WOUND HEALING THEORIES

Wound Healing Theories

Wound Healing Theories

Introduction

Treatment of wounds has undergone many changes ever since the ground-breaking work of George Winter in 1962. Since then, a number of different varieties of wound dressings have been developed, that are designed to suit the needs of patients comfort, wound management, and thus improving the overall outcome of patient care. For the past 40 years, numerous dressings that enable an environment of a moist wound have been developed. According to the postulates of winter, epithelial cells migrated more rapidly with the scab in case of moist wounds as compared to dry wounds where the cells have to spend more energy and time. Winter on his experimental models of domestic pigs measured histological the Epithelialization of wounds that were covered with occlusive materials. The results show a significant progress in healing with this kind of dressing (Winter 1962; Winter 1975).The use of simple gauze on wounds had some disadvantages as it couldn't keep a constant moist environment and also it was difficult to change the gauze dressing without secondary trauma to the wound and the removal of the newly formed epithelium. Under those circumstances simple gauze started to be replaced by new dressings created with the concept that the wound environment would have to be moist and a different type of wound would need a different type of dressing which would have better control of its micro environment (Hinman et al. 1963; Turner 1985). Seaman (2002) states that healthcare professionals should be aware of moist wound dressings and also ideally differentiate between the various categories; such that appropriate decisions can be implemented for the patient. Studies by Ashcroft and Mills (2002) have also proved that a moist environment can increase the rate of the inflammatory response, thus leading to a rapid rate of cell proliferation and healing in wounds that are much deeper. By this method, more complex wounds can also be treated with better outcomes. This has been demonstrated by the rapid decline in chronic wounds, especially diabetic foot ulcers and the amputations associated with such wounds (Alvarez, 1983).

Based on the Modern Wound Healing Theory by Winter, characteristics of an ideal moist wound dressing, as also described by Seaman in 2002, would be: Firstly to constantly maintain a moist wound environment. Secondly the excess of exudates should be absorbed; the third reason is that dead spaces should be removed. The fourth reason is to provide a means of thermal insulation and barrier against the prevention of microbes, and finally protect the wound. In this case we can say that the wound should be carefully dressed. The ideal dressing can be recommended which has to be easy while applying and removing, hypo allergic, provide space for Moisture Vapour Transmission to the wound, and must control the level of proteases while being comfortable to the patient (Scycher and James Lee 1992). With the evidence proposed by George Winter, there are a number of modern dressings that cater to all the characteristics of ...