Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments

Abstract

Significance: Successful treatment of wounds relies on precise control and continuous monitoring of the wound-healing process. Wet or moist treatment of wounds has been shown to promote re-epithelialization and result in reduced scar formation, as compared to treatment in a dry environment.

Recent advances: By treating wounds in a controlled wet environment, delivery of antimicrobials, analgesics, other bioactive molecules such as growth factors, as well as cells and micrografts, is allowed. The addition of growth factors or transplantation of cells yields the possibility of creating a regenerative wound microenvironment that favors healing, as opposed to excessive scar formation.

Critical issues: Although several manufacturers have conceived products implementing the concept of moist wound healing, there remains a lack of commercial translation of wet wound-healing principles into clinically available products. This can only be mitigated by further research on the topic.

Future directions: The strong evidence pointing to the favorable healing of wounds in a wet or moist environment compared to dry treatment will extend the clinical indications for this treatment. Further advances are required to elucidate by which means this microenvironment can be optimized to improve the healing outcome.

Johan P.E. Junker, PhD

Figure 1.

Chronic venous stasis ulcer treated in a wet environment. (A) Wound after two failed debridements and split-thickness skin graft. (B) The wound chamber with antibiotics covering the wound. (C) The healed wound 3 weeks after débridement and split-thickness skin graft. (Reprinted with permission from Vranckx et al.) To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 2.

In vivo expression of human epidermal growth factor (hEGF) in wound fluid retrieved daily from wound chambers and determined by ELISA. EGF expression: 920 pg/mL hEGF on day 1 and 624.5 pg/mL on day 2. In control wounds, EGF expression reached 6.6 pg/mL on day 1. (Reprinted with permission from Vranckx et al.) KC, keratinocytes.

Figure 3.

Reconstitution of new epithelium of porcine full-thickness wounds. X-Gal staining to demonstrate lacZ expression. (A) LacZ keratinocytes are first seen in clusters on the bottom of the wounds on day 4, (B) having migrated upward on day 6, and (C) are present in all layers of the epithelium by day 8. (Reprinted with permission from Vogt et al.) To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 4.

Hematoxylin and eosin–stained section showing porcine wound transplanted with micrografts. (A) A micrograft on the wound bed 1 h after transplantation. (B) A micrograft in wound 6 days after transplantation showing the micrograft with proliferating keratinocytes. (C) Micrografts in wound 10 days after transplantation. The stratum corneum of four different micrografts is surrounded by keratinocytes in different stages of migration. (D) Wound 14 days after transplantation showing the dermis and stratum corneum of transplanted micrografts in various stages of transepidermal elimination. Bar equals 200 μm in all panels. (Reprinted with permission from Hackl et al.) To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 5.

Wet wound healing reduces inflammation and scar formation. Masson's trichrome staining of (A) dry and (B) wet porcine wounds 28 days postwounding. The dry wound has a significantly greater width of scar tissue compared with the wet wound. Arrows indicate scar tissue borders. (Reprinted with permission from Reish et al.) To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound