The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds

Abstract

Improved healing of full-and partial-thickness cutaneous wounds in wet and moist environments is due primarily to retention of biological fluids over the wound preventing desiccation of denuded dermis or deeper tissues. This also allows faster and unimpeded migration of keratinocytes over the wound surface and enables the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and reepithelialization. Despite all these documented benefits creating and maintaining a sealed moist environment over large surface areas such as large skin graft donor sites or extensive burns is technically difficult if not impossible. The preliminary investigation carried out between 1999 and 2000 studied the healing of a split-thickness skin graft (STSG) following application of moist exposed burn ointment (MEBO). This compound provides a moist environment without the need of an overlying occlusive dressing, and compares favorably with SofraTulle semi-open dressing. Healing of STSG donor sites was then evaluated from January to September 2001 in a prospective study comparing the effect of Tegaderm, a semipermeable membrane occlusive dressing, and MEBO, two different types of moist dressings. Wound healing was evaluated by measuring transepidermal water loss (TEWL), and scar quality was assessed by two independent observers using a visual analogue scale. Faster healing was observed clinically with MEBO application. Physiological healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality demonstrating a positive relationship between function and cosmetic appearance. Moreover, simple ointment application was definitely more practical than application of the occlusive self-adhesive membrane.

Modulation of wound contracture α‐smooth muscle actin and multispecific vitronectin receptor integrin αvβ3 in the rabbit's experimental model

“…Regardless of this apparent discrepancy and despite the fact that MEBO resulted in more wound contracture on day 20 than silver sulfadiazine and almost the same contraction as Tegaderm and saline, MEBO treatment resulted in early better quality of scar formation when compared with the other three groups. Ultimately better quality mature scars have been demonstrated following MEBO treatment by other studies (42,43). It seems that the ratio of reepithelialization/contracture at the time of clinical healing is the determining factor as to the final scar quality.…”

A Prospective Randomized Study to Compare the Effectiveness of Honey Dressing vs. Povidone Iodine Dressing in Chronic Wound Healing

“…Occlusion of a wound cavity with the help of a semipermeable membrane retains the moisture of wound exudates and serves as a moisture-retentive dressing [21]. Evaporation of wound exudates through an open dressing, namely, gauze or cotton pads, leads to cooling, desiccation, and dehydration of surface cells.…”

Reply to: Vloemans and Middelkoop: "The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds"

“…Vloemans and Middelkoop [2] and their most valuable comments on our contribution to this journal [1]. We fully agree with them regarding the inadequacy of the semipermeable membrane as a moist retentive coverage in some partial thickness wounds.…”