance, to be contradictive. However,this information, together with the knowledge that chronicwound exudates are fundamentally different from acutewounds, offers an explanation for the apparent contradiction.Chronic wound exudates contain high levels of protein-degrading enzymes and other tissue-damaging componentsthat are able to damage tissues6. Acute wounds, however,contain low and controllable levels of these components thatare little able to act on tissues. Chronic wound exudatesdamage tissues because of these components and not asresult of exposure to the water itself..7. CONCLUSION: WOUND DRESSINGS AND HYDRATIONWound hydration levels are important for wound healing.Optimising moisture balance is a key property of modernwound dressings. Recently, wound dressings better able tomanage both the fluid levels and the damaging componentscontained within chronic wound exudate are better placed tomanage these damaging fluids effectively. Dressings are nowavailable that manage both of these sides to chronic woundexudate but are now able to donate “fresh” solutions (e.g.,Ringer’s solution) from the dressings, further optimisinghydration levels at the wound site and enhancing the healingbenefits of a hydrated wound (Figure 3).stratum corneumepidermisdermishypodermisFigure 1: structure of the skinFigure 3: schematic of dressing action1 Madison KC. (2003). Barrier function of the skin: "la raison d'être" of the epidermis. Journal of Investigative Dermatology 121(2): 231-241. 2 Bishop SM, Walker M, Rogers AA, Chen WYJ. (2003). Importance of moisture balance at the wound-dressing interface. Journal of Wound Care 12(4): 125-128.3 Atiyeh BS, Hayek SN. (2005). Intérêt d'un onguent chinois (MEBO) dans le maintient local de l'humidité. Journal des Plaies et Cicatrisation 9: 7-11.4 Winter GD. (1962). Formation of the scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature (London) 193: 293-294.5 Junker JP, Kamel RA, Caterson EJ, Eriksson E. (2013). Clinical impact upon wound healing and inflammation in moist, wet, and dry environments. Advances In Wound Care 2(7): 348-356.6 McCarty SM, Percival SL. (2013). Proteases and delayed wound healing. Advances In Wound Care 2(8): 438-447.Figure 2: Mechanical debridement in combination withapplication of wound dressing which optimises woundhydration, resulting in wound cleansing and progression.(Photo courtesy of F. Meuleneire, Belgium)

Barrier function of the skin: &quot;la raison d'être&quot; of the epidermis.

Clinical impact upon wound healing and inflammation in moist, wet, and dry environments.

Figure 2: Mechanical debridement in combination with application of wound dressing which optimises wound hydration, resulting in wound cleansing and progression. (Photo courtesy of F. Meuleneire,

Hydration, Its Role In Wound Healing

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