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Wound healing and hyper-hydration: a counterintuitive model

02 January 2018
Volume 2 · Issue 1

Abstract

Winter's seminal work in the 1960s, relating to providing an optimal level of moisture to aid wound healing (granulation and re-epithelialisation), has been the single most effective advance in wound care over many decades. As such, the development of advanced wound dressings that manage the fluidic wound environment have provided significant benefits in terms of healing to both patient and clinician. Although moist wound healing provides the guiding management principle, confusion may arise between what is deemed to be an adequate level of tissue hydration and the risk of developing maceration. In addition, the counter-intuitive model ‘hyper-hydration’ of tissue appears to frustrate the moist wound healing approach, and advocate a course of intervention whereby tissue is hydrated beyond what is a normally acceptable therapeutic level. This paper discusses tissue hydration, the cause and effect of maceration, and distinguishes these from hyper-hydration of tissue. The rationale is to provide the clinician with a knowledge base that allows optimisation of treatment and outcomes, and explains the reasoning behind wound healing using hyper-hydration.

Ahomeostatic moist wound environment is generally accepted as beneficial to the healing process and is representative of an adequately hydrated wound. Conversely, maceration of the periwound skin is considered to be the result of putative excessive hydration that has a far-reaching and negative influence that impacts adversely on the patient and clinician.1,2

There is a lack of clarity regarding the optimal level of hydration required to support healing. Furthermore, the origin of fear associated with excessive hydration of the periwound skin (maceration) appears to be founded on anecdotal evidence.2 Here we try to clarify tissue hydration in relation to wound healing and maceration, and rationalise the counter-intuitive model of healing through hyper-hydration. Developing understanding, based on the available evidence, of wound/soft tissue hydration, periwound maceration, and the nuances of hyper-hydration has the potential to improve not only patient outcomes but also clinicians' appreciation of topical wound dressings, and the role they have to play in support of healing.

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