Promoting wound healing after surgery by choosing the right dressing
Time:Nov 16, 2021
Wound cleansing and the application of adequate phase-oriented wound dressings are an important line of defence against surgical site infections (SSI), a serious complication which affects millions of patients every year. Dressings not only act as a physical barrier to avoid wound contamination but can actively support the healing process.

It is hard to find something more vital to mankind than healing and dressing a wound – a medical art that dates back to ancient times: In one of the oldest medical texts, a clay tablet dating back to 2200 BC, wound dressing – “making the plasters” – is described as one of the “three healing gestures,” together with washing wounds and bandaging them1. Our ancestors used mixtures of mud or clay, plants and herbs to protect wounds and absorb exudates. Oil was a key ingredient in these plasters, preventing them from sticking to the wound and slowing down bacterial growth. Now, more than four millennia later, we use more advanced dressing materials, but the goal remains the same: to make wounds heal fast, to avoid infections, and if they should occur, to manage them, especially after surgery.

However, even with great advances in modern medicine, the most common healthcare-associated infection (HAI) remains surgical site infections (SSI). Millions of patients worldwide suffer every year from SSI, which threaten their lives, cause longer hospital stays, higher costs and contribute to the spread of antibiotic resistance. Infections of surgical wounds can cause severe damage, hindering wound healing and leading to significant mortality and morbidity. Most SSI are caused by bacteria of the skin flora surrounding the surgical incision such as Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Therefore, post-operative measures such as appropriate dressing of the surgical site are crucial to support healing and prevent SSIs.

Wound healing: a complex, multi-factor process

When surgeons close surgical incisions, they typically apply a sterile dressing. This material provides a bacterial barrier until physiological re-epithelisation occurs. The wound dressing is usually left in place for 24 to 48 hours unless significant drainage or bleeding from the site occurs. Overall, this early post-operative phase is critical for wound healing, which is a highly regulated process and requires the close interaction of many factors such as cytokines, growth factors, blood and the extracellular matrix to restore injured skin.

Modern surgical wound dressings interact with the healing process

Based on the wound type, choosing a surgical site dressing with ideal characteristics for barrier protection is a priority for avoiding SSI. However, there are no standardised recommendations on the best type of post-surgical dressing type. Today, there are more than 3000 types of dressings available in the market, offering surgeons the possibility of making the best choice of dressing based on the wound type.

Further, modern dressings can do much more than just cover the wound: They can also positively influence the healing process. Therefore, they must meet several requirements which include:

*giving protection against bacterial infection
*being sterile, non-toxic and non-allergic
*providing and maintaining a moist environment
*removing excessive exudate
*enhancing epidermal migration, promoting angiogenesis and connective tissue synthesis
*allowing gas exchange between the wound and the environment
*maintaining appropriate tissue temperature to support blood flow
*avoiding becoming stuck to the wound and remaining easy to remove after healing
*providing debridement action to enhance leukocyte migration
*and easing pain.

Dressings are usually made of synthetic polymers and can be classified in passive, interactive and bioactive products:

Passive products, such as gauze dressings*, are highly permeable, non-occlusive and simply cover the wound.

Interactive dressings create a moist environment, are semi-occlusive or occlusive, and actively support wound healing. Films, foam, hydrogel, hydrocolloids and alginates dressing belong to this category. Hydroactive fibre dressings made of cellulose fibres reduce the risk of maceration by efficiently trapping wound exudate, debris and bacteria. Transparent polyurethane film dressings can be used to allow an easy monitoring of surgical wounds while protecting fresh epithelial tissue from external factors such as microbes and liquid.

Bioactive dressings are produced from biocompatible and biodegradable materials such as biocellulose, which are important for the healing process.

Antimicrobial wound dressings can help reduce bacterial colonisation and minimise the incidence of infections. Growth factors and enzymes are also sometimes included to support repair processes and promote debridement of necrotic tissue, respectively. Mechanical debridement is also a key component of wound management, as it allows removal of debris, slough, senescent cells and biofilm, preparing the wound bed for reepithelialisation. In fact, keeping a wound clean and free of debris is crucial to prevent the development of SSI.

In case of highly exuding wounds, superabsorbent wound dressings represent a very valuable option, as they are able to take up excess amounts of fluid. This is particularly important in the management of chronic wounds. Negative pressure wound therapy (NPWT) also represents a popular treatment modality for both acute and chronic wounds. NPWT systems apply subatmospheric pressure to the wound, improving wound healing.
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