Promote wound healing: the best tips

A major goal of modern wound treatment is to optimally support the body's self-healing powers. This requires a deep understanding of the physiology of wound healing in order to be able to develop individual therapy strategies based on the latest scientific knowledge. 

Phases of wound healing

Cleaning phase (exudation):

Reinigungsphase (Exsudation)

A blood clot forms immediately after the wound is formed. This is a kind of plug that closes the injured blood vessel and prevents further blood loss. In the case of superficial wounds, the cleaning phase takes about one day, and around four days for larger wounds. Here, so-called scavenger cells (phagocytes) migrate into the wound via blood vessels where they absorb and eliminate damaged cells and pathogens. This results in a natural cleaning of the wound. 

Granulation phase:

Granulationsphase

Between the third and seventh day after the injury, the body forms so-called replacement tissue (granulation tissue) to gradually close the wound. This creates new connective tissue and replaces damaged blood vessels.

Epithelialisation phase:

Ephitelisierungphase

The duration of the epithelialisation phase depends on the size of the wound. Surface cells multiply and completely close the affected area. This is different with a deep wound that extends into the underlying dermis; in such a case, the body may need several months to regenerate such an area. Here, light-coloured scar tissue remains, which contains neither sebaceous nor sweat glands.

Regeneration phase:

Regenerationsphase

During the regeneration phase, the wound is completely closed. The newly created skin/scar is, however, still sensitive to environmental stimuli and requires special care to provide it with moisture and regenerative substances.

Antiseptic wound treatment

Bacterial infections are the main risk for complications in wound healing. Many antiseptics act by destroying or denaturing the cell wall of a pathogen and disturbing the pathogen’s metabolism resulting in cell death. Compared to antibiotics, antiseptics have the advantage that resistance occurs much less frequently, and may be even virtually non-existent for some antiseptics.

Modern antiseptics have a high therapeutic index and good tolerability, and, in contrast to antibiotics, are also suitable for preventive use in certain clinical indications. These measures can render prolonged treatment unnecessary in many cases. The indication for antisepsis depends on the stage, severity, location and degree of contamination/infection of the wound.

Requirements for modern wound antiseptics:

  • Broad spectrum of activity
  • Rapid onset of action
  • No disturbance of wound healing
  • Absorption as low as possible
  • Effective even under high blood and protein stress
  • Water-based
  • Active ingredients in the lowest possible concentration 
  • Painless application
  • No toxic/allergenic substances
  • No development of resistance
  • Colourless
  • No contraindications in pregnancy/lactation/children

Recognized publications therefore recommend treatment of acutely infected wounds with octenidine or povidone-iodine. The first-line preparations for the treatment of chronic wounds include octenidine or polyhexanide.

Octenidine can therefore be used for any type of wound. The duo-active complex contained in octenisept® (octenidine and phenoxyethanol) is also faster than the individual substances (povidone-iodine, PHMB) and possesses a broad-spectrum of antimicrobial activity.

Efficacy of the active ingredients

Octenidine/phenoxyethanol

  • Gram-positive: efficacy positive
  • Gram-negative: efficacy positive
  • Fungi: efficacy positive
  • Spores: efficacy negative
  • Viruses: efficacy positive
  • Warning: not to be used in pockets, fistulas, etc. 

Povidone iodine

  • Gram-positive: efficacy positive
  • Gram-negative: efficacy positive
  • Fungi: efficacy positive
  • Spores: efficacy positive
  • Viruses: efficacy positive
  • Warning: only for acute wounds, irritations, allergies, endocrine disorders 

Polihexanide

  • Gram-positive: efficacy positive
  • Gram-negative: limited positive efficacy
  • Fungi: efficacy positive
  • Spores: efficacy negative
  • Viruses: efficacy negative
  • Warning: Long acting times, potentially carcinogenic

The right product for every phase of wound healing

Optimal wound healing requires absence of penetrating pathogens and “tranquil” healing conditions. A moist environment is also essential if the wound is to heal quickly without scarring, as cells responsible for closing the wound multiply and move particularly quickly under moist conditions.

Wundheilungsphasen

Important user information

octenisept®

octenisept® 

Active substances: octenidine dihydrochloride, phenoxyethanol (Ph.Eur.). Composition: 100 g solution contain: 0.1 g octenidine dihydrochloride, 2.0 g phenoxyethanol (Ph.Eur.). Other ingredients: cocamidopropylbetaine, sodium D gluconate, glycerol 85%, sodium chloride, sodium hydroxide, purified water. Indications: For repeated, short-term antiseptic treatment of mucous membranes and adjacent tissues prior to diagnostic and surgical procedures - in the ano-genital region including the vagina, vulva and glans penis as well as prior to bladder catheterization - in the oral cavity. For short-term supporting therapy of interdigital mycotic infections and adjuvant antiseptic wound treatment. Contraindications: octenisept® may not be used in cases of hypersensitivity to any of the components of the preparation. octenisept® should not be used for rinsing the abdominal cavity (e.g. intra-operatively) or the bladder, nor the tympanic membrane. Undesirable effects: rare: burning, redness, itching and warmth at the application site, very rare: allergic contact reaction, e.g. temporary redness at the application site; frequency unknown: after lavage of deep wounds with a syringe, persistent edema, erythema and also tissue necrosis have been reported, in some cases requiring surgical revision. Rinsing of the oral cavity may cause a transitory bitter sensation. Revision 11/18

To prevent possible tissue injury, the product must not be injected into the deep tissue using a syringe. The product is intended for superficial use only (application by swab or spray pump).

Schülke & Mayr GmbH, 22840 Norderstedt, Germany, Tel. +49 40 52100-666, info@schuelke.com

Traditional versus moist wound treatment

Traditionally, it was thought that wounds heal best when treated dry. The “exsiccation” of the wound and the formation of scabs were considered positive signs of wound healing. Nowadays, the disadvantages of the traditional wound treatment are evident. Firstly, the necessary cellular nourishment was interrupted, proliferation reduced and cell migration inhibited. In addition, the dressing changes were often traumatic due to the adhesion of the dressing material to the wound.

Meanwhile, a paradigm shift is taking place in wound treatment: Optimal wound treatment is carried out under moist conditions. Moist wound treatment creates ideal physiological conditions for wound healing: New cells can develop, proliferate and migrate more easily. Proper exudate management is also important in this context. The goal is to collect excess wound exudate while promoting an ideally moist wound environment. The dressing should ensure gas exchange and be capable of being replaced as atraumatically as possible.

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