The Benefits of Moist Wound Healing

TOPNURSE~Moist wound healing is the practice of keeping a wound in an optimally moist environment in order to promote faster healing. Research has shown that moist wound healing is three to five times quicker than the healing of wounds that are allowed to dry out.

British researcher George D. Winter described the benefits of moist wound healing in the 1960s. His research demonstrated that moist environments optimize healing of wounds. In the 1970s and 80s, moist wound healing became a standard practice. During the late 1980s and 90s, the field of moist wound dressings was thoroughly researched and many new wound dressing products were developed such as hydrogels, foams and alginates. Increasingly, wound dressings began to be seen as not just protective measures, but active parts of the healing process.

What are the Benefits of Moist Wound Healing?

Before the theory of moist wound healing was developed, dressings were used primarily to absorb fluid, protect the wound from injury and limit exposure to infections. The natural scab on the wound was considered to be a normal part of the healing process. However, moist healing theory discovered that by preventing the body from developing a scab, wounds could not only be healed faster, but also better. Here are some of the benefits of moist wound healing:

Wound Healing Takes Less Time: When the body creates a scab or eschar, that requires time and energy. Additional energy is required to break down the scab after the wound is healed. In a moist wound healing environment, the body is able to focus on healing the wound rather than protecting it, and wounds heal faster.

Keratinocyte Cells Function More Easily: Keratinocytes, a major component of the epidermis, have several critical roles in wound healing. The cross-talk between keratinocytes and the other types of cells involved in wound healing is crucial for effective closure of the wound. In dry wounds, keratinocytes must burrow underneath the wound bed in order to find a moist area to move forward. In a moist wound healing environment, keratinocytes can easily travel across the wound surface more quickly and easily.

Autolytic Debridement is Facilitated: Moist environments trap endogenous proteolytic enzymes in the wound. This allows those enzymes to more efficiently perform autolytic debridement to break down necrotic tissue. Along with speeding healing, moist wound environments allow for the body’s natural process of healing to work more effectively.

Decreases Incidence of Wound Infection: A moist wound environment reduces the possibility of infection by creating a hypoxic environment in the wound bed which promotes angiogenesis, decreases the pH, and makes the wound area inhospitable to bacteria.

Preserves Growth Factors in Wound Fluid: Growth factors are natural proteins which control key cellular activities during the tissue repair process. Moist wound healing allows the growth factors to be preserved on the wound bed to repair tissues more quickly.

Stimulates Collagen Synthesis: Moist wound healing promotes production of collagen by the fibroblasts. Since collagen is the basis of the new tissue that will heal the wound, this increased production helps the body lay down the matrix for new tissue more quickly so that the cells necessary for healing are attracted.

Reduces Pain: Another benefit of moist wound treatment is that there is reduced pain. With less pain, there is also a reduced stress response and less fatigue in patients which also aids in the healing process. Decreased pain can also lead to better patient mobility, which improves circulation, oxygenation, and allows for better healing.

Reduces Scarring: Moist wound treatment, by promoting the growth and movement of new cells and ensuring that proteins for closing the wound are efficient, causes reduced inflammation, promotes more even skin formation and therefore reduces scarring.

The Importance of Moist Wound Healing

For the best wound care outcome and the quickest healing process, moist wound healing is the best choice. Today's wound care dressings have moisture management properties to fulfill all of the functions of the passive dressings of earlier times, but also promote faster healing, reduce pain, encourage vapor transmission, promote autolytic debridement, and also act as a bacterial barrier.

Source

https://www.woundsource.com

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Clearing The Air About Moist Vs. Dry Wound Healing

TOPNURSE~In the beginning, long before Johnson met Johnson and Band-Aids were invented, primitive men and women suffered minor cuts and abrasions and probably left them uncovered to heal. After all, the bleeding had stopped, a scab eventually formed and experience had taught them that their skin would heal in a week or two. So there was no great rush to find a use for those puffy, cottony, soft, white plants growing in the fields just yet.

In those early days of discovery, the scab and the blister were considered nature's miracle wound coverings. The scab became our partial and temporary exoskeleton and the blister was the human equivalent of bubble wrap, both protecting the wounds and encouraging the healing process. A scab is the body's natural wound covering. As long as the site is kept moist, the scab will not inhibit the healing process. At that time, keeping scabs and blisters intact seemed like the keys to wound healing.

Drastic Wounds Call for Drastic Measures

But as time marched on and people suffered larger wounds (such as those that might be acquired while trying to take down a wild boar without decent weaponry), a need arose to stop excessive bleeding and further injury with some kind of wound covering. Trial and error most likely proved that palm leaves worked and poison ivy did not.

It wasn't until around 1500 BC that ancient Egyptians and Greeks started using lint, animal grease and honey as topical wound treatments. They had discovered that the lint provided a fibrous base that promoted wound site closure, the animal grease provided a barrier to environmental pathogens, and the honey served as an antibiotic agent.

What they may not have realized at the time was that their treatment method accelerated the wound healing process by promoting a moist wound bed.

What Is Moist Wound Healing?

There are two main components to moist wound healing: 1) Do not use disinfectants over the wound and 2) Keep the wound moist. The first component, not using disinfectants, makes sense because disinfectants such as iodine, sodium hypochlorite and hydrogen peroxide are toxic to cells and should never be applied over a wound surface. We don't want to kill cells; we want to encourage them to live and proliferate.

The second component refers to the fact that lacerations, abrasions, crush injuries and burns heal faster and with less scarring when treatment involves promoting a moist wound bed.

The proof that moist wounds heal faster than dry wounds came back in 1962, thanks to Dr. George D. Winter and his landmark paper, "Formation Of The Scab And The Rate Of Epithelialization Of Superficial Wounds In The Skin Of The Young Domestic Pig"1. His research showed that, contrary to the conventional wisdom at the time that wounds should be allowed to dry out and form scabs to promote healing, wounds instead heal faster if kept moist. Winter's work began the evolution of modern wound dressings that promote moist wound healing.

Specifically, cell growth needs moisture and the main goal of moist wound therapy is to create and maintain these optimal moist conditions. Cells can grow, divide and migrate at an increased rate to enhance the formation of new tissue. During this phase of wound healing, an aqueous medium with several nutrients and vitamins is essential for cell metabolism and growth.

The Role of Exudate in Wound Healing

In this environment, the wound exudate, the moisture that naturally seeps out from a wound site, serves as a transport vehicle for a variety of bioactive molecules such as enzymes, growth factors and hormones. The different cells in the wound area communicate with each other via these mediators, ensuring that the healing processes proceed in a coordinated manner.

Wound exudate also provides the different cells of the immune system with an ideal medium to destroy invading pathogens such as bacteria, foreign bodies and necrotic tissues, diminishing the rate of infection.

Moist wound healing inhibits the formation of a solid, impenetrable scab, which tends to block the epithelial cells from spreading horizontally through the thin layer of wound exudate and across the wound bed. The wound is then able to close quickly. In addition, pain is significantly reduced when wounds are covered with an occlusive dressing. At first, there were concerns that the presence of moisture in wounds would increase the risk of clinical infection, but that has been shown not to be the case.

To summarize, treating topical wounds is broken down into the following components:

• Cleaning the wound in order to remove dead tissue and debris
• Dressing the wound to promote a moist wound bed and to prevent reinjuring the site
• Determining the frequency of dressing changes
• Reevaluation to measure the rate of healing

Following this protocol provides:

• Up to 50% faster wound healing than dry wound healing
• A lower rate of infection
• No need of systemic antibiotics
• Painless removal of the dressing without damaging newly formed tissue
• Less scarring and better cosmetic results

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Perawatan Luka Lembab (Moist), Modern, dan Terkini

Perawatan Luka Lembab (Moist), Modern, dan Terkini

TOPNURSE~Metode perawatan luka berkembang seiring dengan perkembangan ilmu pengetahuan dan teknologi, termasuk konsep perawatan luka lembab (moist). Hal ini ditandai dengan munculnya bahan-bahan perawatan luka modern yang telah dirancang sesuai dengan karakteristik luka, sehingga proses penyembuhan luka maksimal.

Pada awalnya para ahli berpendapat bahwa penyembuhan luka akan sangat baik bila luka dibiarkan tetap kering . Mereka berpikir bahwa infeksi bakteri dapat dicegah apabila seluruh cairan yang keluar dari luka terserap oleh pembalutnya. Akibatnya sebagian besar luka dibalut oleh bahan kapas pada kondisi kering. Penelitian yang dilakukan Winter (1962) tentang keadaan lingkungan yang optimal untuk penyembuhan luka menjadi dasar diketahuinya konsep “Moist Wound Healing” (Morrison, 2004).

Perawatan Luka Lembab (Moist Wound Healing)

”Moist Wound Healing” adalah metode untuk mempertahankan kelembaban luka dengan menggunakan balutan penahan kelembaban, sehingga penyembuhan luka dan pertumbuhan jaringan dapat terjadi secara alami. Munculnya konsep “Moist Wound Healing” disertai dengan teknologi yang mendukung, hal tersebut menjadi dasar munculnya pembalut luka modern (Mutiara, 2009).

Penggunaan dan pemilihan produk-produk perawatan luka yang kurang sesuai akan menyebabkan proses inflamasi yang memanjang dan kurangnya suplai oksigen di tempat luka. Hal-hal tersebut akan memperpanjang waktu penyembuhan luka. Luka yang lama sembuh disertai dengan penurunan daya tahan tubuh pasien membuat luka semakin rentan untuk terpajan mikroorganisme yang menyebabkan infeksi (Morrison, 2004).

Mempertahankan Kelembapan

Untuk itu dikembangkan suatu metode perawatan luka dengan cara mempertahankan isolasi lingkungan luka agar tetap lembab dengan menggunakan balutan penahan kelembaban, yang dikenal dengan moist wound healing. Metode ini secara klinis memiliki keuntungan akan meningkatkan proliferasi dan migrasi dari sel-sel epitel disekitar lapisan air yang tipis, mengurangi resiko timbulnya jaringan parut dan lain-lain, disamping beberapa keunggulan metode ini dibandingkan dengan kondisi luka yang kering adalah meningkatkan epitelisasi 30- 50%, meningkatkan sintesa kolagen sebanyak 50%, rata-rata re-epitelisasi dengan kelembaban 2-5 kali lebih cepat serta dapat mengurangi kehilangan cairan dari atas permukaan luka (Tarigan, 2007).

Manfaat perawatan luka lembab

1. Luka tidak diijinkan mengering, yang mengakibatkan penyembuhan luka terus menerus 24 jam sehari, balutan ini mendukung lingkungan yang lembab.
2. Kelebihan eksudat akan dipindah. Eksudat diserap ke dalam balutan primer dan sekunder
3. Kontak antara luka dan cairan luka tetap terjaga. Berarti pasien bisa mendapatkan keuntungan dari keseimbangan normal. Faktor penyembuhan selama setiap fase penyembuhan luka.
4. Meningkatkan fungsi optimal sel dan protease yang bertanggung jawab untuk penyembuhan. Perkiraan sel meregenerasi dua kali lebih cepat, penyembuhan lembab dibanding penyembuhan kering
5. Meningkatkan penyembuhan lebih cepat dengan tingkat infeksi yang lebih rendah. Lukanya dilindungi oleh balutan yang kuat yang mana mencegah infeksi dari luar.
6. Lebih nyaman untuk pasien daripada dressing tradisional. Menjaga ujung saraf terhidrasi dalam luka mengurangi rasa sakit.
7. Perubahan perban lebih sedikit diperlukan. Pembalutan bisa dibiarkan di luka selama 3 sampai 5 hari tergantung kondisi luka.
8. Bekas luka berkurang dan lebih baik. Serat kolagen berkoordinasi lebih lurus.
9. Penurunan biaya untuk perawatan luka total. Penurunan jumlah balutan, kebutuhan obat penenang dan menurunkan total biaya bahan perban.

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Luka Bakar

Luka Bakar

TOPNURSE~Luka bakar dan luka akibat benda panas berkaitan dengan risiko tinggi kematian pada anak. Yang bertahan hidup, akan menderita cacat dan trauma psikis sebagai akibat rasa sakit dan perawatan yang lama di rumah sakit.

Penilaian

Luka bakar dapat terjadi pada sebagian lapisan kulit atau lebih dalam. Luka bakar yang dalam (full-thickness) berarti seluruh ketebalan kulit pasien mengalami kerusakan dan tidak akan terjadi regenerasi kulit.

Tanyakan dua hal berikut:

• Sedalam apakah luka bakar tersebut?
  • Luka bakar dalam, berwarna hitam/putih dan biasanya kering, tidak terasa dan tidak memucat bila ditekan.
  • Luka-bakar-sebagian, berwarna merah muda atau merah, melepuh atau berair dan nyeri.
• Seberapa luas tubuh pasien yang terbakar?
  • Gunakan bagan luas permukaan tubuh berdasarkan umur berikut ini.
  • Sebagai pilihan lain, gunakan telapak tangan pasien untuk memperkirakan luas luka bakar. Telapak tangan pasien berukuran kira-kira 1% dari total permukaan tubuhnya.

Bagan perkiraan persentase permukaan tubuh yang terbakar

Perkirakan total daerah yang terbakar dengan menjumlahkan persentase permukaan tubuh yang terkena seperti yang ditunjukkan dalam gambar (lihat tabel untuk daerah A–F yang berubah sesuai dengan umur pasien).

Tatalaksana

• Rawat inap semua pasien dengan luka bakar >10% permukaan tubuh; yang meliputi wajah, tangan, kaki, perineum, melewati sendi; luka bakar yang melingkar dan yang tidak bisa berobat jalan.
• Periksa apakah pasien mengalami cedera saluran respiratorik karena menghirup asap (napas mengorok, bulu hidung terbakar),
  • Luka bakar wajah yang berat atau trauma inhalasi mungkin memerlukan intubasi, trakeostomi
  • Jika terdapat bukti ada distres pernapasan, beri oksigen .
• Resusitasi cairan (diperlukan untuk luka bakar permukaan tubuh > 10%). Gunakan larutan Ringer laktat dengan glukosa 5%, larutan garam normal dengan glukosa 5%, atau setengah garam normal dengan glukosa 5%.
  • 24 jam pertama: hitung kebutuhan cairan dengan menambahkan cairan dari kebutuhan cairan rumatan dan kebutuhan cairan resusitasi (4 ml/kgBB untuk setiap 1% permukaan tubuh yang terbakar)
    • Berikan ½ dari total kebutuhan cairan dalam waktu 8 jam pertama, dan sisanya 16 jam berikutnya.
      Contoh: untuk pasien dengan berat badan 20 kg dengan luka bakar 25%
      Total cairan dalam waktu 24 jam pertama
      = (60 ml/jam x 24 jam) + 4 ml x 20kg x 25% luka bakar
      = 1440 ml + 2000 ml
      = 3440 ml (1720 ml selama 8 jam pertama)
  • 24 jam kedua: berikan ½ hingga ¾ cairan yang diperlukan selama hari pertama
  • Awasi pasien dengan ketat selama resusitasi (denyut nadi, frekuensi napas, tekanan darah dan jumlah air seni)
  • Transfusi darah mungkin diberikan untuk memperbaiki anemia atau pada luka-bakar yang dalam untuk mengganti kehilangan darah.
• Mencegah Infeksi
  • Jika kulit masih utuh, bersihkan dengan larutan antiseptik secara perlahan tanpa merobeknya.
  • Jika kulit tidak utuh, hati-hati bersihkan luka bakar. Kulit yang melepuh harus dikempiskan dan kulit yang mati dibuang.
  • Berikan antibiotik topikal/antiseptik (ada beberapa pilihan bergantung ketersediaan obat: peraknitrat, perak-sulfadiazin, gentian violet, povidon dan bahkan buah pepaya tumbuk). Antiseptik pilihan adalah perak-sulfadiazin karena dapat menembus bagian kulit yang sudah mati. Bersihkan dan balut luka setiap hari.
  • Luka bakar kecil atau yang terjadi pada daerah yang sulit untuk ditutup dapat dibiarkan terbuka serta dijaga agar tetap kering dan bersih.
• Obati bila terjadi infeksi sekunder
  • Jika jelas terjadi infeksi lokal (nanah, bau busuk, selulitis), kompres jaringan bernanah dengan kasa lembap, lakukan nekrotomi, obati dengan amoksisilin oral (15 mg/kgBB/dosis 3 kali sehari), dan kloksasilin (25 mg/kgBB/dosis 4 kali sehari). Jika dicurigai terdapat septisemia gunakan gentamisin (7.5 mg/kgBB IV/IM sekali sehari) ditambah kloksasilin (25–50 mg/kgBB/dosis IV/IM 4 kali sehari). Jika dicurigai terjadi infeksi di bawah keropeng, buang keropeng tersebut .
• Menangani rasa sakit
  • Pastikan penanganan rasa sakit yang diberikan kepada pasien adekuattermasuk perlakuan sebelum prosedur penanganan, seperti mengganti balutan.
  • Beri parasetamol oral (10–15 mg/kgBB setiap 6 jam) atau analgesik narkotik IV (IM menyakitkan), seperti morfin sulfat (0.05–0,1 mg/kg BB IV setiap 2–4 jam) jika sangat sakit.
• Periksa status imunisasi tetanus
  • Bila belum diimunisasi, beri ATS atau immunoglobulin tetanus (jika ada)
  • Bila sudah diimunisasi, beri ulangan imunisasi TT (Tetanus Toksoid) jika sudah waktunya.
• Nutrisi
  • Bila mungkin mulai beri makan segera dalam waktu 24 jam pertama.
  • Anak harus mendapat diet tinggi kalori yang mengandung cukup protein, vitamin dan suplemen zat besi.
  • Anak dengan luka bakar luas membutuhkan 1.5 kali kalori normal dan 2-3 kali kebutuhan protein normal.

Kontraktur luka bakar

​Luka bakar yang melewati permukaan fleksor anggota tubuh dapat mengalami kontraktur, walaupun telah mendapatkan penanganan yang terbaik (hampir selalu terjadi pada penanganan yang buruk).

• Cegah kontraktur dengan mobilisasi pasif atau dengan membidai permukaan fleksor Balutan dapat menggunakan gips. Balutan ini harus dipakai pada waktu pasien tidur.

Fisioterapi dan rehabilitasi

• Harus dimulai sedini mungkin dan berlanjut selama proses perawatan luka bakar.
• Jika pasien dirawat-inap dalam jangka waktu yang cukup lama, sediakan mainan untuk pasien dan beri semangat untuk tetap bermain.

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