From the Guidelines
Wounds should generally not be exposed to air for better healing, as the current medical recommendation is to keep wounds covered with an appropriate dressing to maintain a moist wound environment. This approach promotes cell migration, prevents scab formation that can impede healing, and provides a barrier against infection 1. For most wounds, cleaning the area with mild soap and water, applying an antibiotic ointment if appropriate, and covering with a sterile bandage or dressing is recommended. The dressing should be changed daily or when it becomes wet or dirty.
Some key considerations for wound care include:
- Maintaining a moist wound environment to promote healing
- Using dressings that absorb exudate and maintain a moist environment
- Avoiding the use of topical antiseptic or antimicrobial dressings, as well as other interventions that have not been shown to improve wound healing outcomes 1
- Considering the use of adjunctive therapies, such as hyperbaric oxygen or topical oxygen, in specific situations where standard care has failed to promote healing 1
It's essential to note that the old advice to "let wounds breathe" is outdated and contradicts modern wound care principles. Keeping wounds covered prevents contamination, reduces pain by protecting nerve endings, maintains optimal moisture levels, and ultimately speeds healing time. The only exceptions might be very minor abrasions in non-mobile areas after they have formed a protective scab, or when specifically directed by a healthcare provider for certain wound types.
In terms of specific wound care recommendations, the International Working Group on the Diabetic Foot (IWGDF) guidelines suggest that sharp debridement and basic wound dressings should be used to promote healing, and that the frequency of sharp debridement should be determined by the clinician based on clinical need 1. Additionally, the guidelines recommend against the use of certain interventions, such as autolytic, biosurgical, hydrosurgical, chemical, or laser debridement, as well as topical phenytoin and herbal remedies 1.
From the Research
Wound Exposure to Air for Better Healing
- There is no evidence to suggest that wounds should be exposed to air for better healing. In fact, studies have shown that a moist wound environment is beneficial for the healing process 2, 3, 4.
- A moist environment helps to prevent tissue dehydration and cell death, accelerate angiogenesis, and increase the breakdown of dead tissue and fibrin 2.
- Maintaining a moist wound environment can be achieved through the use of occlusive dressings, such as hydrocolloid dressings, which have been shown to be a useful adjunct in facilitating wound healing 2.
- Recent advances in wound dressings have led to the development of moist wound dressings that can be divided into films, foams, hydrocolloids, hydrogels, and alginates, which can help to create and maintain a moist environment for healing 3.
- An optimal wound dressing should provide a moist environment, have an optimal water vapor transmission rate, and be easy to apply and remove, while also protecting the wound against trauma and contamination 3.
Benefits of Moist Wound Environment
- A moist wound environment has several benefits, including facilitating autolytic debridement, reducing pain, reducing scarring, and activating collagen synthesis 3, 4.
- Moist wound healing can also promote re-epithelialization and result in reduced scar formation, as compared to treatment in a dry environment 4.
- The use of growth factors, such as platelet-derived growth factor, can also enhance wound healing in a moist environment 5.
Clinical Implications
- The clinical implications of moist wound healing are significant, and further research is needed to elucidate the optimal methods for creating and maintaining a moist wound environment 4, 6.
- The use of antimicrobial dressings, such as silver impregnated soft silicone foam dressings, can also help to control infection and promote wound healing 6.