Principles of Wound Care

Dermatology and Wound Management

Introduction: Guiding Healing Toward the Best Outcome

Effective wound care is grounded in knowledge of physiology, tailored to remove barriers, and designed to support optimal healing.
This lesson focuses on three pillars:
- Moist wound healing
- Debridement techniques
- Dressing selection strategies

The Power of Moist Wound Healing

Modern evidence has revolutionised wound care: moist wounds heal faster, with fewer complications.

✅ Benefits of Moist Wound Healing:

Benefit	Explanation
🕒 Faster healing	Moisture enhances cell migration (keratinocytes, fibroblasts) and promotes re-epithelialisation.
✨ Less scarring	Reduces inflammation and supports organized collagen deposition.
🛡️ Infection protection	Prevents scab formation that can trap bacteria; many moist dressings contain antimicrobials.
🔬 Improved cell communication	Growth factors and cytokines can function more effectively.
❤️ Enhanced angiogenesis	Supports new blood vessel formation (critical for oxygen & nutrient delivery).
🔄 Autolytic debridement	Encourages the body’s enzymes to remove dead tissue naturally.
😌 Less pain	Moisture protects exposed nerve endings and reduces trauma during dressing changes.

Cleaning and Debridement: Preparing the Wound Bed

Wound healing can’t start effectively until non-viable tissue is removed.

What Is Debridement?

The process of removing:

Necrotic tissue
Scabs
Biofilm
Dried exudate
Infected tissue

💡 Goal: Convert a chronic wound into an acute healing wound by resetting the healing process.

Autolytic Debridement

Utilises body’s own enzymes and moisture.
Gentle, selective, and painless, but slow.
Best for stable wounds without infection.

Dressings:

Hydrogels
Hydrocolloids
Transparent films

Enzymatic Debridement

Uses topical enzymes to break down necrotic tissue.

Example:

Collagenase ointment

Slower than surgical, more selective than mechanical.

✂️ Surgical (Sharp) Debridement

Fast and effective, especially for infected or heavily necrotic wounds.
Done with scalpels, scissors, or curettes.
Requires clinical skill and consideration of pain and bleeding risk.

⚠️ Use caution in patients on anticoagulants or with bleeding disorders.

Dressing Selection: Strategic & Individualised

The right dressing supports the wound’s environment—moisture balance, infection control, protection, and comfort.

🧠 Considerations When Choosing a Dressing

Factor	What to Assess
🧪 Wound bed	Necrosis, slough, granulation tissue, epithelialisation
💧 Exudate level	Dry, minimal, moderate, heavy
📍 Location	Movement/friction, ease of application
👀 Periwound skin	Maceration, irritation, eczema
🔥 Infection	Use antimicrobial dressings if needed
👤 Patient needs	Pain, allergies, ability to manage dressing, preferences
⏱️ Wear time	How often it needs changing
📦 Dressing properties	Absorbency, adherence, ease of removal

📋 Dressing Types & Indications

Dressing Type	Best For
Film	Superficial, low-exudate wounds; secondary dressing
Foam	Moderate to high exudate; cushioning & absorption
Hydrogel	Dry wounds; donate moisture; aid in debridement
Hydrocolloid	Shallow, low-exudate wounds; supports autolysis
Alginate	Heavy exudate; promotes granulation
Hydrofiber	High exudate; reduces risk of maceration
Superabsorbent	Very heavy exudate; high-capacity management
NPWT	Complex wounds; promotes granulation & draws edges together

💬 Clinical Tip:

“The dressing supports the wound—but doesn’t heal it alone. Addressing underlying causes (e.g., pressure, diabetes, infection) is essential.”

Reassessment Is Critical

Wounds evolve: reassess regularly.
Be ready to change dressing plans as:
- Exudate level changes
- Tissue status progresses
- Infection emerges or resolves
- Patient needs shift

Summary

Wound care is more than applying a bandage—it’s an evidence-based, patient-centred strategy that:

Optimises the healing environment 🌱
Promotes comfort and function 🧘
Prevents complications and scarring 🛡️

References

Coloplast Professional. (n.d.). Understanding Moist Wound Healing. Retrieved from https://www.coloplastprofessional.co.uk/education-library/knowledge/advanced-wound-care-knowledge/wound-healing/understanding-moist-wound-healing/
Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound dressings and comparative effectiveness data. Advances in Wound Care, 3(8), 511–529. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC3842869/
West Coast Wound Center. (n.d.). Benefits of Moist Wound Healing. Retrieved from https://westcoastwound.com/benefits-of-moist-wound-healing/
Zhang, Y., Zhang, M., & Lin, W. (2021). Advances in biomaterials and dressings for wound healing. Frontiers in Bioengineering and Biotechnology, 9, 735616. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8568799/
Velnar, T., Bailey, T., & Smrkolj, V. (2023). Wound healing and the role of the immune system. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507882/
Pourmohammadi, K., et al. (2022). Emerging trends in wound healing strategies: Biomaterials and beyond. Journal of Translational Medicine, 20, 315. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9326937/
WoundSource. (n.d.). Wound Debridement Options: 5 Major Methods. Retrieved from https://www.woundsource.com/blog/wound-debridement-options-5-major-methods
Atkin, L. (2020). Wound assessment and dressing selection: An overview. British Journal of Nursing, 29(12), S4–S13. Retrieved from https://www.britishjournalofnursing.com/content/wound-assessment/wound-assessment-and-dressing-selection-an-overview/
Elsayed, M. M. A., et al. (2023). Emerging wound healing approaches: A bibliometric and research trend analysis. Heliyon, 9(11), e18723. Retrieved from https://www.sciencedirect.com/science/article/pii/S2405844023036836