Like Driving a Car: Moist Wound Healing
My discipline is Nursing, specifically wound care. The concept in wound care that is like driving a car is the principle of moist wound healing. This goes against what many of you that aren’t in the nursing field think of when you think about wounds – don’t let them scab and don’t leave them open to the air. This concept can be difficult to grasp because it goes against “common knowledge”, which in this case is incorrect. It is also difficult to quantify – what exactly does it mean to have a moist wound bed? How do you know if it’s the right amount of moisture?
I think it’s important to break this concept into the why and the how. First, the why. When wounds are healing, the body creates new tissue to fill in the empty space. Once the new tissue is created, the body amazingly is able to create new skin that grows inward from the edges of the wound. In order for the body to complete this amazing work of creating new tissue and new skin, it needs the exact right “goldilocks” conditions. Of course there are other variables aside from moisture, but moisture is one of the most important. If there is too much moisture, the wound is at risk of infection, and the skin around the wound can be damaged. If there isn’t enough moisture, the body will not have enough liquid to carry out the processes required to make new skin. This also causes pain when there isn’t enough moisture – probably because the body is amazingly smart and is signalling a problem! The right moisture level also helps regulate the temperature in the wound, which keeps the wound healing.
Now for the how. How do you know the wound is moist enough but not too moist? This is really tricky. Some use the analogy of the whites of the eye – you want the wound to be as moist as the whites of your eye. I find that difficult to visualize. Part of knowing the right moisture level comes with experience, but how do you know until you get that experience? I think you want to be able to see the surface of the wound glisten with moisture, but zero pooling of liquid. It’s also important to assess other factors that give clues about the moisture level. Things such as pain, a dry dressing when it is changed, a higher or lower frequency of dressing change needed. These are all important clues that might indicate an imbalance in the moisture level in the wound. Most importantly, is the rate of healing what you would expect given the type of wound and the other factors related to the patient? If the wound is not healing properly, one important factor may be an inadequate moisture balance.
So there are a lot of things nurses assess to be able to determine if a wound has the right moisture balance. It doesn’t matter what type of wound it is, if the wound is healable you assess the moisture balance in the exact same way (non-healable wounds are treated differently, just to add complications to this principle of moist wound healing. There’s an exception to every rule, right?). Once you know, it’s very easy to incorporate it into your wound care practice. It’s also easy to forget that you are even assessing this factor! Which makes explaining the concept challenging since it is fundamental and second nature to follow the principles of moist wound healing.
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